December 2012 Newsletter

 

 

Transforming Healthcare Through Informatics and Analytics
2012 December
Volume 1, Issue 2
From DCHI…

I just returned from a WHO forum in Geneva on Health Data Standardization and Interoperability. The meeting was organized around panels in which the topics were introduced and the entire group discussed the questions introduced. The focus of the meeting was directed to developing countries. Attendees included representatives from Nepal, Mongolia, Sri Lanka, Viet Nam, Malaysia, Rwanda, South Africa, Philippines, Saudi Arabia, Nigeria, Mozambique, Brazil, Commonwealth of Dominica, China, Chile, Italy, Mexico, Kenya, Ghana, Columbia, Norway, Canada, Japan, U.K., U.S. Switzerland, and others. The common terminologies and standards-developing organizations were represented.

Seven topics were introduced:

1.  Essentials of Health Data Standards for Health Care Delivery

      a.  What is essential?

      b.  What are problems existing standards are solving?

2.  Country Perspectives on Health Data Standards

Implementation

a.  What are issues related to health data standards in each             country?

b.  Examples of success stories on use of health data

standards.

3.  Access to Health Data Standards

a.  How can we improve access to standards?

b.  What are problems to access?

4.   In-country Policy and Governance Mechanisms for Health

Data Standards Adoption

a.  What are best practices for policy and governance?

b.  What are the fundamental requirements?

5.   Innovative Funding Models for Health Data Standards

Access and Adoption

a.  What are potential sources for funding?

b.  How do we promote free access?

6.   Human Capacity for Health Data Standards Implementation

and Maintenance

a.  What are the required core competencies?

b.  How do we increase in-country resources?

c.  How do we engage universities and academic

institutions?

7.  Role of Development Partners in Health Data Standards

a.  Who are some potential partners?

b.  What is the role of donors? How do we keep donors from

being siloed?

c.  How can donor programs promote the use of health

data standards?

d.  What kind of tools and training are necessary for use of

health data standards?

The results of the forum will be published as a book in the near future.

W. Ed Hammond, PhD

Director, DCHI


Upcoming Duke/UNC Seminars

All seminars are held from 4:00-5:00 pm in Hock Plaza (Ground Floor Auditorium),  2424 Erwin Rd, Durham.
Seminars at UNC are held in the UNC Health Sciences Library, Room 328, Chapel Hill.

Jan 16, 4:00 – 5:00 pm
Ryan Shaw, PhD, RN – A Mobile Health Intervention to Sustain Recent Weight Loss

Jan 23, 4:00 – 5:00 pm
Sam Cykert, MD – EHRs and Quality Improvement:  Optimizing Effect
Jan 30, 4:00 – 5:00 pm
Meredith Nahm, PhD – Developing a Research Program in Health Informatics
 
Feb 6, 4:00 – 5:00 pm

Robert Furberg, MBA, PhD – Schumpeter’s Gale:  How Social Trends, Consumer Electronics, and the Liberation of Data are Forcing Change in Healthcare

Feb 13, 4:00 – 5:00 pm
Sohayla Pruitt, MA – Geospatially Enabling Duke’s Enterprise Data Warehouse

Feb 20, 4:00 – 5:00 pm
Michael Shoffner – A Security Primer for Health Informaticians

Feb 27, 4:00 – 5:00 pm
Dohyeong Kim, PhD – Decision-Analytic Modeling for Information-Based Malaria Control

Mar 6, 4:00 – 5:00 pm
James Murphy – To be announced

Mar 20, 4:00 – 5:00 pm
John Graham – To be announced

Upcoming Conferences

Mar 18-22,  San Francisco, CA

Society of Clinical Data Management Annual Conference (reported by Anita Walden)

Anita Walden chaired a session titled “Clinical Research Informatics: The Foundation, Benefits and Future of Data Management” at the Society of Clinical Data Management (SCDM) meeting held September 24, 2013 in Los Angeles, CA. The goal of the session was to educate and inform clinical data managers, and those involved in clinical research, that recognizing informatics is a critical aspect to improving the clinical trial process. Many involved in clinical research are either waiting for technology to influence their roles or think that their current processes will not change.

