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greenbutton [2020/06/12 10:11]
acallaha [Handbook] |
greenbutton [2023/05/26 11:26]
nigam [Learn More] |
| ====== Clinical Informatics Consult at Stanford ====== | ====== Informatics Consultation Service at Stanford ====== |
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| The **Clinical Informatics Consult** service was an IRB approved project to study the use of routinely collected data on millions of individuals for providing better care. Given a specific clinical question, we provided a report with a descriptive summary of similar patients in Stanford’s clinical data warehouse, treatment choices made, and observed outcomes. | The **Informatics Consultation service** was an IRB approved project to study the use of routinely collected data on millions of individuals to provide on-demand evidence in those situations where good evidence is lacking. We used demographics, diagnoses, procedures, medications, laboratory values, clinical notes, mortality, and length of stay information for millions of patients to inform clinical care decisions by summarizing “what happened to patients like mine”. |
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| We used demographics, diagnoses, procedures, medications, laboratory values, clinical notes, mortality, and length of stay information for millions of patients to answer "What happened to other patients like mine?" This [[https://www.youtube.com/watch?v=zRwKm-Uhkiw | 3 minute animation]] summarizes the service we offered and this [[https://www.youtube.com/watch?v=6oEFK24s8yU| short video]] demonstrates the search engine that enabled the service. The study concluded in August 2019, and we are writing up the findings. To know more about setting up such a service at your institution, please e-mail **[[greenbutton@stanford.edu|]]**. | Given a specific clinical question, we provided a report with a descriptive summary of similar patients in Stanford’s clinical data warehouse, treatment choices made, and observed outcomes. The study concluded in August 2019. We responded to 100 consultation requests by 53 users from multiple specialties. Of the 83 requests we fulfilled, 52 consultations guided further research, 17 led to follow up investigations and 10 directly informed patient care.This [[https://www.youtube.com/watch?v=zRwKm-Uhkiw|3 minute animation]] summarizes the workflow of the service we offered during the study. |
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| ===== Learn More ===== | ===== Learn More ===== |
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| | Learn about the [[http://shahlab.stanford.edu/ACE|Advanced Cohort Engine]] (ACE) that enabled the service. For setting up such a service at your institution, write to us at [[greenbutton@stanford.edu|]]. |
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| | Know the [[https://stanmed.stanford.edu/2016winter/on-the-button.html|story]] of how the [[https://med.stanford.edu/news/all-news/2015/10/the-promise-of-personalizing-medical-practice-guidelines-in-real-time.html| Green Button idea]] crystalized into the [[https://stanmed.stanford.edu/2019summer/millions-ehr-harnessed-ultimate-consult-each-patient.html| Informatics Consultation Service]]. Read about our [[https://shahlab.stanford.edu/doku.php?id=service_details| step-by-step]] progress towards launching the IRB approved study. Check out how we fit into the larger vision of being Digitally Driven at [[https://stanfordhealthcare.org/stanford-health-now/ceo-report/biomedical-insights-putting-data-science-to-work-for-patients.html| Stanford Health Care]] as well as listen to the NLM Director Dr. Patricia Brennan's [[https://www.youtube.com/watch?v=h-d7LPCxtHo&t=2220| Congressional testimony]]. |
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| {{youtube>fuyVriaq5Vk?small | One minute video on the Informatics Consult Service}} | {{youtube>fuyVriaq5Vk?small | One minute video on the Informatics Consult Service}} |
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| {{youtube>2ERCBBQOMlg?t=460&small | Grand rounds talk launching the service in 2017}} | |
| Launching the service in 2017. | |
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| [[https://stanmed.stanford.edu/2019summer/millions-ehr-harnessed-ultimate-consult-each-patient.html|Read our story]], [[:service_details| learn how we got started]], check out our [[https://stanfordhealthcare.org/stanford-health-now/ceo-report/biomedical-insights-putting-data-science-to-work-for-patients.html| CEO's annual report]] and {{:shc_data_science_for_patients.pdf| brochure}}, or NLM Director Dr. Patricia Brennan's [[https://www.youtube.com/watch?v=h-d7LPCxtHo&t=2220 | Congressional testimony]] on Investments in Medical Research at Five Institutes & Centers of the NIH. | |
