Graduation Date

Summer 8-17-2018

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Programs

Biomedical Informatics

First Advisor

James C. McClay

Abstract

Replication of clinical research is requisite for forming effective clinical decisions and guidelines. While rerunning a clinical trial may be unethical and prohibitively expensive, the adoption of EHRs and the infrastructure for distributed research networks provide access to clinical data for observational and retrospective studies. Herein I demonstrate a means of using these tools to validate existing results and extend the findings to novel populations. I describe the process of evaluating published risk models as well as local data and infrastructure to assess the replicability of the study. I use an example of a risk model unable to be replicated as well as a study of in-hospital mortality risk I replicated using UNMC’s clinical research data warehouse.

In these examples and other studies we have participated in, some elements are commonly missing or under-developed. One such missing element is a consistent and computable phenotype for pregnancy status based on data recorded in the EHR. I survey local clinical data and identify a number of variables correlated with pregnancy as well as demonstrate the data required to identify the temporal bounds of a pregnancy episode. Next, another common obstacle to replicating risk models is the necessity of linking to alternative data sources while maintaining data in a de-identified database. I demonstrate a pipeline for linking clinical data to socioeconomic variables and indices obtained from the American Community Survey (ACS). While these data are location-based, I provide a method for storing them in a HIPAA compliant fashion so as not to identify a patient’s location.

While full and efficient replication of all clinical studies is still a future goal, the demonstration of replication as well as beginning the development of a computable phenotype for pregnancy and the incorporation of location based data in a de-identified data warehouse demonstrate how the EHR data and a research infrastructure may be used to facilitate this effort.

Download

Share

COinS