The session comprised three presentations. Mary Ann Slack, Deputy Director of the FDA’s Office of Planning and Informatics (OPI), presented “Clinical Data In FDA: Meeting FDA’s Data Challenges Through Standards And Informatics.”  She highlighted the FDA Informatics efforts and provided a vivid picture (see below) of the current state of the review times for a drug or device and the reason for the FDA’s vision of “A standards based end-to-end fully electronic receipt, review, and dissemination environment.” Dianne Reeves, Associate Director for Biomedical Data Standards at the National Cancer Institute, presented “Tools, Standards and New Methods to Enhance the Future of Quality Data Management Practice.”  She highlighted standards, the cancer data repository and registry (caDSR) and a standard Case Report Form initiative for NCI cancer trials, and presented open informatics tools that are available for use in the clinical research process. Lauren Weil, Chief of Data Management at Department of Veterans Affairs, presented “Role of Informatics in Incorporating Electronic Medical Records into Clinical Trials.” She focused on how informatics is used in the clinical trial and data management process. She also discussed the Cooperative Studies Program, which uses electronic health records for clinical trials. This pilot project integrates the clinical trial forms within the EHR system to identify and consent participants for a study.

Duke Office of Clinical Research (DOCR) (reported by Denise Snyder and Cory Ennis)

New Privacy Article

The DUHS Compliance Office has posted a new privacy article to their website titled “Breach of Protected Health Information (PHI).” This article defines what a breach of PHI means as well as the responsibility of the research community to report any suspected breaches.

Research Data Security Plan Update

DOCR continues to work toward cataloging Research Data Security Plans (RDSPs) on open studies that did not submit an initial RDSP. Over 3,500 survey links have been sent to respondents, with approximately 1,600 responses to date. Study teams can now use the eIRB system to submit revisions to previously approved RDSPs. Revisions follow the same review and approval process as the initial RDSP. An updated User Guide with step-by-step instructions can be found in the User Guides section of the eIRB Home page.

Use of External Agency Software

Recently, there have been requests from external agencies to use their software during the course of research projects. (This request does not include programs that are already setup for individuals to access, i.e. web-based electronic CRFs). In these instances, it is important to contact the Information Security Office (ISO) to make the ISO aware of agency’s request. The ISO will complete a security evaluation of the software, and work with the agency to ensure that the software poses no risk to the Duke IT system and that the only identifiers leaving Duke are those agreed to by the participant. If you are not sure the software needs to have ISO review and approval, contact DOCR for more information. For existing, new, or future software contact Rosemary Herhold at rosemary.herold@dm.duke.edu.

 

AMIA 2012 Annual Symposium

The 2012 Annual Symposium was held November 3-7 at the Hilton Chicago in Chicago, Illinois. Several Duke papers received special recognition:

Constance Johnson, PhD, RN won “The Harriet H. Werley Award” for her paper, co-authored with Ryan Shaw, PhD, RN, a recent graduate of the PhD program, titled “A Usability Problem: Conveying Health Risks to Consumers.” This award consists of a cash prize and is given for the paper whose first author is a nurse and judged to make the greatest contribution to advance the field of nursing informatics. Dr. Johnson is an Associate Professor and Lead Faculty for the Nursing Informatics Specialty of the MSN Program at the Duke University School of Nursing.

The panel, “The Paths Toward Informatics Careers in the Post-HITECH Era,” presented by Nawanan Theera-Ampornpunt, Tiffany Kelley, Edmond Ramly, Ryan Shaw, Saif Khairat, and Frank Sonnenberg was selected by the Scientific Program Committee chairs for the Best of AMIA 2012 “Hot Picks” in Image Informatics. Drs. Tiffany Kelly and Ryan Shaw are recent Duke PhD graduates from the DUSON. Recognition as one of the “Hot Picks” was given for entries “most likely to draw attention: popular topics, new features, innovative research areas and highlights of presenters who are well-known plus some rising stars to watch.”

