Managing Clinical Data for Research - Epic & i2b2 Keith Marsolo, PhD Division of Biomedical Informatics Cincinnati Children’s Hospital Medial Center October 28, 2009

Background Cincinnati Children’s in midst of 3+ year Epic rollout Go live dates: –First outpatient clinic – September 2007 –Registration & scheduling – July 2008 –ED – November 2009 –Inpatient – January 2010

Background (2) Dashboards for Outpatient Quality/Outcomes Measures – Division of Clinical Effectiveness (HPCE) Each clinic/specialty focuses on 2-3 diseases and for each disease, defines 3-5 outcome measures Each measure would be displayed in an online chart/dashboard Charts would be refreshed on weekly/monthly/quarterly basis Several hundred measures total Goal: automation, ease of maintenance

Background (3) Pre-Epic, HPCE manually computed many charts, pulling together multiple spreadsheets Original plan was to calculate the measures in Business Objects –“Brittle” solution with many hardcoded literals –Data tied up in application, difficult to use for other purposes –Meta-data design, maintenance, performance an issue

Solution Construct a parameter-based “template” datamart containing major content types: –Demographics –Diagnoses & Problem List –Medications –Orders –Flowsheets Create a divisional mart for each clinic Additional logic to create disease-based registries Push data to Oracle, SQL Server depending on need

Lessons Learned Data needs to look like a spreadsheet (but beware column limits) Make base tables as broad as possible End-user documentation is very important –Partner with IS, HPCE to create a “data wiki” –Contains operational definitions, business rules, screenshots of application, location in data mart

CCHMC Development: –Flat-file export –Visit-based view –Direct data entry –Reporting Data model/ontology changes: fact –Context? Migration strategy (until features ready) –Create Epic mart for reporting –Map legacy data to “Epic-like” format –Move into i2b2

i2b2 Projects New grants: –Rheumatology –Eosinophilic Esophagitis Liver Transplant – redevelopment of existing database IBD

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