Twenty Years of IAIMS: The Columbia University/ New York Presbyterian Hospital Clinical Data...
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Twenty Years of IAIMS:The Columbia University/
New York Presbyterian Hospital Clinical Data Repository
James J. Cimino
Department of Biomedical Informatics
Columbia University College of Physicians and Surgeons
IAIMS Consortium Annual Meeting
Boston, MA
April 10, 2005
• History and evolution (or creation)
• Where we are today
• What we learned
Overview
• History and evolution
History and Evolution (or Creation)
• 1983-1986: IAIMS Planning Grant– Rachel Anderson– Organizational
• 1986-1988: IAIMS Demonstration Grant– Paul Clayton and Rachel Anderson– Center for Medical Informatics– Vision
History and Evolution (or Creation)
• 1983-1986: IAIMS Planning Grant– Rachel Anderson
– Organizational
• 1986-1988: IAIMS Demonstration Grant– Paul Clayton
– Center for Medical Informatics
– Vision
– “$6M Demo”
• 1988-1993: IAIMS Implementation Grant– Funding from NLM, IBM, CU, Presbyterian Hospital– Network– Clinical data architecture
Clinical Data Architecture
• Central repository to collect data from myriad sources• Myriad users of data - some not yet imagined
New York Presbyterian HospitalClinical Information Systems Architecture
Clinical Database
Medical Entities Dictionary
Database Monitor
Medical Logic Modules
DatabaseInterface
Research
Administrative
Alerts & Reminders
Results Review
. . .. . .Radiology LaboratoryDischarge
Summaries
Reformatter Reformatter Reformatter
Clinical Data Architecture
• Central repository to collect data from myriad sources• Myriad users of data - some not yet imagined• Patient-oriented, not visit oriented, database• Relational, not hierarchical, model• Entity-attribute-value model
Clinical Data Architecture
• Central repository to collect data from myriad sources• Myriad users of data - some not yet imagined• Patient-oriented, not visit oriented, database• Relational, not hierarchical, model• Entity-attribute-value model
• Coded data wherever possible• Unify terminology
MED Structure
MedicalEntity
LaboratoryProcedure
CHEM-7PlasmaGlucose
LaboratorySpecimen
PlasmaSpecimen
Substance
Sampled
Part of
Has S
pecimen
Event
LaboratoryTest
DiagnosticProcedure
Substance MeasuredGlucose
Plasma
AnatomicSubstance
Substance
BioactiveSubstance
Chemical
Carbo-hydrate
Where We Are Today - Repository
• Patients: 2.6 million• Visits: >10 million since 1996 with
archives going back to 1979• Visit diagnoses, locations,
procedures, providers, insurance• Lab procedures: 16 million with 130
million results (to 1989)• Radiology procedures reports: 5.7
million• Pathology: 1.4 million• Cardiology procedures: 1.5 million • Resident signout notes:760,000• Operative Notes: 426,000• Clinical Notes: 400,000• Discharge Summaries: 420000
• Medication orders: >60 million• ObGyn Procedure Reports: 241,000• GI Procedure Reports: 101,000• Neurology Procedure Reports:
54,000 • Ideatel BP’s: 215,000• Ideatel Glucose: 650,000• Consult Events: 18000• HEENT Events:13000• Hospitalist Notes:30000• PFT: 25000• Provider profiles 11000• IDX 1.4 million• East Campus
Where We Are Today - MED• Domains:
– HP lab terms– Misys lab terms– Cerner lab terms– Misys Radiology– Digimedix drugs– Cerner Drugs– ICD9-based problem list terms– Other applications– Knowledge terms
• Size:– Concept-based (95,641)– Multiple hierarchy (141,306)– Synonyms (239,581)– Translations (141,717)– Semantic links (225,698)– Attributes (210,456)
[LPRO]->(AE)->[ANTB]->(DS)->[PFUN]->(PO)->[ORGM]<-(PP)<-[OATT]
A procedure assesses the effect of an antibiotic which disrupts aphysiologic function which is a process of an organism which has an
attribute (sensitive/resistant).
MedLEEHISTORY OF PRESENT ILLNESS: This 67 year old with a history of syncope in 1987 and 1989. She reported that she was evaluated both times and the work up was negative for any specific etiology. On the day of admission she reports having one episode of severe diarrhea and she was having increasing abdominal discomfort with flatulence and one episode of vomiting. When she returned to the bath room to move her bowels again she felt light headed and called for a family member. The family member reported that the patient was unconscious at that time and was placed in bed and recovered within 1-2 minutes. there was no history of any precipitating shortness of breath, chest pain or any seizure activity. At the time the patient was seen in the hospital she already felt fine.
Problems present: diarrheadiscomfort (abdomen ) vomitinglightheadedunconscious
Problems absent: pain (chest )seizure
Findings present: demo ( 67 year )
History: syncope
Where We Are Today - Outputs
• 7000 Users• Clinical information systems• MedLEE• Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals
Where We Are Today - Outputs
• 7000 Users• Clinical information systems• MedLEE• Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals– Infobuttons
Where We Are Today - Outputs
• 7000 Users• Clinical information systems• MedLEE• Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals– Infobuttons
• Clinical data warehouse
2000 2001 2002 2003 2004
MI
MI+Beta
select patient_id , time = primary_time
from visit2004_diagnosis
where diagnosis_icd9_code like '410%'
and b.primary_time between '01/01/2000' and '01/01/2005'
and b.comp_code = 30366
Where We Are Today - Outputs
• 7000 Users• Clinical information systems• Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals– Infobuttons
• Clinical data warehouse• Other clinical systems
– Infection Control– CPOE– Marconi– IDEATel– Data Mining– Bioinformatics
Lessons Learned
• The repository architecture paid off
• Model the data, not the applications
• Write once, read many times
• Pay attention to your terminology
• You will reuse data
• You can’t predict how you will reuse it