“Ontology-Based Federated Data Access to Human Studies Information” was selected as one of five “Distinguished Papers” at the Annual Conference. Authors are Ida Sim, MD, PhD, Simona Carini, MA, Samson W. Tu, MS, Landon T. Detwiler, MS, James Brinkley, MD, PhD, Shamim A. Mollah, MA, Karl Burke, MS, Harold P. Lehmann, MD, PhD, Swati Chakraborty, MS, Knut M. Wittkowski, ScD, Brad H. Pollock, PhD, Thomas M. Johnson, BS, and Vojtech Huser, MD, PhD. Swati Chakraborty is a Project Leader at the Duke Clinical Research Institute.

Martha Adams, MD, was elected to the AMIA Board of Directors for a three year term starting January 1, 2013. She also won an AMIA Leadership Award for her leadership of the Working Group Steering Committee. Dr. Adams has been a member of this Committee for many years and the Chair since 2010. She is a Professor Emerita in the Department of Medicine, General Internal Medicine and Clinical Informatics.

Duke Faculty and/or students presented the following posters:

Anthony Castleberry, Hannah Dodson, Donna Harris, Linda Murray, and Leigh Ann Spearman (DUSON): “The ‘Cost Awareness Real Time (C.A.R.T)’ Informatics Application.”

Deborah Armstrong, Krystal Groff, Chao Huang, Karen Luse, and Timothy Lorimer (DUSON): “Cardiovascular Imaging Data Standards: A Graduate Student’s Perspective.”

Hannah Dodson and Leigh Ann Spearman (DUSON): “Heuristic Evaluation in Personal Health Record (PHR) System Usability.”

William Bisanar and Nathan Licht (DUSON: “Will Family Health History Tools Work for Complex Families? Scenario-Based Testing of a Web-Based Consumer Application.”

Vivian West and Ed Hammond (DCHI): “Assessment of Technology for Enabling Self Care in Older Adults.”

M. Smerek, A. Walden, J. Frund, A. Waters, C. Franklin, (DTMI) and G. Del Fiol (University of Utah): “Development of a Multifunctional System to Facilitate Recruitment into a Community-Based Registry and Biorepository.”

Drug Information Association 2013

Doug Wixted, an Informatics Project Leader on the MURDOCK Study, submitted an abstract accepted as a speaker presentation at the Drug Information Association (DIA) 2013 Annual Meeting June 23-37, 2013 in Boston, MA. The presentation titled “The MURDOCK Study: Informatics as a Cornerstone for Understanding the Molecular Underpinnings of Chronic Diseases,” will focus on the promise and challenges associated with secondary use of data from participants’ electronic health records (EHRs). Doug will speak as part of a session titled “Changing Landscape of IT in the Pharmaceutical Industry,” alongside speakers from Oracle and EMC2.

Enterprise Biobanking Informatics (reported by Helena  Ellis)

The Duke Biobank has obtained institutional financial commitment to fund deployment of Labvantage as Duke’s enterprise-wide Biobank Information Management System, which will be used for human biological specimens used by Duke researchers. The implementation plan is a two year, phased project begining January 2013. The Duke Biobank will partner with DHTS and DOCR for system and customer service support. Additional information and links to resources can be found on the Duke Biobank website (  http://biobank.duke.edu/).

Index of Biospecimens

The Duke Biobank Index of Biospecimens, known as “the Index” (https://sites.duke.edu/biobank/), is a simple web-based searchable database for Duke researchers looking for biospecimen collections that may be available for collaboration at Duke. FAQs for the Index are available on the Duke Biobank website (https://biobank.duke.edu/resources/duke-index-of-biospecimens-the-index-faq). Fourteen protocols are currently registered in the Index, with 21 additional protocols in the pipeline. The Duke Biobank will assist biobanks or investigators who have collections they wish to register. Contact the biospecimen-expediter <biospecimen-expediter@duke.edu> for more details.

