4-page Case Study - Posted 4/12/2012
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Paradigm Shift of Clinical Research, Accelerates the deployment with Clinical DW
Ajou University Medical Center is an educational, research and medical institution. IT upgraded its IT environment to a next-generation environment in 2007. While developing and deploying OCS, PACS and EMR, IT became interested in utilizing BI
technology to support clinical research. Its medical staffs requested for faster and more convenient ways to utilize and analyze data collect for research. As such, IT decided to deploy Clinical Data Warehouse (CDW) and began system deployment starting with
standardization of forms and terms and after formalizing many items, it created a system enabling easy usage of statistics and analysis. With the completion of CDW, Ajou University Medical Center internally enabled more effective and fast support of treatment
and research utilizing clinical medical information, while externally widely expanding doors of research exchange with other institutions.
The IT environment of Ajou University Medical Center is becoming state of the art. Ajou University Medical Center has been deploying next generation system in 3 stages. In 2007, it began the 1st stage by developing a general medical information system called
SMART(Strategic Medical Automation and infoRmation Techno-logy). SMART system was comprehensively implemented covering overall hospital tasks including OCS(Order Communication System), which includes treatment, treatment support and administrative tasks and
PACS(Picture Archiving Communication System).
In the 2nd stage, Ajou University Medical Center promoted development of CDW(Clinical Data Warehouse) system for supporting EMR(Electronic Medical Record), electronic medical card and clinical research. Ajou University Medical Center, which successfully
completed the 2nd stage in early 2011, plans to promote the 3rd stage aimed with CRM for customer specific management and strategic business management system.
Among the informatization business promoted so far, there is one system that is gaining interest amongst the staffs of the medical service industry. It is CDW. This system is not just for simple analytic tasks. It is founded on realizing EBM(Evidence based
medicine) one of the mega-trends witnessed in the medical service industry.
Evidence-based medicine is a clinical research and treatment related approach method based on sufficient scientific experiments and verifications. In detail, it is a series of process – approaching patients in clinical trials, accurately recognizing necessary
information for treating these patients, effectively reviewing related information, and assessing the value of information and evaluating the results after applying the information to patients.
From the perspective of medical information system, evidence-based medicine refers to extracting and analyzing data store in OCS, PACS and EMR through various conditions and aspects. It also means that all medical information stored in all systems can be
viewed and utilized from the perspective of BI(Business Intelligence). As such, CDW, as the center of evidence-based medicine, transforms clinical activities and experiences of the medical staffs into data. Thus, deployment of CDW is a high priority challenge
in many medical institutions.
So, why is Ajou University Medical Center’s CDW receiving interest in the medical service industry? This is because Ajou University Medical Center successfully developed comprehensive system with thorough readiness. Ajou University Medical Center, Medical
Information System, Manager, Myoung-Ryoul Hong said, “CDW is not the kind of system that can be developed when necessary. Standardization of forms and terms should be promoted first, before deploying OCS and EMR. If CDW is deployed without these preparations
then, many areas of the medical information system will need revisions. In our case, we considered CDW from the 1st stage of the project, so we were able to reduce trial and errors.”
Ajou University Medical Center’s CDW is part of its 2nd stage but it started in the 1st stage. Hong said, “When we were planning the 1st stage, we received requests from our medical staff to configure a system that will enable them to utilize medical related
information in clinical research. So when the 2nd project began about 1 year ago, we promoted tasks to standardization of forms and terms.”
In the case of the OCS and PACS developed in the 1ststage, they contained standardized data so there was little for concern about data standardization. However, standardization played a pivotal role to process data in terms of BI because descriptive information
is recorded in EMR. The idea configured by the Ajou University Medical Center consisted of standardizing forms and standardizing terms used in various documents to create standardized data that used to be inputted manually in the past.
In order to set the standard about forms and terms, consultations with several concerned parties were necessary. As such, Ajou University Medical Center formed a preparatory committee consisting of related medical specialists, medical doctors, clinical engineers,
medical record administrators and administrative staffs.
Ajou University Medical Center formed an EMR forms standardization committee, terms standardization committee and medical equipment technology committee for CDW related activities and enabled them to seamlessly cooperate with each other. Through the activities
of these committees, Ajou University Medical Center was able to convert various forms into electronic documents. With these documents, users can select standard terms or example sentences to replace existing manual recording and the contents of the documents
will be stored in EMR as standardized information.
