The AMDIS Connection | Please Dont Call It a Warehouse
Clinical data repositories have been around a long time, at least 20 years in one form or another. I had the opportunity to participate in an experiment, of sorts, with a CDR used as an ambulatory EHR. We were asked to do a very simple test: To see legacy system scheduling for outpatient care at the University of Michigan, and allow that to be viewed side by side with a new system. We used a web-based app, and a SQL database to store information.
As people saw the web front end—built in Java and nicely done from a style standpoint—they asked, couldn't you add x-ray reports? In a repository, the answer was yes; it wasn't much of a problem to add another source. Not long after that, someone asked about adding lab results. Thus it began to grow, and within about a year and a half, it became CareWeb. Only now, a decade after its creation, is it finally being replaced by a commercial system. For all those years, it was a mainstay of the medical center's ambulatory care process. It was the only source of complete information on outpatients, which is the largest volume of patients seen.
Today, a clinical data repository is something that is usually added on at the end of the implementation of a commercial EHR. However, we're encouraging the next generation of CMIOs to seek the introduction of a CDR much earlier in the rollout of an EHR. This is ideal because of that ability to take data and re-present them in ways that are most useful for clinicians.
We are in an era of rapid deployment of clinical information systems, but at the same time, we are still besieged by the problems of usability. Although an interface or a workflow might make good logical sense within the construct of a commercial product's development, all too often that "vision" for the product doesn't translate well clinical practice.
Here is where the clinical data repository can be incredibly powerful in the introduction of healthcare IT. People want to see trended, graphed, displayed and aggregated information from many different sources on one screen. Information that's packaged as usable, quick snapshots can facilitate outpatient care, which as we all know has become very time-intensive. A CDR is a major weapon that really needs to be in the arsenal of the CMIO in order to answer the questions and problems of repurposing data that are collected by means of more standardized input environments—your EHR, for example.
The main message here is that the clinical data repository should be considered by the CMIO as an all-in-one tool; one that can address data concerns or deliver customized views, such as oncology, where a longitudinal record is vital to caring for the patient. That is fairly easily done with CDR information presented in a web-based layer.
As people saw the web front end—built in Java and nicely done from a style standpoint—they asked, couldn't you add x-ray reports? In a repository, the answer was yes; it wasn't much of a problem to add another source. Not long after that, someone asked about adding lab results. Thus it began to grow, and within about a year and a half, it became CareWeb. Only now, a decade after its creation, is it finally being replaced by a commercial system. For all those years, it was a mainstay of the medical center's ambulatory care process. It was the only source of complete information on outpatients, which is the largest volume of patients seen.
Today, a clinical data repository is something that is usually added on at the end of the implementation of a commercial EHR. However, we're encouraging the next generation of CMIOs to seek the introduction of a CDR much earlier in the rollout of an EHR. This is ideal because of that ability to take data and re-present them in ways that are most useful for clinicians.
We are in an era of rapid deployment of clinical information systems, but at the same time, we are still besieged by the problems of usability. Although an interface or a workflow might make good logical sense within the construct of a commercial product's development, all too often that "vision" for the product doesn't translate well clinical practice.
Here is where the clinical data repository can be incredibly powerful in the introduction of healthcare IT. People want to see trended, graphed, displayed and aggregated information from many different sources on one screen. Information that's packaged as usable, quick snapshots can facilitate outpatient care, which as we all know has become very time-intensive. A CDR is a major weapon that really needs to be in the arsenal of the CMIO in order to answer the questions and problems of repurposing data that are collected by means of more standardized input environments—your EHR, for example.
The main message here is that the clinical data repository should be considered by the CMIO as an all-in-one tool; one that can address data concerns or deliver customized views, such as oncology, where a longitudinal record is vital to caring for the patient. That is fairly easily done with CDR information presented in a web-based layer.