clinical data repository

clinical data repositories (CDR)

most institutions have this in electronic or written format to represent an aggragated database of clinical information

• laboratory results

• diagnostic reports

• various clinical documentation

clinical data repositories usually house a multitude of

searchable

exportable

The data are readily _______ and _______, often because the information is gathered from standard clinical care procedures (Robertson and Williams, 2016)

• laboratory

• radiology

• admission

• pharmacy

CDR integrates physician-centered data from different existing information systems including

Carter, 2001

CDR is a location where both clinical data and other data of interest, such as external data sources and financial data are assimilated

same sample

a clinical data reporitory can successfully depict the __________ across different points in time, from varying sources both within and outside health institutions

• patient demographics

• patient’s primary care provider

• medication list

• allergies

• hospital inpatient visits

• emergency department encounters

• outpatient practice visits

• immunizations

• diagnoses

• procedures

• lab results

• social history

• vitals

common kinds of available information in CDR

making more informed patient care decisions for healthcare providers

advantage of CDR

longitudinal view id a patient’s medical record

can assist in improving patient experience, and having information about prior test results and procedures help avoid redundant treatment

Bergeron (2013)

describes a clinical data repository as a structured and systematically gathered "storehouse” of patient-specific data, which is usually mirrored from a clinical application, or supplemented with data from other clinical systems

decision analysis

CDR is it is maintained as a separate database created particularly in aiding ___________

the main application of CDR

avoids computational loading, and response time to a query is improved

because almost all patient information is mirrored in a CDR

why are customized, and even complex, queries are possible without sacrificing the performance of the source applications?

since the data typically originated from one source with little to no manipulation

why are near-real-time retrieval of clinical data possible?

• location

• indicies

• catalogues

• semantic translations or equivalences

• syntactic structures

• links to external information

CDR different levels of integration which are usually dependent on

by setting constraints on how easily someone can make queries for any of its contents

how does the level of integration of a CDR influence its functionality?

how they restrict the users

the purpose for its use

data repositories also vary in

access control to the CDR

functions as a safeguard to uphold data security and integrity

study

a database that collects observations for a specific clinical research study

electronic health record

a database of observations made as a result of direct health care

registry

observation collected and organized for the purpose of studying or guiding particular outcomes on a defined population (Associated studies are either multiple or long-term and evolving over time)

warehouse

a repository that adds levels of integration and quality to the primary (research or clinical) data of a single institution, to support flexible queries for multiple uses (Is broader in application than a registry)

collection

a library of heterogeneous data sets from more organizations than a warehouse or more sources than a registry

collection

organized to help users find a particular data set, but not to query for data combined across data sets

federation

repository distributed across multiple locations, where each location retains control over access to its own data, and is responsible for making the data comparable with the data of other locations

Wade (2014)

emphasizes that the longitudinal nature of the CDR requires a way of linking various observations of the same identified subject

personally-identified data

moat repositories usually contain ___________, however, due to privacy issues, they only release de-identified data, which can lead to the omission of some data in a dataset

identifiers

The lack of ______ could also prevent the linking of data for some patients

disadvantage of CDR

most are only integrated with clinical data

• lab results, diagnoses, and demographics might be available for use in one platform, but overall patient satisfaction, the amount of time a patient had to wait before being treated, and other information not related directly to his care might be unavailable

Gensinger, 2014

a clinical data repository standardizes data from disparate sources into a cohesive format

• It comprises numerous tables, each offering a partial view of patient information

• time (by year, month, week, or day)

• location

• diagnosis

The structure of clinical data repositories allows data to be extracted along dimensions such as _____, ______, _______ among many others.

This data can often be accessed in smaller units within the same dimension.

Wager, Lee, and Glaser, 2014

Clinical data repositories help organizations transform large amounts of information from distinct transactional files into a unitary decision-support database

patients

visits or encounters

data repositories are often organized primarily around ______ and secondly around _________ —a method that easily accommodates views that span multiple visits (Ball and Douglas, 2013)

• this allows clinicians to trend and chart results independent of the visits and test panel organization

"one-stop shopping"

CDRs also provide access to information where it is needed

Since they receive information from a multitude of feeder systems, well-deployed CDRs can create a ________ environment (Ball and Douglas, 2013)

graphical user interface (GUI)

CDRs also provide access to information where it is needed by allowing the clinical staff to access a variety of patient-focused information through a consistent and easy-to-use __________ (Ball and Douglas, 2013)

• handheld devices

• bedside computing devices

• computers in physician offices

• computing devices deployed at nursing stations

The GUI access can be deployed through:

• In any case, this wide variety of information access moves far closer to deployment of information at the point of care

(Ball and Douglas, 2013)

cross-continuum

CDRs offer a ________ view of information, since they allow information to be gathered and viewed from sources other than an acute setting

• This type of ambulatory-focused information combines with the acute information to give clinicians a new level of insight into the wellness of their patients

(Ball and Douglas, 2013)

physician

medical technologist

nurse

radiologist

Data collected through an electronic health record system may be retrieved at the request of an authorized user, whether a ______, ______, ______, _____

EHR

The ______ may present patient care information as text, tables, graphs, sounds, images, full-motion video, or signals on an electronic screen, phone, pager, or paper (Bronzino and Peterson, 2014).

data visualization

the art of representing data in a pictorial or graphical format

data visualization

helps in simplifying a wide array of information, and it allows decision-makers to derive analytical results from information presented visually

data visualization

correlations, patterns, and trends, which might be undetected from text-based clinical data, can be revealed and recognized with more ease because of ________

visualization

is increasingly becoming an important tool in decision-making

scenario analysis

The graphical representation feature of most clinical data repositories enable ______ , which helps users use different kinds of filters in order to change the level of information that may be seen

• age & gender

straightforward data

This visualization kind of analysis is a good opportunity in empowering the frontline staff by giving them _______, which will facilitate the performance of their tasks more efficiently and effectively (Rains and McCuistion, 2018)