Clinical data repository

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A Clinical Data Repository (CDR) or Clinical Data Warehouse (CDW) is a real time database that consolidates data from a variety of clinical sources to present a unified view of a single patient. It is optimized to allow clinicians to retrieve data for a single patient rather than to identify a population of patients with common characteristics or to facilitate the management of a specific clinical department. Typical data types which are often found within a CDR include: clinical laboratory test results, patient demographics, pharmacy information, radiology reports and images, pathology reports, hospital admission, discharge and transfer dates, ICD-9 codes, discharge summaries, and progress notes. [1]


A Clinical Data Repository could be used in the hospital setting to track prescribing trends as well as for the monitoring of infectious diseases. One area CDR's could potentially be used is monitoring the prescribing of antibiotics in hospitals especially as the number of antiobiotic-resistant bacteria is ever increasing. In 1995, a study at the Beth Israel Deaconess Medical Center conducted by the Harvard Medical School used a CDR to monitor vancomycin use and prescribing trends since vancomycin-resistant enterococci is a growing problem. They used the CDR to track the prescribing by linking the individual patient, medication, and the microbiology lab results which were all contained within the CDR. If the microbiology lab result did not support the use of vancomycin, it was suggested to change the medication to something appropriate as under the Center for Disease Control CDC guidelines. The use of CDR's could help monitor infectious diseases in the hospital and the appropriate prescribing based on lab results. [2]

The use of Clinical Data Repositories could provide a wealth of knowledge about patients, their medical conditions, and their outcome. The database could serve as a way to study the relationship and potential patterns between disease progression and management. The term "Medical Data Mining" has been coined for this method of research. Past epidemiological studies may not have had as complete of information as that which is contained in a CDR, which could lead to inconclusive data/results. The use of medical data mining and correlative studies using the CDR could serve as a valuable resource helping the future of healthcare in all facets of medicine. [3] The idea of data mining a CDW was used for screening variables that were associated with diabetes and poor glycemic control. It allowed for novel correlations that may have not been discovered without this method. [4]

One potential use of a clinical data repository would be for clinical trials. This would allow for researchers to have all the information from a study in one place as well as let other researchers benefit from the data to further innovation. They would also be advantageous since they are digital and real-time. This would be easier to log data and keep it accurate since it would be digital rather than in paper form.

The clinical data repository is not without its weaknesses, however. Since they usually don't integrate with other non-clinical sources, following patient treatment across the care continuum becomes very difficult. In turn, tracking the true cost per case for each patient isn't feasible. IT teams spend most of their time gathering and compiling data instead of interpreting information and finding opportunities for cutting costs and improving patient care. [5]

Related Research Articles

Antibiotic Antimicrobial substance active against bacteria

An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention of such infections. They may either kill or inhibit the growth of bacteria. A limited number of antibiotics also possess antiprotozoal activity. Antibiotics are not effective against viruses such as the common cold or influenza; drugs which inhibit viruses are termed antiviral drugs or antivirals rather than antibiotics.

Antimicrobial resistance Ability of a microbe to resist the effects of medication

Antimicrobial resistance occurs when microbes evolve mechanisms that protect them from the effects of antimicrobials. The term antibiotic resistance is a subset of AMR, as it applies to bacteria that become resistant to antibiotics. Resistant microbes are more difficult to treat, requiring higher doses, or alternative medications which may prove more toxic. These approaches may also be more expensive. Microbes resistant to multiple antimicrobials are called multidrug resistant (MDR).

Vancomycin

Vancomycin is an antibiotic medication used to treat a number of bacterial infections. It is recommended intravenously as a treatment for complicated skin infections, bloodstream infections, endocarditis, bone and joint infections, and meningitis caused by methicillin-resistant Staphylococcus aureus. Blood levels may be measured to determine the correct dose. Vancomycin is also recommended by mouth as a treatment for severe Clostridium difficile colitis. When taken by mouth it is very poorly absorbed.