 

Institutional Biobanking Terminology

On 13 July 2012 the Duke Biobank staff and members of the Biobank Informatics Working Group launched an initiative to establish standard biobanking terminology. The biobanking terminology is focused on essential biobanking terms and data elements, which will be implemented in the LabVantage system. It will also be made available to the CTSA Consortium and shared with the International Society for Biological and Environmental Repositories (ISBER). Standardization of biobanking terminology will help promote semantic interoperability across all biobanking and clinical research groups at Duke. The project is expected to last up to one year. There will be a public comment period before finalization of the terminology.

DUSON – (reported by Rachel Richesson)

At the Clinical and Translational Science Award (CTSA) Annual Informatics Meeting in Chicago, Nov. 7-8, Rachel Richesson, PhD, (DUSON faculty) presented a poster “Standardized Approaches to the Collection and Analysis of Medication Data Using Public Data Standards and Software.”   Dr. Richesson, in collaboration with MSN student, Chandel Dundee, presented “Managing Medication Data in a Longitudinal Community-Based Registry and Biorepository.”

Linda Harrington, PhD, RN-BC will receive her DNP next month from the School of Nursing, after successfully defending her Capstone project titled “Evaluation of the Use of Bar-code Medication Administration in Nursing Practice Using an Evidence-Based Checklist.” Constance Johnson, PhD served as advisor and chair of the Capstone committee.  Dr. Harrington is the Vice President for Advancing Nursing Practice, Baylor Health Care System, Dallas, Texas.

DHTS-Information Management (reported by Howard Shang, Monica Horvath, and Shelley Rusincovitch)

Introducing DEDUCE-Geo

DEDUCE v4.3 was released on November 17, 2012. Version 4.3 includes the first version of DEDUCE-Geo, a geospatial mapping tool enabling the spatial visualization of healthcare data and trends, which have been traditionally viewed as rows and columns in a database table. DEDUCE users can filter patients by a variety of subject areas and visualize their results within an interactive mapping web application that offers a variety of key features and capabilities.

Geospatial mapping offers an innovative approach to healthcare management that can assist in research and management activities ranging from the determination of intervention strategies and formulation of healthcare reform, to the establishment of new service areas and districts.   Offering the ability to visualize this type of data on a map enhances decision-making abilities of planners, helps determine pockets of need within areas, aids in allocation of funding, and can even decrease response time to disease outbreaks.

Researchers and decision-makers frequently request printed maps for reports used to make decisions and understand a particular phenomenon. The process is often manual, iterative, and very much dependent upon geospatial professionals familiar with the software, data, and technology needed to generate the maps. DEDUCE-Geo offers a solution that integrates geospatial data within Duke’s Enterprise Data Warehouse and utilizes cutting-edge Internet mapping technologies that work to simplify the process of accessing spatial information, and ultimately expedites the decision-making process. It provides an easy to use interface for the Duke community, regardless of their geospatial knowledge and background, so that the benefits to accessing and visualizing geospatial information can be realized by all.

See Getting Started with DEDUCE-Geo and DEDUCE-Geo Features and Capabilities for more information.

Duke Maestro Care

Ongoing work continues on the integration of data from Maestro Care, the Duke-specific Epic Healthcare platform for electronic health records (EHRs), into Duke’s Decision Support Repository (DSR). The DSR will contain historic data as far back as 1996 and add new availability of Maestro Care data in existing subject areas. The Duke Health Technology Services-Information Management (DHTS-IM) team is also reviewing new subject areas from Maestro Care that may be prioritized for DEDUCE incorporation. These recommendations will be reviewed by the Maestro Care Research Advisory Committee.

