Healthcare Informatics
Research Program
Merry Ward, PhD
Scientific Program Manager
Healthcare Informatics Research
Vision
Improve patient outcomes with an HIT
system that manages and creates
knowledge for patient and provider use
use.
An Informatics Research Program
R
i
IInfrastructure
f t t
Requires
Ap
platform to test
research-based
clinical applications
with near-real time
patient data without
perturbing the live
HIT system.
system
– Currently
researchers have
difficulty field
testing new
applications.
Access to longitudinal
patient
ti t data
d t to
t create
t
new knowledge about
response to treatments,
care management
practices, adverse
events, patient safety,
population health, and
individualized medicine.
–
–
Currently researchers
have limited access to
patient data
data.
Much of the rich textual
information about patients
remains unavailable.
Overview
Describe the VA context
Describe two programs that together are
designed to establish a computational
infrastructure, provide greater access to
data and develop research methods to
data,
process and analysis unstructured (text)
data.
data
The VA Context
Veterans Health Administration is
the largest healthcare system in
U.S.
It has a fully integrated HIT
system better known as VistA
system,
VistA.
VistA is an integrated suite
of 104 packages including:
including:
Patient Records (CPRS)
Order Entry
Imaging
M di ti Ad
Medication
Administration
i i t ti
Medical Centers and Development Sites
IT Field Office
VistA in Medical Center = 128
Complexity of VistA Data
57,917
57 917 fields in VistA
Free text
Word processing
17,649
2,277
30%
66%
Free Text
4%
Word Processing
All Other
Volume of VistA Data
Documents
(Progress Notes,
Notes Discharge Summaries
Summaries, Reports)
– 1.4 Billion…….. +
+638,000
638,000 each workday
Orders
– 2.5 Billion…….... +
+955,000
955,000 each workday
Images
– 1.3 Billion……… +884
+884,000
,000 each workday
Vital Sign
g Measurements
– 1.6 Billion……… +
+729,000
729,000 each workday
Medications Administered via BCMA
– 1.4 Billion……… +607
+607,000
,000 each workday
Estimated through FY 09
10
Challenges researchers have using
Vi
tA d
t
VistA
data:
Access
– VistA data specific for each locality/VAMC
– Limited national data
– Authorization process cumbersome
Q lit
Quality
– 128 versions of VistA (locale specific)
– Data are not collected for research purposes
Security
11
HSRD Initiatives to Conduct Research
dB
ild R
h IInfrastructure
f t
t
and
Build
Research
Consortium for Healthcare Informatics
), a program
p g
p
project
j
to
Research ((CHIR),
unlock the rich textual information in VistA.
Veteran Information and iNformatics
Computing Infrastructure (VINCI), a highhighperformance computing environment with
access to national data.
C
Consortium
ti
ffor H
Healthcare
lth
Informatics Research ((CHIR))
Matthew Samore, MD, Salt Lake City
Principal Investigator
CHIR Sites
– Portland
P l d
– Palo Alto
– Salt Lake City
– Nashville
– Indianapolis
– Tampa
– West Haven
– Boston
CHIR mission
– Conduct basic and applied
pp
research to advance the effective
use of unstructured health record
data by VA providers, investigators,
and provider
provider--investigators.
investigators
Research portfolio
Applied projects
Initial shortshort-term p
projects
j
–
–
–
–
Ejection fraction
Lymph node status
Device information in chest xx-rays
Prothrombin time & international normalized ratio
Major projects
– Ontology development and text processing for
methicillin--resistant Staphylococcus aureus (MRSA)
methicillin
surveillance
ill
– clinical classification and prediction associated with
post--traumatic stress disorder ((PTSD))
post
p
VINCI: Veteran Information
and
d iNf
iNformatics
ti C
Computing
ti
Infrastructure
Jonathan R. Nebeker MS MD
Director, HSR&D
Jack Bates
Director OI&T
Director,
18
VINCI
Veterans’
Veterans
Informatics,
Information,
formation and
Computing
Infrastructure
1 Provide a secure, high1.
high-
performance computing
environment
2. Build an integrated
research database
3. Provide access to data
4. Maintain customer
support and outreach
programs
19
1
1. Computing Environment
Hardware
– Servers: 14 servers and RAM
– Fast storage (SAN): 50 to 100 TB usable
Remote, Virtualized Computing
– VINCI
C Remote Desktop
– Protected Development Environments
Applications
– Off
Off--the
the--shelf statistical applications
– Custom data processing tools
20
Environment: Data Security
Rule #1: No protected health information
(PHI) leaves VINCI servers.
VINCI
Temporary
Directories
Upload
Working
Directory
SFTP transfer
Local
Server
Downloa
d
Audit Increase automated
security over time
Remind of Rule
21
2
2. Database
National Data
– HDR: Allergies, Vitals, Encounters,
Outpatient pharmacy,
pharmacy Surgery,
Surgery Prosthetics
– DSS: In Pharmacy, Radiology Procedures,
Cost
Regional Data Warehouse (RDW)
– Notes,
Notes Micro,
Micro Health factors,
factors Consults
Consults, Labs
Labs,
Appointments, Primary care assignments
Specialty (to be negotiated)
– CART
CART--CL, NSQIP, HIV, CMS
22
3
3. Data Access
Procedures
– VINCI organizes applications to facilitate
the process
– NDS, Privacy, Research approve
application
– Collaborative
C ll b ti d
development
l
t off automated
t
t d
approval and authorization tool
S i d
Serving
data
t
– Data extractions by VINCI staff
– Self
Self--Service
– Metadata
23
4
4. Support & Outreach
Help Desk
– Web and phone
– Support for both Research and OI&T
Outreach
– Advisory Groups
G
– Surveys
24