Methicillin-resistant <i>Staphylococcus aureus</i> Bacterium responsible for difficult-to-treat infections in humans

Methicillin-resistant Staphylococcus aureus (MRSA) refers to a group of Gram-positive bacteria that are genetically distinct from other strains of Staphylococcus aureus. MRSA is responsible for several difficult-to-treat infections in humans. MRSA is any strain of S. aureus that has developed or acquired a multiple drug resistance to beta-lactam antibiotics. Beta-lactam (β-lactam) antibiotics are a broad-spectrum group that include some penams and cephems such as the cephalosporins. Strains unable to resist these antibiotics are classified as methicillin-susceptible S. aureus, or MSSA.

Medical prescription Health-care program implemented by a physician

A prescription, often abbreviated ℞ or Rx, is a health care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient. The term often refers to a health care provider's written authorization for a patient to purchase a prescription drug from a pharmacist.

Health informatics Applications of information processing concepts and machinery in medicine

Healthcare informatics or biomedical informatics is the branch of science and engineering that apply informatics fields to medicine. The health domain provides an extremely wide variety of problems that can be tackled using computational techniques.

Linezolid Antibiotic medication

Linezolid is an antibiotic used for the treatment of infections caused by Gram-positive bacteria that are resistant to other antibiotics. Linezolid is active against most Gram-positive bacteria that cause disease, including streptococci, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA). The main uses are infections of the skin and pneumonia although it may be used for a variety of other infections including drug-resistant tuberculosis. It is used either by injection into a vein or by mouth.

A medical error is a preventable adverse effect of care ("iatrogenesis"), whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment. Globally, it is estimated that 142,000 people died in 2013 from adverse effects of medical treatment; this is an increase from 94,000 in 1990. However, a 2016 study of the number of deaths that were a result of medical error in the U.S. placed the yearly death rate in the U.S. alone at 251,454 deaths, which suggests that the 2013 global estimation may not be accurate. In line with the high importance of the research area, a 2019 study identified 12,415 scientific publications related to medical errors, and outlined as frequently researched and impactful themes errors related to drugs/medications, applications related to medicinal information technology, errors related to critical/intensive care units, to children, and mental conditions associated with medical errors.

Vancomycin-resistant <i>Staphylococcus aureus</i>

Vancomycin-resistant Staphylococcus aureus (VRSA) are strains of Staphylococcus aureus that have become resistant to the glycopeptide antibiotic vancomycin.

Colitis Inflammation of the colon (large intestine)

Colitis is an inflammation of the colon. Colitis may be acute and self-limited or long-term. It broadly fits into the category of digestive diseases.

Telehealth Health care by telecommunication

Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Telemedicine is sometimes used as a synonym, or is used in a more limited sense to describe remote clinical services, such as diagnosis and monitoring. When rural settings, lack of transport, a lack of mobility, decreased funding, or a lack of staff restrict access to care, telehealth may bridge the gap. as well as provider distance-learning; meetings, supervision, and presentations between practitioners; online information and health data management and healthcare system integration. Telehealth could include two clinicians discussing a case over video conference; a robotic surgery occurring through remote access; physical therapy done via digital monitoring instruments, live feed and application combinations; tests being forwarded between facilities for interpretation by a higher specialist; home monitoring through continuous sending of patient health data; client to practitioner online conference; or even videophone interpretation during a consult.

Vancomycin-resistant <i>Enterococcus</i> Bacterial strains of Enterococcus that are resistant to the antibiotic vancomycin

Vancomycin-resistant Enterococcus, or vancomycin-resistant enterococci (VRE), are bacterial strains of the genus Enterococcus that are resistant to the antibiotic vancomycin.

Point-of-care testing is defined as medical diagnostic testing at or near the point of care—that is, at the time and place of patient care. This contrasts with the historical pattern in which testing was wholly or mostly confined to the medical laboratory, which entailed sending off specimens away from the point of care and then waiting hours or days to learn the results, during which time care must continue without the desired information.

Clinical pharmacy

Clinical pharmacy is the branch of pharmacy in which clinical pharmacists provide direct patient care that optimizes the use of medication and promotes health, wellness, and disease prevention. Clinical pharmacists care for patients in all health care settings but the clinical pharmacy movement initially began inside hospitals and clinics. Clinical pharmacists often work in collaboration with physicians, physician assistants, nurse practitioners, and other healthcare professionals. Clinical pharmacists can enter into a formal collaborative practice agreement with another healthcare provider, generally one or more physicians, that allows pharmacists to prescribe medications and order laboratory tests.

