Applying a common data model to Asian databases for multinational pharmacoepidemiologic studies: opportunities and challenges

Objective: The goal of the Asian Pharmacoepidemiology Network (AsPEN) is to study the effectiveness and safety of medications commonly used in Asia using databases from individual Asian countries. An efficient infrastructure to support multinational pharmacoepidemiologic studies is critical to this effort. Study Design and Setting: We converted data from the Japan Medical Data Center (JMDC) database, Taiwan’s National Health Insurance Research Database (NHIRD), Hong Kong’s Clinical Data Analysis and Reporting System (CDARS), South Korea’s Ajou University School of Medicine (AUSOM) database, and the US Medicare 5% sample to the Observational Medical Outcome Partnership (OMOP) Common Data Model. Results: We completed and documented the process for the Common Data Model (CDM) conversion. The coordinating center and participating sites reviewed the documents and refined the conversions based on the comments. The time required to convert data to the CDM varied widely across sites and included conversion to standard terminology codes and refinements of the conversion based on reviews. We mapped 97.2%, 86.7%, 92.6%, and 80.1% of domestic drug codes from the United States, Taiwan, Hong Kong, and Korea to RxNorm, respectively. The mapping rate from Japanese domestic drug codes to RxNorm (70.7%) was lower than from other countries, and we mapped remaining unmapped drugs to Anatomical Therapeutic Chemical Classification System codes. Because the native databases used international procedure codingsystems for which mapping tables have been established, we were able to map more than 90% of diagnosis and procedure codes to standard terminology codes. Conclusion: The Common Data Model established the foundation and reinforced collaboration for multinational pharmacoepidemiologic studies in Asia. Mapping of terminology codes was the greatest challenge, because of differences in health systems, cultures, and coding systems

Doctor of Philosophy

dissertationControlled clinical terminologies are essential to realizing the benefits of electronic health record systems. However, implementing consistent and sustainable use of terminology has proven to be both intellectually and practically challenging. First, this project derives a conceptual understanding of the scope and intricacies of the challenge by applying informatics principles, practical experience, and real-world requirements. Equipped with this understanding, various approaches are explored and from this analysis a unique solution is defined. Finally, a working environment that meets the requirements for creating, maintaining, and distributing terminologies was created and evaluated

Desenvolvimento de uma Infraestrutura baseada em HL7® FHIR® para Interoperabilidade Clínica

Throughout the years, the healthcare business knowledge, requirements, and the number of patients seeking medical attention has grown tremendously to a point where sensitive cases needed the input from multiple healthcare institutions in order to track the patient’s medical history and make the most adequate decisions for each situation. Technology and digital information fulfils a great role in addressing these problems and improving healthcare provision. However, due to the immense number of organizations and systems in this business, sharing a patient’s clinical information can be a major problem if the systems are not capable of understanding the data sent to each other. Ensuring interoperability between systems is crucial to guarantee the continuous flow of a patient’s clinical history transmission and to improve the health professionals’ work. As a company working in the field of healthcare, ALERT’s main goal is to help organizations improve in their health business and to help prolong life, by providing the necessary technology that is capable of benefiting the health professional’s work management and sharing the necessary information with other organizations. Thus, the company seeks to constantly improve its product suite, ALERT®, by meeting the worldwide organizations requirements and assuring interoperability based on the existing health standards in the market. This way, the company wants to add in the ALERT suite the latest standard, Fast Healthcare Interoperability Resources (FHIR ® ), which brings great technological innovations for interoperability’s improvement, provided by the standards developing organization, Health Level Seven International (HL7), being also considered to be a suitable standard for mobile applications thanks to its capabilities and ease of implementation. Herewith, thisthesis presents a development and architectural approach to apply FHIR features in the product suite, along with the problem and solution analysis, including the evaluation of suitable frameworks for the implementation phase. Considering the experiments’ results, the implemented FHIR services actually improved the product’s performance, and thanks to the standard’s specification, the implementation of its core features proved to be simple and straightforward while respecting the key criteria for some of the developed services.Ao longo dos anos, o conhecimento, as exigências, e o número de pacientes à procura de cuidados médicos na área de negócio de cuidados de saúde, tem vindo a aumentar drasticamente ao ponto de ser necessária a opinião de outras instituições para casos de maior sensibilidade, de modo a que o historial médico do paciente fosse acompanhado e que servisse para tomar as decisões mais adequadas para o problema em questão. A tecnologia e a informação digital representam um grande papel na resolução de problemas e promoção de entrega de cuidados de saúde. No entanto, devido à imensa quantidade de organizações e sistemas nesta área de negócio, a partilha de informação clínica relativa a um paciente pode vir a ser um grave problema caso os sistemas não sejam capazes de compreender os dados que estão a ser transmitidos entre eles. Deste modo, assegurar interoperabilidade entre sistemas é crucial para garantir um fluxo contínuo de transmissão de informação relativa ao historial clínico de um paciente, e para melhorar o trabalho dos profissionais de saúde. Sendo uma empresa que trabalha na área de cuidados de saúde, a ALERT tem como principal objetivo ajudar as organizações a melhorar o seu negócio de saúde e ajudar a prolongar a vida, fornecendo a tecnologia necessária que beneficie a gestão de trabalho dos profissionais de saúde e que partilhe informação com outras organizações. Portanto, a empresa procura constantemente melhorar o seu produto ALERT®, procurando cumprir com os requisitos de organizações globais e garantindo interoperabilidade baseada nos standards de saúde existentes no mercado. Assim, a empresa pretende adotar o último standard lançado, Fast Healthcare Interoperability Resources (FHIR®), que traz grandes inovações tecnológicas para o aperfeiçoamento da interoperabilidade, fornecida pela organização de desenvolvimento de standards, Health Level Seven International (HL7), sendo também considerado um standard adequado para aplicações móveis graças às suas capacidades e facilidade de implementação. Com isto, esta tese apresenta uma abordagem arquitetural e de desenvolvimento para a aplicação de funcionalidades FHIR no produto, juntamente com a análise do problema e da solução, incluindo a avaliação de ferramentas adequadas para a fase de implementação. Os resultados de teste obtidos para os serviços FHIR implementados, demonstraram uma melhoria na performance do produto, e graças à especificação do standard, a implementação das principais funcionalidades provou ser simples e direta, respeitando os principais critérios para os serviços desenvolvidos

