By George Spain
Information Services

Six years ago the Information Technology Strategic Plan called the Electronic Medical Record (EMR) the "Holy Grail." Now, the Enterprise Data Warehouse (EDW) represents MUSC's massive excavation effort in the search for that treasure.

The search for the EMR began back in the 1960s when the Mayo Clinic tried to develop such a system. During the 1970s and 1980s, several electronic medical record systems were developed. Duke Medical Center's 'The Medical Record' is an example of early in-patient care systems. However, translating electronic bits and bytes into useful, universally translatable health care information has consumed decades of research and millions of dollars.

About three years ago, MUSC assembled a team of data miners and gave them the job of both finding the grail and also uncovering the Rosetta Stone that would translate the bits and bytes of its history into information that would help health care professionals do a better job of their mission to teach, heal and discover. In order to do this, all they had to do was "change what's possible."

The group's initial project is the Clinical Data Warehouse (CDW) for Research (see related story below).

"The CDW is a great example of 'innovation through collaboration' that involved joint efforts and synergy among multiple groups across MUSC and MUHA that will have a broad impact on all aspects of our mission in research, education and clinical care in ways that we can only begin to imagine," said Associate Provost for Research Stephen M. Lanier, Ph.D.

The broad support provided through the MUHA team was critical to the success of this project, and it is a great example of synergy among different groups that will be making a difference in the lives of individuals for years to come, he said.

Jihad Obeid, M.D., SmartState Endowed Chair in Clinical Biomedical Informatics, who served as principal investigator on the Institutional Review Board approved CDW proposal, said the project puts MUSC on par with others in the prestigious group of Clinical and Translational Science Awards (CTSA) funded institutions around the country such as Harvard, Duke and Vanderbilt that provide similar services for their researchers.

The hospital's Enterprise Data Analytics analyst Pat Wagstaff, R.N., noted it wasn't an easy task.

"Before data could be released for use by researchers, we had to verify its accuracy by performing manual chart audits as well as comparisons to past CMS and Joint Commission data submissions. We have spent almost 16 months proving out the validity of the data," he said.

Jeff Burdick, who along with co-OCIO analyst Crystal Smith developed the self-service user interface, added, "At the same time, we have relied on interested researchers to come up with a simple framework that allows self-service answers to initial queries within established privacy and security guidelines."

Jean Craig, Ph.D., from the Office of Biomedical Informatics, sums up the accomplishment this way, "The advantage is that researchers have the opportunity to obtain aggregate counts very quickly, whenever they choose, through a simple interface. Consequently, knowing the data needs will improve the process for getting IRB approval followed by access to data or access to a patient population for clinical trials."

Loretta Lynch-Reichert, operations manager for the Associate Provost for Research (APR), said it was an impressive collaborative effort that made this data available to the MUSC community. APR chaired the research working group for the project, the Office of the CIO built it, the hospital, the university, and ARRA stimulus funding paid for it, and SCTR, through the CTSA National Institutes of Health (grant UL1 RR029882), administers the query request system for the research community.

Many labored in the dig for the EMR's Rosetta stone that would turn digital signals into practical information easily accessible to health care professionals, while still carefully guarding the privacy and confidentiality of patients — program manager: Dan Furlong; OCIO Information Services: Frank C. Clark, Ph.D.; Dan Furlong; Jeff Burdick; Crystal Smith; Larry Gale; Mike Coffman; Mitchelle Morrison. Enterprise Analytics Team & Hospital Administration: Casey Liddy; Nestor Esnaola, M.D.; Pat Wagstaff, R.N.; Amy Wilson, Ph.D.; Stuart Smith; Patrick Cawley, M.D. Office of the Associate Provost for Research: Stephen M. Lanier, Ph.D.; Loretta Lynch-Reichert. SCTR:
Jihad Obeid, M.D.; Jean Craig, Ph.D.; Amanda Zimmerman.

Clinical Data Warehouse promises researchers fast access to information

It once took weeks. It was a labor-intensive chore for information techies and a source of frustration for researchers, but the information was vital to any hope of getting funding for advanced clinical research. That was then.

This is now. The Clinical Data Warehouse (CDW) for researchers is one component (known as a data mart) of the larger Enterprise Data Warehouse (EDW) that will eventually contain patient, financial, human resources, student, and payroll data in a single, easily accessible database that can be used by researchers, risk managers, outcomes managers, financial analysts, business managers, deans and others with the goal of better diagnosis, treatment, follow-up and patient safety.

Dr. Jean Craig, SCTR, explains the CDW query system to Dr. Patrick Flume.

For now, the focus is on the CDW for research and the speed — lots of it — that it brings to the process. Using the in-house developed website, researchers initiate inquiries to see if MUSC's data repositories contain enough of criteria-specific population to initiate further study.

"Literally, what took weeks and on occasion, months, now takes seconds or minutes," said Dan Furlong, CDW program manager for the past three years. "In the past, you handed a written request to IT data managers, who would then glean through their databases to pull the relevant information. The process took some time because there was no easy way toquery the database and the results had to be continuously refined to get the 'clean' data necessary to adhere to the rules of scientific investigation. It was very labor intensive."

Now, using the web-based tools that begin at https://sctr.musc.edu/index.php/cdw, any full-time MUSC faculty (or sponsored MUSC employee) can initiate a Stage 1 inquiry to determine, in mere seconds, if a sufficient population exists among MUSC patients to support further study.

If results warrant, the researcher can then initiate a Stage 2 investigation. Stage 2 is more tightly controlled and requires further authorization because the information returned may contain patient Protected Health Information (PHI) — a very tightly held privacy right — and must be approved by the Institutional Review Board (IRB). In this stage the researchers perform retrospective research studies or chart reviews, identify patients who may qualify for specific research studies or clinical trials, identify patterns of diseases, treatments and outcomes.

For example, a researcher might want to ascertain the number of female minority cancer patients, between the ages of 25 and 50, who were treated at MUSC between 2005 and 2011. If a sufficient number exists, the researcher could then move on to Stage 2 to acquire additional information on the patient's diagnosis (type of cancer), treatment (medications and procedures) and perhaps even subsequent visits to MUSC.

As exciting and beneficial as the CDW is for researchers, Frank C. Clark, Ph.D., chief information officer, was quick to point out that it is just the beginning of the vision OCIO has for the whole Enterprise Data Warehouse project.

"Right now CDW is a promising subset of the full EDW. It's important to note that the CDW is not used for delivering patient care, but for research purposes. It represents an easy way to access the information in the Oacis data repository. Our plans are to eventually include and integrate patient information from other, large data resources such as Colleague and Smartstream and others. When we get where we want to be, the EDW will be that 'single source of truth' valuable not only to researchers, but also in diagnosis, treatment, patient outcomes, and above all, patient safety," said Clark.