Generalizable EHR-R-REDCap pipeline for a national multi-institutional rare tumor patient registry

Objective To develop a clinical informatics pipeline designed to capture large-scale structured Electronic Health Record (EHR) data for a national patient registry. Materials and Methods The EHR-R-REDCap pipeline is implemented using R statistical software to remap and import structured EHR data into the Research Electronic Data Capture (REDCap)-based multi-institutional Merkel Cell Carcinoma (MCC) Patient Registry using an adaptable data dictionary. Results Clinical laboratory data were extracted from EPIC Clarity across several participating institutions. Laboratory values (Labs) were transformed, remapped, and imported into the MCC registry using the EHR labs abstraction (eLAB) pipeline. Forty-nine clinical tests encompassing 482 450 results were imported into the registry for 1109 enrolled MCC patients. Data-quality assessment revealed highly accurate, valid labs. Univariate modeling was performed for labs at baseline on overall survival (N = 176) using this clinical informatics pipeline. Conclusion We demonstrate feasibility of the facile eLAB workflow. EHR data are successfully transformed and bulk-loaded/imported into a REDCap-based national registry to execute real-world data analysis and interoperability.

Nursing Informatics Competency After Experiencing Simulated Electronic Health Records: Descriptive Study

Nursing has embraced flexible online advanced education as a means of increasing the supply of nurse professionals. Virtual simulation and other adaptive learning technologies enhance learning efficiency and student outcomes. A simulated electronic health record (DocuCare) was adopted in an online graduate nursing informatics course. An assignment using DocuCare to learn core concepts of nursing informatics was developed for graduate students enrolled in a nursing informatics course. A validated standard informatics survey instrument was used to measure three individual domains (basic computer skills, roles, and advanced computer skills (clinical informatics)) as well as the combined informatics competency level. Overall, the nursing informatics competency level was between competent and proficient; basic computer skills and roles were above proficient; and advanced computer skills (clinical informatics) fell between competence and proficient levels.

PhD Nursing Students’ Perceptions Towards Clinical Informatics Course

This paper aims to investigate PhD nursing students’ perceptions regarding a clinical informatics course. Open-ended questionnaires and reviews were used to explore the students’ perception of the course. A total of 84.62% (11/13) students responded to the survey. Only four respondents had an understanding of clinical informatics and others did not. All the respondents considered clinical informatics to be a very important and useful course for PhD nursing students.

Leveraging Clinical Informatics Tools to Extract Cumulative Anthracycline Exposure, Measure Cardiovascular Outcomes, and Assess Guideline Adherence for Children With Cancer

PURPOSE Cardiovascular disease is a significant cause of late morbidity and mortality in survivors of childhood cancer. Clinical informatics tools could enhance provider adherence to echocardiogram guidelines for early detection of late-onset cardiomyopathy. METHODS Cancer registry data were linked to electronic health record data. Structured query language facilitated the construction of anthracycline-exposed cohorts at a single institution. Primary outcomes included the data quality from automatic anthracycline extraction, sensitivity of International Classification of Disease coding for heart failure, and adherence to echocardiogram guideline recommendations. RESULTS The final analytic cohort included 385 pediatric oncology patients diagnosed between July 1, 2013, and December 31, 2018, among whom 194 were classified as no anthracycline exposure, 143 had low anthracycline exposure (< 250 mg/m2), and 48 had high anthracycline exposure (≥ 250 mg/m2). Manual review of anthracycline exposure was highly concordant (95%) with the automatic extraction. Among the unexposed group, 15% had an anthracycline administered at an outside institution not captured by standard query language coding. Manual review of echocardiogram parameters and clinic notes yielded a sensitivity of 75%, specificity of 98%, and positive predictive value of 68% for International Classification of Disease coding of heart failure. For patients with anthracycline exposure, 78.5% (n = 62) were adherent to guideline recommendations for echocardiogram surveillance. There were significant association with provider adherence and race and ethnicity ( P = .047), and 50% of patients with Spanish as their primary language were adherent compared with 90% of patients with English as their primary language ( P = .003). CONCLUSION Extraction of treatment exposures from the electronic health record through clinical informatics and integration with cancer registry data represents a feasible approach to assess cardiovascular disease outcomes and adherence to guideline recommendations for survivors.

Development of a core competency framework for clinical informatics

ObjectivesUntil this point there was no national core competency framework for clinical informatics in the UK. We report on the final two iterations of work carried out in the formation of a national core competency framework. This follows an initial systematic literature review of existing skills and competencies and a job listing analysis.MethodsAn iterative approach was applied to framework development. Using a mixed-methods design we carried out semi-structured interviews with participants involved in informatics (n=15). The framework was updated based on the interview findings and was subsequently distributed as part of a bespoke online digital survey for wider participation (n=87). The final version of the framework is based on the findings of the survey.ResultsOver 102 people reviewed the framework as part of the interview or survey process. This led to a final core competency framework containing 6 primary domains with 36 subdomains containing 111 individual competencies.ConclusionsAn iterative mixed-methods approach for competency development involving the target community was appropriate for development of the competency framework. There is some contention around the depth of technical competencies required. Care is also needed to avoid professional burnout, as clinicians and healthcare practitioners already have clinical competencies to maintain. Therefore, how the framework is applied in practice and how practitioners meet the competencies requires careful consideration.