Web application of physiological data based on FHIR

This paper works toward implementing a prototype demonstrating some of the capabilities of the FHIR specification. The specification requires a clear understanding of its different components in order to be successfully implemented, therefore the primary concern of this work is to understand and analyse FHIR’s concepts. The research conducted in this work revealed that FHIR is a well-designed specification, based on a powerful data model and technologies. Therefore, it sould help solving the interoperability issues of the healthcare eco-system. It has also been pointed that since FHIR is a recent standard, many of its uses and benefits are still to be discovered. Moreover, FHIR integrates well in the current health information technology context since it can be used in addition to existing standards

MS

thesisDelivery of high quality health care requires access to complete and accurate patient information. Variation in data context and content across disparate clinical systems adversely affects the integration of information needed for effective patient care and outcomes research. This study detects the extent and nature of data variation across three disparate clinical systems used along different points of the perinatal care continuum at Intermountain Health Care (IHC). Three analytical methods were used to examine data variation: data structure analysis; clinician perception of missing data elements; and patient record review of key data values. Knowledge acquisition techniques and consensus among clinical domain experts were used to select sample data elements for the data structure analysis. Findings revealed only 17% of the sample data elements had ompatible structure and meaning across the prenatal, labor and delivery (L&D), and newborn intensive care (NICU) clinical data systems. Impact on clinician efficiency from missing and contradicting information in nonintegrated perinatal systems was captured and analyzed using a Critical Incident Technique-based clinician survey. In a 1-month period, 75% of responding clinicians reported missing data and 34% reported contradicting data. The time taken to resolve problems from 1 month's missing data was estimated to be 231 hours for 23 clinicians. Data values from patient records for eight laboratory results were compared across the three perinatal systems. The best match across any two systems was 88% (blood type) and the worst was 0% (antibody screen, chlamydia). The highest incidence of contradicting data was 2.5% for blood type. Comparing agreement of the three methods, triangulation,"" gave additional insight into IHC's data variation problem. The data model study and the patient record review study showed missing data element problems beyond what clinicians perceived. In all, the consistency of data capture in the three perinatal systems at IHC is worse than expected. The data necessary to computationally execute the logic of the perinatal care process models is intermittent and unreliable. Rework of the perinatal applications based on a uniform data model and standard terminologies will provide an infrastructure to achieve IHC's vision of interdisciplinary care."

Data Infrastructure for Medical Research

While we are witnessing rapid growth in data across the sciences and in many applications, this growth is particularly remarkable in the medical domain, be it because of higher resolution instruments and diagnostic tools (e.g. MRI), new sources of structured data like activity trackers, the wide-spread use of electronic health records and many others. The sheer volume of the data is not, however, the only challenge to be faced when using medical data for research. Other crucial challenges include data heterogeneity, data quality, data privacy and so on. In this article, we review solutions addressing these challenges by discussing the current state of the art in the areas of data integration, data cleaning, data privacy, scalable data access and processing in the context of medical data. The techniques and tools we present will give practitioners — computer scientists and medical researchers alike — a starting point to understand the challenges and solutions and ultimately to analyse medical data and gain better and quicker insights

Arizona Health Information Exchange

abstract: Arizona strives to be the national role model for the secure, interoperable health information exchange to facilitate safe, secure, high quality and cost effective health care. The purpose of the Health Information Exchange in Arizona is to improve the quality, safety and efficiency of wellness in the Arizona population by securely connecting patients and health care providers so that relevant and understandable information is available anytime, anywhere