Enterococcus faecium is a Gram-positive, gamma-hemolytic or non-hemolytic bacterium in the genus Enterococcus. It can be commensal in the gastrointestinal tract of humans and animals, but it may also be pathogenic, causing diseases such as neonatal meningitis or endocarditis.

Dalbavancin

{{Drugbox | Verifiedfields = changed | Watchedfields = changed | verifiedrevid = 385028149 | image = Dalbavancin_B0.svg | alt = | pronounce = | tradename = Dalvance, Xydalba, Zeven | Drugs.com = Monograph | MedlinePlus = a614036 | licence_CA = | licence_EU = yes | DailyMedID = Dalbavancin | licence_US = | pregnancy_AU = | pregnancy_AU_comment = | pregnancy_US = C | pregnancy_US_comment = | pregnancy_category= | dependency_liability = | addiction_liability = | routes_of_administration = Intravenous | class = | ATC_prefix = J01 | ATC_suffix = XA04 | ATC_supplemental = | legal_AU = | legal_AU_comment = | legal_BR = | legal_BR_comment = | legal_CA = | legal_CA_comment = | legal_DE = | legal_DE_comment = | legal_NZ = | legal_NZ_comment = | legal_UK = | legal_UK_comment = | legal_US = Rx-only | legal_US_comment = | legal_EU = Rx-only | legal_EU_comment = | legal_UN = | legal_UN_comment = | legal_status = | bioavailability = | protein_bound = | metabolism = | metabolites = | onset = | elimination_half-life = | duration_of_action = | excretion = | CAS_number_Ref =   | CAS_number = 171500-79-1 | PubChem = 16134627 | IUPHAR_ligand = | DrugBank_Ref =   | DrugBank = DB06219 | ChemSpiderID_Ref =   | ChemSpiderID = 23340937 | UNII_Ref =   | UNII = 808UI9MS5K | KEGG_Ref = | KEGG = D03640 | ChEBI_Ref =   | ChEBI = 82721 | ChEMBL_Ref =   | ChEMBL = 3301669 | NIAID_ChemDB = | PDB_ligand = | synonyms = | IUPAC_name = 2-deoxy-1-O-[(3S,15R,18R,34R,35S,38S,48R,50aR)-5,31-dichloro-38-{[3-(dimethylamino)propyl]carbamoyl}-6,11,34,40,44-pentahydroxy-42-(α-D-mannopyranosyloxy)-15-(methylamino)-2,16,36,50,51,59-hexaoxo-2,3,16,17,18,19,35,36,37,38,48,49,50,50a-tetradecahydro-1H,15H,34H-20,23:30,33-dietheno-3,18:35,48-bis(iminomethano) 4,8:10,14:25,28:43,47-tetrametheno[1,14,6,22]dioxadiazacyclooctacosino[4,5-m][10,2,16]benzoxadiazacyclotetracosin-56-yl]-2-[(10-methylundecanoyl)amino]-β-D-glucopyranuronic acid | C=88 | H=100 | Cl=2 | N=10 | O=28 | smiles = CC(C)CCCCCCCCC(=O)N[C@@H]1[C@H]([C@@H] O)O | StdInChI_Ref =   | StdInChI = 1S/C88H100Cl2N10O28/c1-38(2)13-10-8-6-7-9-11-14-61(106)94-70-73(109)75(111)78(86 121)128-87(70)127-77-58-31-43-32-59(77)124-55-23-19-42(29-50 89)71(107)69-85(119)98-67(80 92-25-12-26-100 5)48-33-44(102)34-57(125-88-76 74 72 60 126-88)62(48)47-28-40(17-22-52 103)65(82 99-69)95-83(117)66(43)96-84(118)68-49-35-46(36-54 63 90)123-56-24-18-41(30-53 104)64(91-3)81(115)93-51(79 97-68)27-39-15-20-45(122-58)21-16-39/h15-24,28-36,38,51,60,64-76,78,87-88,91,101-105,107-112H,6-14,25-27,37H2,1-5H3,(H,92,114)(H,93,115)(H,94,106)(H,95,117)(H,96,118)(H,97,113)(H,98,119)(H,99,116)(H,120,121)/t51-,60-,64-,65-,66-,67+,68+,69+,70-,71-,72-,73-,74+,75+,76+,78+,87-,88+/m1/s1 | StdInChIKey_Ref =   | StdInChIKey = IZJRUXNZMRDQJI-SZUNQUCBSA-N }}