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| ===== Example Consultations ===== | ===== Example Consultations ===== |
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| - How frequently was a positive procalcitonin (defined as a result ≥ 0.5 or ≥ 2.0) associated with a positive blood culture in adults between 2013 and 2017? [[https://drive.google.com/file/d/1Za2raSDIwDaDQj_tVTN0fKqeLyhwQZz9/view?usp=sharing|See report]]. | - In a young patient presenting with mononeuritis multiplex what is their ultimate diagnosis? [[https://drive.google.com/file/d/12hXIH1T7IoAN2SR0lAVIpN5tOiPeZXeo/view?usp=sharing|See report]]. |
| - Of patients administered opioids as inpatients or prescribed opioids as an outpatient and discharged with adequate, inadequate, or no bowel regimen, how many suffer constipation, bowel perforation, or colitis within the 30-day post-discharge period? [[https://drive.google.com/file/d/1--fXMkiW2_cmp3jZCIcKMcg0dLkTjjXe/view?usp=sharing|See report]]. | - Is there a relationship between HSV or VZV infection in patients treated with PD-1/PD-L1 inhibitor immunotherapy? [[https://drive.google.com/file/d/1Mr8sB8DA7I9jXoOq7uSWYXefZYEIvKoq/view?usp=sharing|See report]]. |
| - In female patients at least 18 years old and diagnosed with a urinary tract infection, and prescribed a sulfonamide antibiotic, is there any difference in peak blood glucose after treatment compared to patients prescribed a cephalosporin antibiotic or penicillin derivative antibiotic? [[https://drive.google.com/file/d/1jg0jwH9MivsIneOQ1SKWa65WEBzgONh1/view?usp=sharing|See report]]. | - Between 2013 and 2017, in women, men, adults ≤ 45 years old and adults > 45 years old, how frequently was a positive procalcitonin (defined as a result > 0.5) associated with a positive blood culture?[[https://drive.google.com/file/d/1UEsKDuaSj226EZJrDjIYxZyZs_ZJ2Nb8/view?usp=sharing|See report]]. |
| - What is the population of admitted children (age 1 year - 17 years inclusive) who have acute kidney injury (AKI; defined as > 1.5x their baseline creatinine value) within the first 7 days of admission? [[https://drive.google.com/file/d/1_3_CugtlEpwMKxzJkYjanZ6VUV-NOOZq/view?usp=sharing|See report]]. | |
| - How many patients aged 0 to 17 years received a new diagnosis of fever of unknown origin (FUO), Kawasaki disease, apparent life-threatening event or brief resolved unexplained event (ALTE/BRUE), or seizure (febrile, simple partial, complex partial, generalized idiopathic epilepsy) in the year 2016? [[https://drive.google.com/file/d/1ttu3CKyZKa2VS8u2jvUFJxLapoTuQ5YS/view?usp=sharing|See report]]. | |
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| ===== Handbook ===== | ===== The Team ===== |
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| To learn more about setting up a version of the service at your institution, read our {{ :ics_how_to_guide.pdf |handbook}}. | |
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| ===== Consult Team ===== | |
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| * [[https://med.stanford.edu/profiles/166781|Saurabh Gombar MD, PhD]] | * [[https://med.stanford.edu/profiles/166781|Saurabh Gombar MD, PhD]] |
| * Vladimir Polony | * Vladimir Polony |
| * Ken Jung, PhD | * Ken Jung, PhD |
| | * Ethan Steinberg |
| | * Keith Morse, MD |
| | * [[https://profiles.stanford.edu/robert-tibshirani|Robert Tibshirani, PhD]] |
| | * [[https://profiles.stanford.edu/trevor-hastie|Trevor Hastie, PhD]] |
| * [[https://med.stanford.edu/profiles/nigam-shah|Nigam Shah MBBS, PhD]] (Principal Investigator) | * [[https://med.stanford.edu/profiles/nigam-shah|Nigam Shah MBBS, PhD]] (Principal Investigator) |
| * [[https://profiles.stanford.edu/robert-harrington|Robert Harrington, MD]] (Executive Sponsor) | * [[https://profiles.stanford.edu/robert-harrington|Robert Harrington, MD]] (Executive Sponsor) |
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| ===== Data Science Collaborators ===== | |
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| * [[https://profiles.stanford.edu/robert-tibshirani|Robert Tibshirani, PhD]] | |
| * [[https://profiles.stanford.edu/trevor-hastie|Trevor Hastie, PhD]] | |
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