Dr. Lydia L. is an academic clinician in one of the large clinical research departments in the UW School of Medicine & Public Health. In the course of her work, a clinical observation combined with an extensive literature review led her to formulate a new research question in her field of specialization, treatment of chronic diabetes. Dr. Lydia has formulated a hypothesis, selected primary and secondary outcomes, and consulted with a biostatistician to do a power calculation based on predicted effect sizes. She needs to enroll and consent 47 patients for her pilot study, but much of the data she needs is locked up in the UW Health Enterprise Data Warehouse (EDW) as part of protected patient records in the HealthLink (Epic) electronic health record (EHR). What are the next steps available to Dr. Lydia to access the information she needs?
This is the first in a series of communications to introduce biomedical informatics, and the tools and services available to UW investigators through the ICTR Biomedical Informatics (BMI) group.
The American Medical Informatics Association [AMIA] defines biomedical informatics as, “the interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving and decision making, motivated by efforts to improve human health.” Biomedical informatics most often involves three areas: 1) Accessing clinical data in the electronic health record for secondary research uses via a data query; 2) Managing genomic data or other very large or complex data sets; and 3) Applying informatics methods to improve healthcare delivery via clinical decision support, enhanced access to images, or improving work systems.
Dr. Lydia’s story begins, as many do, with the question of how to access clinical data specifically needed to answer her research question. The BMI team can facilitate that process by helping her develop an appropriate query to the EDW. In informatics, a query is a computational request that returns an answer or value; in other words, a very precisely written request intended to return information relevant to the research question. In the case of Dr. Lydia, her query might include reference to various ICD-9 codes for diabetes; laboratory assays for fasting blood sugar and A1C levels; and/or specific pathological findings of peripheral vascular disease & nephropathy.
Importantly, a well-developed query will yield accurate and conclusive data, while a poorly designed query will not. Umberto Tachinardi, ICTR BMI director, notes,
For many researchers, the greatest challenge to effectively utilizing EHR data is developing a computable research question. Appropriate query development is a central service our team provides to investigators. Ideally, query development will follow the formation of a research hypothesis. Consultation with our ICTR BMI team can reduce instances of poor query development which can lead to disappointing data.
Join us as we follow Dr. Lydia as she uses BMI services at multiple steps in her research project:
- Preparatory to Research Activities
- Subject Recruitment & Enrollment
- Data Acquisition
- Data Computing & Storage Services.