Dataset Information

Taking advantage of continuity of care documents to populate a research repository.

ABSTRACT:

Objective

Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology's Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create a low volume standards based import pipeline for the Informatics for Integrating Biology and the Bedside (i2b2) clinical research platform. We validate this approach by creating a small repository at Partners Healthcare automatically from C-CDA documents.

Materials and methods

We designed an i2b2 extension to import C-CDAs into i2b2. It is extensible to other sites with variances in C-CDA format without requiring custom code. We also designed new ontology structures for querying the imported data.

Results

We implemented our methodology at Partners Healthcare, where we developed an adapter to retrieve C-CDAs from Enterprise Services. Our current implementation supports demographics, encounters, problems, and medications. We imported approximately 17?000 clinical observations on 145 patients into i2b2 in about 24?min. We were able to perform i2b2 cohort finding queries and view patient information through SMART apps on the imported data.

Discussion

This low volume import approach can serve small practices with local access to C-CDAs and will allow patient registries to import patient supplied C-CDAs. These components will soon be available open source on the i2b2 wiki.

Conclusions

Our approach will lower barriers to entry in implementing i2b2 where informatics expertise or data access are limited.

SUBMITTER: Klann JG

PROVIDER: S-EPMC6080729 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Publications

Taking advantage of continuity of care documents to populate a research repository.

Klann Jeffrey G JG Mendis Michael M Phillips Lori C LC Goodson Alyssa P AP Rocha Beatriz H BH Goldberg Howard S HS Wattanasin Nich N Murphy Shawn N SN

Journal of the American Medical Informatics Association : JAMIA 20141028 2

<h4>Objective</h4>Clinical data warehouses have accelerated clinical research, but even with available open source tools, there is a high barrier to entry due to the complexity of normalizing and importing data. The Office of the National Coordinator for Health Information Technology's Meaningful Use Incentive Program now requires that electronic health record systems produce standardized consolidated clinical document architecture (C-CDA) documents. Here, we leverage this data source to create ...[more]

PMID: 25352566

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Project description:BackgroundContinuity of care is an important element of advanced prostate cancer care due to the availability of multiple treatment options, and associated toxicity. However, the association between continuity of care and outcomes across different racial groups remains unclear.ObjectiveTo assess the association of provider continuity of care with outcomes among Medicare fee-for-service beneficiaries with advanced prostate cancer and its variation by race.DesignRetrospective cohort study using Surveillance, Epidemiology, and End Results (SEER)-Medicare data.SubjectsAfrican American and white Medicare beneficiaries aged 66 or older, and diagnosed with advanced prostate cancer between 2000 and 2011. At least 5 years of follow-up data for the cohort was used.MeasuresShort-term outcomes were emergency room (ER) visits, hospitalizations, and cost during acute survivorship phase (2-year post-diagnosis), and mortality (all-cause and prostate cancer-specific) during the follow-up period. We calculated continuity of care using Continuity of Care Index (COCI) and Usual Provider Care Index (UPCI), for all visits, oncology visits, and primary care visits in acute survivorship phase. We used Poisson models for ER visits and hospitalizations, and log-link GLM for cost. Cox model and Fine-Gray competing risk models were used for survival analysis, weighted by propensity score. We performed similar analysis for continuity of care in the 2-year period following acute survivorship phase.ResultsOne unit increase in COCI was associated with reduction in short-term ER visits (incidence rate ratio [IRR] = 0.65, 95% confidence interval [CI] 0.64, 0.67), hospitalizations (IRR = 0.65, 95% CI 0.64, 0.67), and cost (0.64, 95% CI 0.61, 0.66) and lower hazard of long-term mortality. Magnitude of these associations differed between African American and white patients. We observed comparable results for continuity of care in the follow-up period.ConclusionsContinuity of care was associated with improved outcomes. The benefits of higher continuity of care were greater for African Americans, compared to white patients. Advanced prostate cancer survivorship care must integrate appropriate strategies to promote continuity of care.

Dataset Information

Taking advantage of continuity of care documents to populate a research repository.

Objective

Materials and methods

Results

Discussion

Conclusions

Publications

Taking advantage of continuity of care documents to populate a research repository.

Similar Datasets

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