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
Overview
• History and evolution (or creation)
• Where we are today
• What we learned
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 Hospital
Clinical Information Systems Architecture
Medical Logic
Modules
Clinical Database
Alerts & Reminders
Database Monitor
Results Review
Database
Interface
Medical Entities
Dictionary
Administrative
Research
Reformatter
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Radiology
Reformatter
Discharge
Summaries
Reformatter
Laboratory
...
Clinical Data Architecture
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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
Entity-Attribute-Value Clinical Data Repository
Clinical Data Architecture
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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
Medical Entities Dictionary:
A Central Terminology Repository
Communicating Terminology Changes
K#1 = 4.2
K#1 = 3.3
K#2 = 3.2
K#1 = 3.0
K#3 = 2.6
K#1
K#2 K#3
Solution: Hierarchical Integration
K#1 = 4.2
K#1 = 3.3
K#2 = 3.2
K#1 = 3.0
K#3 = 2.6
K
K#1
K#2 K#3
MED Structure
Medical
Entity
Substance
Chemical
Laboratory
Specimen
Anatomic
Substance
Plasma
Carbohydrate
Bioactive
Substance
Plasma
Specimen
Event
Diagnostic
Procedure
Laboratory
Test
Plasma
Glucose
Glucose
Laboratory
Procedure
CHEM-7
Part of
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:
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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:
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Concept-based (95,641)
Multiple hierarchy (141,306)
Synonyms (239,581)
Translations (141,717)
Semantic links (225,698)
Attributes (210,456)
Where We Are Today - Outputs
• 7000 Users
• Clinical information systems
[LPRO]->(AE)->[ANTB]->(DS)->[PFUN]->(PO)->[ORGM]<-(PP)<-[OATT]
A procedure assesses the effect of an antibiotic which disrupts a
physiologic function which is a process of an organism which has an
attribute (sensitive/resistant).
Where We Are Today - Outputs
• 7000 Users
• Clinical information systems
• MedLEE
MedLEE
Problems present:
diarrhea
discomfort (abdomen ) 
vomiting
lightheaded
unconscious
Problems absent:
pain (chest )
seizure
Findings present:
demo ( 67 year )
History:
syncope
HISTORY 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.
Where We Are Today - Outputs
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7000 Users
Clinical information systems
MedLEE
Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals
Where We Are Today - Outputs
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7000 Users
Clinical information systems
MedLEE
Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals
– Infobuttons
Where We Are Today - Outputs
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7000 Users
Clinical information systems
MedLEE
Decision support systems
– Vigilens: TB, Freq Admit, Lab Vals
– Infobuttons
• Clinical data warehouse
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
MI
MI+Beta
2000
2001
2002
2003
2004
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
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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
Acknowledgements
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New York Presbyterian Hospital
Columbia University
National Library of Medicine
IBM
People:
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Tom Morris
Henrik Bendixen
Rachel Anderson
Paul Clayton
Steve Johnson
George Hripcsak
Bob Sideli
Somitra (Sen) Sengupta