Architecture for Research Computing in Health (ARCH) Using i2b2 to Find Patient Cohorts of Interest

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1 Architecture fr Research Cmputing in Health (ARCH) Using i2b2 t Find Patient Chrts f Interest T access i2b2, please visit and lgin with yur CWID and passwrd. T request access, please cntact i2b2-supprt@med.crnell.edu. What data are available in i2b2? As f April 2015, investigatrs can query de-identified data frm Epic, the utpatient EHR f the Weill Crnell Physician Organizatin, fr 2.6 millin unique patients. Available data frm Epic include: Demgraphics Age (as f tday; aka last date f data laded int i2b2) Age (at time f encunter) Ethnicity Language Marital Status Religin Sex State Vitals Status Encunters: 36 millin recrds Recrded in Epic as individual clinic lcatins Displayed in i2b2 using flders and subflders based n academic departments and divisins Diagnses: 22 millin recrds Recrded in Epic as encunter diagnses using ICD-9 cdes Displayed in i2b2 using flders and subflders based n the ICD-9 hierarchy Prcedures: 96 millins recrds Recrded in Epic as rders using Current Prcedural Terminlgy (CPT) Displayed in i2b2 using flders and subflders based n the CPT hierarchy What future data will be available t i2b2? Epic data Medicatins summer 2015 Labs summer 2015 Scial Histry 1

2 Family Histry Other surces Bispecimen inventry Tumr Registry Additinal items frm Allscripts (aka Eclipsys), Epic, and ther systems by request; please cntact with requests Hw d I create a query? 1. T ptimize query run times, keep query elements as specific as pssible by dragging Flders and Cncepts frm Cntainers int query grups. Cntainers: the highest level f hierarchy Demgraphics, Diagnses, Encunters, and Prcedures that cntain flders & cncepts and are expandable Flders: cntains cncepts (can cntain ther flders) and are expandable (e.g. Malignant neplasms, Malignant neplasms f digestive rgans) Cncept: the lwest level f hierarchy and is nt expandable (e.g. Cancer f jejunum) Drag flder and cncept items int query grups D NOT drag cntainer items (dented by a gray bar) int query grups GOOD QUERY D query flder 153: Malignant neplasm f cln and cncept Cancer f jejunum BAD QUERY D NOT query cntainers Demgraphics, Diagnses, Encunters, Prcedures : 2

3 2. There are tw ways t search fr terms: a. NAVIGATE TERMS (manual search) Fr example, if yu wish t query patient ppulatins having lip cancer start by expanding the Diagnses cntainer t view the : Malignant neplasm f lip, ral cavity, and pharynx flder, in rder t narrw dwn the diagnsis selectin t the 140: Malignant neplasm f lip flder: b. FIND TERMS (keywrd search) Frm the example abve search using the ICD-9 diagnsis cde f interest: 3. If a query times ut when query elements are specified in a certain rder, try rerganizing the grups and re-running the query. 3

4 4. T ptimize query run times, place the query element that wuld lgically return the fewest number f patients in Grup 1. Ex: Hw many female patients had a diagnsis f cln cancer? Query elements: Grup 1à Fewest patient cunt = cln cancer Grup 2à Highest patient cunt = female GOOD QUERY Cmpute Time: 1.5 sec BAD QUERY Cmpute time: 15.2 sec 4

5 Hw des i2b2 stre data and prtect patient privacy? i2b2 cntains data that has been de-identified in accrdance with the HIPAA Privacy Rule s Safe Harbr definitin ( The fllwing eighteen patient identifiers are NOT available in i2b2: Names All gegraphic subdivisins smaller than a state, including street address, city, cunty, precinct, ZIP cde and their equivalent gecdes, except fr the initial three digits f a ZIP cde if, accrding t the current publicly available data frm the Bureau f the Census, (1) the gegraphic unit frmed by cmbining all ZIP cdes with the same three initial digits cntains mre than 20,000 peple, and (2) the initial three digits f a ZIP cde fr all such gegraphic units cntaining 20,000 r fewer peple are changed t 000 All elements f dates (except year) fr dates directly related t an individual, including birth date, admissin date, discharge date and date f death; and all ages ver 89 and all elements f dates (including year) indicative f such age, except that such ages and elements may be aggregated int a single categry f age 90 r lder Telephne numbers Fax numbers addresses Scial Security numbers Medical recrd numbers Health plan beneficiary numbers Accunt numbers Certificate/license numbers Vehicle identifiers and serial numbers, including license plate numbers Device identifiers and serial numbers Web Universal Resurce Lcatrs (URLs) Internet Prtcl (IP) addresses Bimetric identifiers, including finger and vice prints Full-face phtgraphic images and any cmparable images Any ther unique identifying number, characteristic r cde One f the varius ways i2b2 uphlds regulatry standards f PHI is thrugh the use f date shifting. All patient recrds in i2b2 have been randmly date shifted backwards by 1 t 364 days. The exact number days shifted varies frm patient t patient; hwever, the number f days shifted remains cnsistent per patient. As a result, date shifting in i2b2 preserves the sequence f care events (i.e. a prcedure ccurred fllwing a diagnsis) but hinders the ability t identify seasnal trends (i.e. influenza diagnsis in Nvember 2014). 5

6 Why d I receive a slightly different cunt as a result f running the same query? A randm number is intentinally added r subtracted t bfuscate the results, especially fr diagnses r prcedures with dates. This bfuscatin is necessary t ensure patient privacy. Hw many years f data are included in the i2b2 data repsitry? i2b2 cntains all Epic data that has been cllected and stred by WCMC clinical practices since The years f data will vary by clinical practice, depending n the start date f Epic implementatin. Currently i2b2 data is up-t-date with all available Epic data thrugh 12/31/2014. By summer f 2015, Epic data will be refreshed mnthly. Hw reliable is the data in the i2b2 data repsitry? The quality f data in i2b2 is dependent n the data quality f data entered int Epic by a clinical practice. Practices that frequently, cnsistently, and accurately enter data in Epic acrss time will have greater data quality available in i2b2. After perfrming a de-identified query, can an investigatr btain identified data? Yes, identified and prvider-specific data is available t investigatrs wh have IRB apprval. Please share apprved IRB dcumentatin describing the items f interest frm i2b2 with i2b2-supprt@med.crnell.edu t btain identified data. T learn mre abut ARCH, please visit If yu have any questins, please cntact i2b2-supprt@med.crnell.edu 6

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