City of hope research informatics common data elements

City of Hope Research Informatics Common Data Elements

Information Architecture Framework

AbdulMalik Shakir, Kelli Olsen MS, Adina Londrc MPH, Susan Pannoni, Stacy Berger, Joyce C. Niland PhD,

City of Hope, Duarte, CA

April 2014

Disclosure

• Mr. Shakir discloses that as of Q1 2014 he is no longer an employee of City of Hope.

• Mr. Shakir is co-founder and partner of Hi3 Solutions, a privately owned Health Information Consulting and Technology vendor headquartered in Los Angeles, CA.

• Mr. Shakir is actively involved in informatics projects with the American College of Surgeons and the American College of Cardiology.

Learning Objective

After participating in this activity the learner should be better able to:

• Understand enterprise data management issues and challenges and the role of meta-data management in addressing them.

• Identify relevant informatics standards and frameworks useful for use in harmonizing the semantics of enterprise data elements.

• Be familiar with similar data harmonization initiatives with work products that can be leverage for internal use.

Research Informatics Common Data Elements (RI-CDE)

• RI-CDE is a repository of data elements, their business and technical metadata, and their semantic relationships.

• RI-CDE enables a methodology by which the semantics of common data elements are harmonized throughout the enterprise, yielding a uniform nomenclature for shared concepts and traceability to their realization in information systems, databases, and application interfaces.

• The RI-CDE serves as the foundation for enabling decision support and semantic interoperability.

Research Informatics Enterprise Architecture Framework (RI-EAF)

• RI-EAF is an architectural framework for information management developed by the City of Hope (COH) Department of Information Science (DIS) in 2010.

• The purpose of RI-EAF is to facilitate the planning, procurement, engineering, and deployment of information systems needed to support research activities at COH.

• RI-EAF is based, in part, upon The Open Group Architecture Framework (TOGAF); the Health Level Seven (HL7) Services Aware Interoperability Framework (SAIF); the HL7 Common Terminology Services Release 2 (CTS II); and the ISO 11179-3 Metadata Registry Meta-model.

What is a Framework?

• In general, a framework is a real or conceptual structure intended to serve as a support or guide for the building of something that expands the structure into something useful.– In computer systems, a framework is often a layered structure

indicating what kind of programs can or should be built and how they would interrelate.

– Some computer system frameworks also include actual programs, specify programming interfaces, or offer programming tools for using the frameworks.

– A framework may be for a set of functions within a system and how they interrelate; the layers of an operating system; the layers of an application subsystem; how communication should be standardized at some level of a network; and so forth.

RI-EAF Information Architecture

ApplicationView Point

EnterpriseInformationView Point

Information Concept(from Information Architecture)

Code System(from Information Architecture)

Actor(Organization, Person, Location)

Motivation(Mission, Objective, Measure)

Activity(Function, Process, Project)

Information System(from Application Architecture)

Business Architecture

TechnologyView Point

ApplicationEnterpriseView Point

Actor(from Business Architecture)

Activity(from Business Architecture)

Information System(Application, Service, Module)

System Relationship(Data Exchange,

Component / Service, Successor)

Data Access(CRUD, Send, Receive)

Hardware Device(from Technical Architecture)

Data Structure (from Information Architecture)

Application Architecture

TechnologyView Point

InformationEnterpriseView Point

Actor(from Business Architecture)

Motivation(from Business Architecture)

Information Concept(Conceptual Domain, Concept,

Semantic Relationship)

Data Structure(Database, Interface,

Data Item)

Code System(Value Concept, Coded Term,

Value Set)

Hardware Device(from Technical Architecture)

Information System(from Application Architecture)

Information ArchitectureApplication View Point

TechnologyInformationView Point

Data Structure(from Information Architecture)

Hardware Device(Server, User Interface,

Storage Device)

System Software(Operating System, Network Software,

Communication Protocol)

Software Tool(Programming Language,

Database Management System,Application Development

Environment)

Information System(from Application Architecture)

Technical Architecture

TechnologyView Point

InformationEnterpriseView Point

Actor(from Business Architecture)

Motivation(from Business Architecture)

Information Concept(Conceptual Domain, Concept,

Semantic Relationship)

Data Structure(Database, Interface,

Data Item)

Code System(Value Concept, Coded Term,

Value Set)

Hardware Device(from Technical Architecture)

Information System(from Application Architecture)

Information Architecture

RI-CDE Information Model

Diagnosis Use Case

Diagnosis Use Case

• What activities create or consume diagnosis data?• What business actors participate in activities that involve

the use of diagnosis data?• What workflows include activities that involve the use of

diagnosis data?• What information systems enable workflows that involve

the use of diagnosis data?• What data structures used by information systems include

data elements that implement diagnosis information?• What code system terms are used to encode diagnosis data

in data structure data elements?

Diagnosis Related Workflows New Patient Services (NPS)

conducts preliminary review and patient is screened via existing

workflow processes.

