The Biomedical Translational Research Information System (BTRIS) James J. Cimino Chief, Laboratory for Informatics Development National Institutes of Health Clinical Center Senior Scientist, Lister Hill Center for Biomedical Communications National Library of Medicine NLM Informatics Training Conference July 9, 2008
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The Biomedical Translational Research Information System (BTRIS) James J. Cimino Chief, Laboratory for Informatics Development National Institutes of Health.
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The Biomedical Translational Research Information System (BTRIS)
James J. CiminoChief, Laboratory for Informatics Development
National Institutes of Health Clinical Center
Senior Scientist, Lister Hill Center for Biomedical CommunicationsNational Library of Medicine
NLM Informatics Training ConferenceJuly 9, 2008
The Clinical Center, 1981
What Problem are We Trying to Solve?
• Patients in the NIH Clinical Center are on research protocols, but…
• …their data are in a clinical information system
• Need to extract individual data for analysis
• Need to do cross-patient queries for additional analysis
Patient Information Graphics System (PIGS)
• Integration of a desktop computer (pre-PC) to mainframe clinical information system (TDS)
• Download vital sign and drug administration data
• Various graphical displays
• SCAMC, 1981
The Columbia University Medical Center Clinical Data Warehouse
• Clinical data repository to collect data from ancillary systems
• Coded with the Medical Entities Dictionary
• Back end for clinical information systems
• Reorganized for use as Clinical Data Warehouse
How often are patient with the diagnosis of myocardial infarction started on beta blockers?
2003 2004 2005 2006 2007
MI
MI+Beta
Find all patients with Diagnosis in class MYOCARDIAL INFARCTION AND with Medication in class BETA BLOCKER
How often are patient with the diagnosis of myocardial infarction started on beta blockers?
Find all patients with Diagnosis in class MYOCARDIAL INFARCTION
The Clinical Center, 2008
The Clinical Center, 2008• Patient data stored in EHR (Eclipsys)
• Need to extract individual data for analysis
• Need to do cross-patient queries for additional analysis
• Data may require transformation:– De-identification and Re-identification– Indexing– Aggregation by time– Abstraction by classification– Conversion to relevant concepts
What is BTRIS?• Biomedical data
– Research data collected using clinical information systems
– Clinical data collected using clinical information systems
– Research data from research information systems
– Non-human data
• Reuse of data to support translational research
• Hence: Biomedical Translational Research Information System
The NIH, 2008
What is BTRIS?
BTRIS
What is BTRIS?
BTRIS
O n t o l o g y
Data Acquisition ProcessesCoding Indexing De-Identifying Permission Setting
BTRIS
What is BTRIS?
Data Repository
Data Retrieval FunctionsAuthorization Subject-Oriented Cross-Subject Re-Identification NLP
Data Analysis ToolsSubject Recruitment Hypothesis Generation Hypothesis Testing
Queries from Requirements-Gathering• Provide Medication lists at time of patient
encounters. Include drug diaries for inpatient, outpatient and in-between encounters in the patient medical record. Include all chemo and non-chemo drugs from CRIS and IC systems
• Provide Medication administration documentation (drug diaries) with times as part of patient record
• Provide ability to compare patient results, Medication Administration Records between dates and/or encounters
• Provide drug randomization info, compliance records and drug accountability info for all investigational, study and prescription drugs
• Provide all Clinical Center lab results with times of specimen draws
• Provide external lab results• Provide archival images• Provide demographics data including age, BMI,
race, gender, contact info, etc • Provide access to genomics and bio-markers data• Provide cumulative blood volumes, research drugs
and radiation for subject over a given period• Provide ability for ICs to feed expanded
diagnosis/problem lists • Provide searching and filtering patients' data by all
• Standardize medication and lab test codes. • Provide integration of adverse events data in the
data warehouse,• Provide integration of protocol census, status and
subject accrual tracking data from Protrak in the data warehouse
• Provide ability to attribute different events to protocols, viz., consent signed, protocol activated, orders, observations, adverse events, etc
• Provide integration of staff, patient and user index data across source systems in data warehouse.
• Provide original informed consent, and updated consents for re-contact of patients for research for all protocols. Provide searchable consents and image of consents in database. Provide answers to:
– Can tissues be used for cancer/genetic research, other research, germ line testing
– Can patient be re-contacted for questions?
• Provide single patient amendments• Provide access and track biological specimen data • Provide access to Appointment Data• Provide “Review of Systems” info for each patient
visit. • Provide patient de-identification services• Standardize Units Of Measure
Ad Hoc Committees
• Principal Investigator User Group– Identify needs– Set priorities– Test-marketing
• Policy Working Group– Patient protection– Principal investigator protection
Demonstration Project – July 2008
• All data on all patients in 29 protocols
• Multiple data sources and types
• Scrambled data, open to all
• Real, identified data open only to PIs
• Class-based and patient-list based queries
• Additional functions as available
BTRIS 1.0 – July 2009
• Real database
• Expanded RED
• Expanded sources, all data on all patients
• Images
• Functions as per PI User Group and community
Source Data from Clinical Systems
BTRIS Data Model
has
has
is a
is acan be
Subject
LivingSubject ID
Lab Test
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Substance Administration
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
MedicationType
Protocol Subject
Protocol ID (FK)Person ID (FK)LivingSubject ID (FK)
Allergy
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Diagnostic Imaging
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Observation
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Provider
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Provider Type
Clinical Document
Protocol ID (FK)Encounter Date (FK)Person ID (FK)LivingSubject ID (FK)
Adverse Event
Protocol ID (FK)
Episode of Care
Visit IDVisit Type
Encounter
Protocol ID (FK)Encounter DatePerson ID (FK)LivingSubject ID (FK)
Visit ID (FK)Visit Type (FK)
Primary Investigator
Protocol ID (FK)Person ID (FK)LivingSubject ID (FK)
Protocol
Protocol ID
Consent
Protocol ID (FK)Person ID (FK)LivingSubject ID (FK)
Contacts
Person ID (FK)LivingSubject ID (FK)
Person
Person IDLivingSubject ID (FK)
Research Entities Dictionary (RED)
MRN BTRIS ID Identifiers
1234 B00001 John….
1447 B00002 Mary….
2347 B00003 Umberto...
BTRIS ID Other Data
B00001 Sodium 132
B00002 Sodium 143
B00003 Sodium 138
BTRIS
Identified Data
MRN Identifiers Other Data
1234 John…. Sodium 132
1447 Mary…. Sodium 143
2347 Umberto... Sodium 138
BTRIS ID Other Data
B00001 Sodium 132
B00002 Sodium 143
B00003 Sodium 138
Deidentified Data
Gender Avg Data
Male Sodium 135
Female Sodium 143
Other Sodium 218
PIsNIH
ResearchersPatient
Recruitment
Non-NIHResearchers
Issues
• Patient ownership of de-identified data
• If genomic data are included, can we truly de-identify?
• Is protocol number a patient identifier?
• What data should not be shown to PIs?
• What is the extent of data control by PIs?
BTRIS Will:
• Be the preferred system to analyze NIH clinical and non-clinical data
• Aggregate and standardize disparate and isolated data sets
• Automate and streamline processes that are traditionally manual and cumbersome
• Prioritize data sources and functionality based on needs of user community
Moving Forward
• Despite centuries of clinical research, data are still fragmented
• Sophisticated terminology is the key to reuse of disparate data
• Policy issues are bigger than technical issues
• Future of BTRIS: today the NIH, tomorrow the world?