Informatics Infrastructure for Syndrome Surveillance, Decision Support, Reporting, and Modeling of Critical Illness
Informatics Infrastructure for Syndrome Surveillance, Decision Support, Reporting, and Modeling of Critical Illness
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DOI：
10.4065/mcp.2009.0479
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发表时间：
2010-03-01
影响因子：
8.9
通讯作者：
Gajic, Ognjen
中科院分区：
文献类型：
--
作者：
Herasevich, Vitaly;Pickering, Brian W.;Gajic, Ognjen
目的：开发和验证危重疾病综合征监测、决策支持、报告和建模的信息学基础设施。方法利用从电子病历（emr）导入的开放式模式数据，我们开发了一个近实时的关系数据库（多学科流行病学和转化研究在重症监护数据集市）。导入的数据域包括生理监测、用药单、实验室和放射学调查以及医生和护理记录。开放数据库连接支持使用布尔数据组合，允许授权用户开发综合征监视、决策支持和报告（数据“嗅探器”）例程。每个类别中数据库条目的随机样本根据相应的独立人工审查进行验证。结果：重症监护数据集市的多学科流行病学和转化研究平均每年容纳15000名重症监护病房（ICU）入院患者，每天容纳20万份生命记录。数据库条目与手动EMR审计在性别、死亡率和机械通气使用（kappa，所有人1.0）以及年龄、实验室和监测数据（Bland-Altman平均差+/- SD，所有人1(0)）方面的一致性很高。解释或计算变量的一致性较低，如特定综合征诊断（kappa，急性肺损伤为0.5）、ICU住院时间（平均差值+/- SD， 0.43+/-0.2）或机械通气时间（平均差值+/- SD， 0.2+/-0.9）。结论：将医院EMIR中的ICU基本数据提取到一个开放的综合数据库中，有助于ICU的过程控制、报告、综合征监测、决策支持和结果研究。
OBJECTIVE To develop and validate an informatics infrastructure for syndrome surveillance, decision support, reporting, and modeling of critical illness.METHODS Using open-schema data feeds Imported from electronic medical records (EMRs), we developed a near-real-time relational database (Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart). Imported data domains Included physiologic monitoring, medication orders, laboratory and radiologic investigations, and physician and nursing notes. Open database connectivity supported the use of Boolean combinations of data that allowed authorized users to develop syndrome surveillance, decision support, and reporting (data "sniffers") routines. Random samples of database entries in each category were validated against corresponding Independent manual reviews.RESULTS The Multidisciplinary Epidemiology and Translational Research in Intensive Care Data Mart accommodates, on average, 15,000 admissions to the Intensive care unit (ICU) per year and 200,000 vital records per day. Agreement between database entries and manual EMR audits was high for sex, mortality, and use of mechanical ventilation (kappa,1.0 for all) and for age and laboratory and monitored data (Bland-Altman mean difference +/- SD, 1(0) for all). Agreement was lower for Interpreted or calculated variables, such as specific syndrome diagnoses (kappa, 0.5 for acute lung Injury), duration of ICU stay (mean difference +/- SD, 0.43+/-0.2), or duration of mechanical ventilation (mean difference +/- SD, 0.2+/-0.9).CONCLUSION Extraction of essential ICU data from a hospital EMIR into an open, integrative database facilitates process control, reporting, syndrome surveillance, decision support, and outcome research in the ICU.