Patient Presents to COH:

Preliminary ‘diagnosis’ (disease site) is captured in CIS NEW

PATIENT SERVICES PROFILE(formerly in SRM Face Sheet)

Patient is seen by COH Physician. IF patient has a

surgical procedure then synoptic data is available and in the

COPATH system

Review Billing Data in Data Warehouse (DW) as a Validation

Cross-Check

Utilize ‘diagnosis complaint / admit reason’ field within SRM Face

Sheet Module of CIS

Actors:• Blue = New Patient Services (NPS)• Orange = Dept of Information Sciences (DIS)• Green = Dept of Pathology • Red = Finance Dept

Workflows and Activities:• New Patient Screening• Patient Registration• Diagnostic Procedures and Test• Treatment Procedures and Outcomes• Patient Services Billing

Information Systems and Data Stores• New Patient Services• Allscripts EMR• CoPath Pathology System• Enterprise Data Warehouse

Free Text

Example of SRM Face Sheet

MEDRECNO 155547

Example of New Patient Services (NPS) Profile and Patient Issues Table of EDW (Based on ICD-9 Codes)

Free Text

Additional Use Case: Utilizing Cancer Registry Data to Collect National Quality Foundation (NQF) Metrics

Current Measures Breast Cancer

Chemo considered / administered within 4 months of dxfor women < 70 yrs Stage II / III HR (-) breast cancer

Tamoxifen considered / administered within 1 year of dx for women with Stage II / III HR (+) breast cancer

Colon Cancer Adjuvant chemo considered / administered within 4 months

of dx for patients < 80 yrs with Stage III (lymph node +) colon cancer

Future Measures Prostate Cancer

Avoidance of overuse bone scans for staging low-risk patients

Adjuvant hormonal therapy for high-risk patients

Current State Analysis Observations• Undocumented inter-departmental data dependencies• Duplicate data entry and redundant data stores• Proliferation of terminology homonyms, synonyms, and

conflation• A mixture of discrete structured data, unstructured text, and

scan image data• Inconsistent encoding of structured data• Timeliness of structured data encoding is driven by financial

interest and not clinical or research needs• Semantically consistent data analysis and performance

measurement is complex, time consuming, and error prone

Proposed Diagnosis Workflow New Patient Services (NPS)

conducts preliminary review and patient is screened via existing

workflow processes.

Patient Presents to COH:

Preliminary ‘diagnosis’ (disease site) is captured in CIS NEW

PATIENT SERVICES PROFILE(formerly in SRM Face Sheet)

DIS verified that backend data access to the CIS NEW PATIENT SERVICES PROFILE (Registration Screen) is available through EDW (to identify breast & colorectal patients initially, for quality metrics)

Patient is seen by COH Physician. IF patient has a

surgical procedure then synoptic data is available and in the

COPATH system

Reviewing COPATH Outside Slides/Outside Consults to identify Breast & Colorectal Pts.

Review Billing Data in Data Warehouse (DW) as a Validation

Cross-Check

Utilize ‘diagnosis complaint / admit reason’ field within SRM Face

Sheet Module of CISDIS newly developed ‘Patient List Analytic Report’ utilizing the ‘diagnosis complaint / admit reason’ field merged with COPATH Synoptic data to identify new Breast & Colorectal patients with a surgical procedure completed at COH

Legend:Blue = New Patient Services (NPS)Orange = Dept of Information Sciences (DIS)Green = Dept of Pathology Solid Line = Current ProcessRed = Finance Dept Dotted Line = Newly Proposed Process

Additional Resources• TOGAF: http://www.opengroup.org/togaf/

• HL7 SAIF: http://wiki.hl7.org/index.php?title=Product_SAIF

• HL7 CTS II: http://wiki.hl7.org/index.php?title=Common_Terminology_Services_-_Release_2_(Normative)

• ISO 11179-3: http://www.cc.gatech.edu/projects/curator/oldsite/docs/ISO_IEC_11179-3.pdf

• NCI EVS: http://evs.nci.nih.gov/

• NCI caDSR: https://wiki.nci.nih.gov/display/caDSR/caDSR+Wiki

• BRIDG Domain Analysis Model: http://www.cdisc.org/bridg

• NLM UMLS: http://www.nlm.nih.gov/research/umls/

• NCI Meta-thesaurus: http://ncim.nci.nih.gov/ncimbrowser/

Thank You

Abdul-Malik ShakirDirector, Research Informatics Information Architecture

City of Hope1500 East Duarte RoadDuarte, CA 91010-3000

Office: (626) 256-4673 Mobile: (626) 644-4491Email: [email protected]

AbdulMalik ShakirPresident and Chief Informatics Scientist

Hi3 Solutions 3500 West Olive Ave, Suite # 300, Burbank, CA 91505

Skype: +1 909.833.4661 Mobile: (626) 644-4491 Email: [email protected]

Closing Thought