With the large investment of resources for the Maestro Care deployment, it is important to measure the impact of this new system, including patient outcomes, provider satisfaction, and workforce efficiency. The new Maestro Care Benefits Realization Workgroup Committee will guide this effort. The Committee, led by Monica Horvath, PhD, Team Lead for the Health Intelligence and Research Services team (HIRS) within DHTS-IM, had its kick-off meeting on November 12, 2012. As a monthly work group, the committee will provide strategic guidance to the HIRS Maestro Care benefits evaluation effort. The committee will review preliminary data analysis results, helping to identify untapped benefit realization opportunities, assist in engaging key stakeholders, and advise on project prioritization and scope. Members of the multidisciplinary committee come from across the health enterprise, including but not limited to Performance Services, Maestro Care Reporting, Entity Engagement, DHTS-IM, DCRI, Patient Revenue Management Organization (PRMO), and Duke Primary Care.

DISCERN Manuscript Acceptance

DHTS-IM worked with investigator Jonathan Bae, MD, on a hospital readmission alerting system using DISCERN. A manuscript about the system, titled “Development of a Real-Time General Medicine 30-Day Readmissions Notification System,” has been accepted and will be published in spring 2013 by the Journal of Hospital Administration. DHTS-IM staff members Tanya Barros, Ilona Stashko, and Monica Horvath, PhD are co-authors with Dr. Bae, who is an Assistant Professor of Medicine, Assistant Professor of Pediatrics, and Associate Medical Director for Quality and Patient Safety at Duke Medicine.

DHTS Performance Metrics

DHTS is in the process of adopting a new management model that links strategic objectives with outcome measures aligned with the health system’s overall mission, vision, and values. The DHTS Performance Metrics are currently in the development phase, with a number of measures defined and one tracking sheet already published. The Health Intelligence and Research Services team (HIRS) within DHTS-IM is working with the DHTS Program Management Office to help develop, capture, and report these performance metrics, and is examining options for better visualizations of the data with a trial of the software product Tableau Professional for visualizations and Tableau Reader to create and display dashboards.

Staff Introductions

Randall Blanco has joined DHTS-IM as a Senior IT Manager, and is responsible for managing the Data Analyst team. The team works closely with customers to understand and support their data needs and translate them into technical specifications. Randall has extensive experience in database technologies, project management, technical operations, software engineering, application/product development, business development, strategic planning & forecast, process development/research & innovation, and human resource/staff management. His degrees include a B.S. in Mathematics and Computer Science from Mississippi College, M.S. in Computer & Information Science & Engineering from University of Florida, and M.B.A. in International Business from Loyola University, Baltimore, MD.

MURDOCK Horizon 1.5 Registry (reported by Anita Walden)

SCRUM Implementation

Led by Julie Frund, certified SCRUM Master, the Horizon 1.5 Registry development team has implemented the SCRUM process, an iterative and incremental agile methodology for managing software, product or application projects. The Registry development team adopted this methodology to improve development and communication processes across the team. It also allows for shorter prototype or production release times to demonstrate progress, and incorporates a feedback mechanism for lessons learned. A potential benefit of this process is to reduce the burden on the users, allowing them to provide story scenarios of their workflow.  It also provides a better product in the context of how the system will be used.

The methodology has been slightly adapted to meet the team’s needs. Since its implementation it has been easier to estimate timelines, and allows flexibility in maintaining parallel work streams or projects. If anyone else has adopted SCRUM, please contact Julie Frund (julie.frund@duke.edu), Andy Waters (andy.waters@duke.edu) or Anita Walden (anita.walden@duke.edu) to share practices and tools.

NCBO Coding Tool Evaluated for Use in MURDOCK Registry System

 

Rachel Richesson from the School of Nursing and the HORIZON Registry team comprised of Michelle Smerek, Andy Waters, Anita Walden, Jessie Tenenbaum, Guilherme Del Fiol, Doug Wixted and Chandel Dundee (a graduate student in the Duke Nursing Informatics program) integrated and completed the first round of testing of the National Center for Biomedical Ontology (NCBO) auto-complete and coding.  The tool is designed to promote standardized collection of medication terms from a terminology source. When the medication name is selected from a dropdown list, the Registry database is populated with information such as the preferred term and a concept unique identifier called a CUI from a terminology-supported reference. Preliminary testing results indicate that the NCBO tool will be a good solution for the need to annotate participant-reported medication names with coded medication information from a standard vocabulary (RxNorm). A poster describing this effort, “Managing Medication Data in a Longitudinal Community-Based Registry and Biorepository” was presented at the Clinical and Translational Science Award (CTSA) Annual Informatics Meeting in Chicago, Nov. 7-8.