Polypeptide antibiotic

Polypeptide antibiotics are a chemically diverse class of anti-infective and antitumor antibiotics containing non-protein polypeptide chains. Examples of this class include actinomycin, bacitracin, colistin, and polymyxin B. Actinomycin-D has found use in cancer chemotherapy. Most other polypeptide antibiotics are too toxic for systemic administration, but can safely be administered topically to the skin as an antiseptic for shallow cuts and abrasions.

Deprescribing is the planned and supervised process of intentionally stopping a medication or reducing its dose to improve the person's health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient's current situation. Deprescribing can help correct polypharmacy and prescription cascade.

<i>Clostridioides difficile</i> (bacteria) Species of bacteria

Clostridioides difficile, also known as Peptoclostridium difficile, C. difficile, or C. diff, is Gram-positive species of spore-forming bacteria. Clostridioides spp. are anaerobic, motile bacteria, ubiquitous in nature and especially prevalent in soil. Its vegetative cells are rod-shaped, pleomorphic, and occur in pairs or short chains. Under the microscope, they appear as long, irregular cells with a bulge at their terminal ends. Under Gram staining, C. difficile cells are Gram-positive and show optimum growth on blood agar at human body temperatures in the absence of oxygen. C. difficile is catalase- and superoxide dismutase-negative, and produces two types of toxins: enterotoxin A and cytotoxin B, which disrupts cytoskeleton signal transductions in the host. Under stress conditions, the bacteria produce spores that are able to tolerate extreme conditions that the active bacteria cannot tolerate.

Antimicrobial stewardship is the systematic effort to educate and persuade prescribers of antimicrobials to follow evidence-based prescribing, in order to stem antibiotic overuse, and thus antimicrobial resistance. AMS has been an organized effort of specialists in infectious diseases, both in Internal Medicine and Pediatrics with their respective peer-organizations, hospital pharmacists, the public health community and their professional organizations since the late 1990s. It has first been implemented in hospitals. In the U.S., within the context of physicians' prescribing freedom, AMS had largely been voluntary self-regulation in the form of policies and appeals to adhere to a prescribing self-discipline until 2017, when the Joint Commission prescribed that hospitals should have an Antimicrobial Stewardship team, which was expanded to the outpatient setting in 2020.

References

  1. ↑ MacKenzie, S. L.; Wyatt, M. C.; Schuff, R.; Tenenbaum, J. D.; Anderson, N. (2012). "Practices and perspectives on building integrated data repositories: Results from a 2010 CTSA survey". Journal of the American Medical Informatics Association. 19 (e1): e119–e124. doi:10.1136/amiajnl-2011-000508. PMC   3392848 . PMID   22437072.
  2. ↑ Samore M Lichtenberg D; Saubermann L; Kawachi C; Carmeli Y (1997). "A Clinical Data Repository Enhances Hospital Infection Control". Harvard Medical School. 1997: 56–60. PMC   2233433 . PMID   9357588.
  3. ↑ Prather JC, Lobach DF, Goodwin LK, Hales JW, Hage ML, Hammond WE (1997). "Medical Data Mining: Knowledge Discovery in a Clinical Data Warehouse". Duke University Medical Center. 1997: 101–105. PMC   2233405 . PMID   9357597.
  4. ↑ Breault, Joseph L.; Goodall, Colin R.; Fos, Peter J. (September 2002). "Data mining a diabetic data warehouse". Artificial Intelligence in Medicine. 26 (1–2): 37–54. doi:10.1016/S0933-3657(02)00051-9. PMID   12234716.
  5. ↑ "Clinical Data Repository vs. Data Warehouse: Which Do You Need?". healthcatalyst.com. 2014-07-10.
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