In the case of terms, Ajou University Medical Center referred to ICD 10(International Classification of Diseases, a code system for classification of diseases and symptoms established by WHO(World Health Organization’ as well as KCD4(Korean Standard Classification
of Diseases•Cause of Death) and NANDA(Nursing Diagnosis, Nursing Interventions Classification) to set standards. Hong said, “We promoted terms standardization taking into account both Korean and international exchanges and we also enabled mutual connection
reference with ICD 10, KCD4and SNOMED-CT. This is to enable code exchange when we have to exchange materials for research cooperation with outside medical institutions.” On the other hand, Ajou University Medical Center endeavored to enhance quality of treatment
by applying evaluation of treatment quality, Clinical Indicators for management and standard treatment guide(Clinical Pathway) based on the activities of the committees.
After completing deployment of EMR system based on standardization of forms and terms, Ajou University Medical Center aggressively began deploying CDW. In deploying CDW, Ajou University Medical Center focused on selecting BI platform to rapidly, reliably
and economically process large volume of data. Since Ajou University Medical Center’s CDW had to store 15 years of clinical information, it should be massive volume. Initially, it was expected to store about 4TBs of data in CDW but it chose a total of 7TBs
taking into consideration future expansion.
It chose SQL Server 2008 R2 as the platform of CDW taking into account data amount, transaction and economic feasibility. Hong said, “We confirmed cases of SQL Server usage to handle mass amount of data in several medical institutions and we became convinced
of its performance and reliability. Compared to Oracle, SQL Server had a decided advantage with better economics and the fact that major systems including OCS and EMR are developed in the .Net environment.”
On the other hand, Ajou Medical Center developed its DCW with client/server configuration considering the speed of data processing and the characteristics of medical data, which required high level of security. Although the basic configuration of the DCW
is client/server, Ajou University Medical Center can flexibly convert to the Web in the future to actively respond to changes in future demands.
Easy collection and analysis of clinical data
Ajou University Medical Center considers easy utilization of data accumulated from clinical trials in research as the first effect of CDW deployment. In the past, it had to respond individually to demands of medical staffs, however now work efficiency has
increased significantly for both the requesting party and responding party.
Hong said, “We received various demands from our medical staff including analyzing 10years of data and in the past we had to develop individual programs to provide support for requests of statistic materials. Simple tasks used to take 1~2 days while complicated
tasks would sometimes take several months. The longest time consuming task was extracting clinical data of specific category from about 10 years of data and analyzing them and it took us about 2months to respond to additional demands for data manipulation.
But now the user can immediately view desired data directly on DCW.”
Of course development tasks are not eliminated completely. There are some instances that require development tasks but this also is not as ineffective as in the past. Hong added, “For most statistics, users can use CDW and check directly, but for complicated
analysis conditions, developers would provide support for writing the programs and add them in CDW menu for future reuse when receiving similar requests. “
Reliably process 4TB of clinical data
There are many significant advantages from choosing SQL Server in developing CDW. Ajou University Medical Center’s Information Management Team provides high performance and high quality service thanks to SQL Server.
Hong said, “We operate about 4TB of data in our CDW and execute batch processing with extracting and migrating newㆍrevised data on a daily basis from backbone systems including OCS and EMR. We were able to acquire the performance necessary for processing
these huge amounts of data and transactions with SQL Server.”
Utilize creative clinical data
Usage of clinical related data increased due to CDW and Ajou University Medical Center began to see results it did not expect initially. Its medical staffs used CDW, a strong information system basis and brought forth various usage scenarios related to clinical
research. In June 2011, Spring Academic Convention of The Korean Society of Health Information and Health Statistics, Dr. Rae-Woong, Park, Professor of Medical Information Department, Ajou University Medical Center received Excellence Research Award. Dr. Park’s
team received great evaluations for developing an algorithm to discover clue of medicine side effects by extracting anonymous information from EMR and CDW data as well as developing a system using this algorithm.
Seamless connection and integration with clinical information of outside institutions
Clinical research cooperation with inside/outside institutions is one of the unique competitive edges of Ajou University Medical Center. And it is important in terms of CDW. Ajou University Medical Center was selected as an main provider for inside/outside
cooperative tasks for clinical research about new task of health-medical development by the Ministry of Health and Welfare in early 2012. As a challenge supervising institution, Ajou University Medical Center is in charge of developing a system for integratingㆍanalyzing
clinical medical information of multiple institutions based on high-speed parallel processing anonymizing technology together with the Catholic University of Korea, Seoul St. Mary’s Hospital, Gachon University Gil Hospital and KAIST.
Hong said, “This challenge includes setting common contents in CDW of each medical institutions and promoting standardization tasks to deploy anonymous integrated CDW and enabling joint utilization of clinical medical information between all participating
institutions. Ajou University Medical Center was selected as the main provider of this project and our well-established CDW system played a major role in the decision.”.
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