Data Standard Initiatives at Duke (reported by Anita Walden)

The use of exchange and semantic data standards is an important foundation for promoting interoperability in healthcare, research, surveillance, quality improvement and other entities within and across institutions. Duke has been a leader in developing domain and therapeutic data standards to promote consistent data collection at the point of care and for secondary use since 2003, and has or is currently facilitating ten different therapeutic or domain specific initiatives. Most will be national or international standards through standards development organizations such as Health Level Seven (HL7) or the Clinical Data Interchange Standards Consortium (CDISC). A poster highlighting the projects Duke is facilitating was presented at the Clinical and Translational Science Awards (CTSA) Informatics meeting November 7th in Chicago.  Please contact Anita Walden (anita.walden@dm.duke.edu) for more information about these initiatives

Duke Bioinformatics Shared Resources (DBSR) (reported by Salvatore Mungal and Wei Chen)

caArray and GenePattern, deployed in 2010 to meet the data storage and data sharing needs of the Duke Cancer Institute (DCI) investigators with high-dimensional gene expression datasets, are both being used widely. The DCI Bioinformatics group has launched an aggressive campaign to build GenePattern modules to meet the requirements of reproducible research.

Currently, a total of 24 new GenePattern modules have been developed, ranging from data management and preprocessing to data analysis and visualization. Two new modules have been built – one is for the GPU version of the Latent Protein Trees algorithm and the other implements the Shotgun Stochastic Search for exploring and summarizing subset progression models. These modules have been piloted for analysis of existing mRNA microarray datasets in breast and ovarian cancer from several DCI investigators, and externally from The Cancer Genome Atlas (TCGA) project.

For deployment of the RProteomics software application to caGrid, a URL has been established and security clearance has been obtained to use a special port outside the firewall that will access the application. Implementation and deploying of the software to the training grid continues. This project, when completed, will provide data, translation, and analytical grid services for proteomics mass spectrometry, and will use provenance and the latest security measures to facilitate reproducible research. It will also extend the functionality of existing grid technology to make sharing data and applications tractable.

All of the applications use NCI’s caBIG® syntactic, semantic, and data standards to facilitate interoperability, and will use the National Cancer Informatics Program’s (NCIP) formal standards when they become available.

Duke Center for Health Informatics (DCHI)

Rene’ Hart has joined the staff at DCHI as a staff assistant. Rene’ most recently has owned her own business as a resume writer, and has worked in several academic assistant positions in Florida. She was a student at North Carolina State University in her earlier life, but is proud to now be an employee of Duke.

DCHI Grant with the Department of Defense

Ed Hammond, PhD, Director of the Duke Center for Health Informatics, and PI has been notified by the Department of Defense that Duke’s grant titled “Novel Presentation of Health Related Data” has been selected for funding. The objective of the research is to explore visualization of large sets of health data with interactive use to provide better understanding of what is in the data. The hypothesis is that data visualization is more effective than traditional methods of data exploration, and that the type of visualization is highly dependent on the related data and nature of the queries and what someone is trying to learn from the data. DCHI will work with David Borland, PhD at RENCI, to develop and evaluate visualization methods. Jeffrey Ferranti, MD, Carl Pieper, PhD, and Vivian West, PhD will also participate in the research.

Visit the DCHI website (www.dukeinformatics.org) for additional information including
informatics news, publications, conferences, faculty, education, and research.

Copyright © 2012 Duke Center for Health Informatics
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