The Importance of Unambiguous Medical Terminology in Patient Care and Research. Or, why doctors and healthcare administrators shouldn’t glaze over when informatics is discussed Robert M Califf MD Vice Chancellor for Clinical Research Duke University. The Information Situation.
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Or, why doctors and healthcare administrators shouldn’t glaze over when informatics is discussed
Robert M Califf MD
Vice Chancellor for Clinical Research
While Baltimore was criticized for its hydrants, this was a problem that was not unique to Baltimore. During the time of the Great Fire "American cities had more than six hundred different sizes and variations of fire hose couplings." It is known that as outside fire fighters returned to their home cities they gave interviews to newspapers that condemned Baltimore and talked up their own actions during the crisis. In addition, many newspapers were guilty of taking for truth the word of travelers who, in actuality, had only seen the fire as their trains passed through the area. All of this aside the responding agencies and their equipment did prove useful as their hoses only represented a small part of the equipment brought with them. One benefit to this tragedy was the standardization of hydrants nationwide
UC Project for Global Inequality
3 the same things!
Use forFeedbackon Priorities
Evaluation of Speedand FluencyThe Cycle of Quality: Generating Evidence to Inform Policy
Califf RM et al, Health Affairs, 2007
Ischemic Discomfort the same things!
Acute Coronary Syndrome
No ST Elevation
Libby P. Circulation 2001;104:365, Hamm CW, Bertrand M, Braunwald E, Lancet 2001; 358:1533-1538; Davies MJ. Heart 2000; 83:361-366.
Anderson JL, et al. J Am Coll Cardiol. 2007;50:e1-e157, Figure 1. Reprinted with permission.
Reduction in deaths: Therapy # pts Relative Absolute C/E
MI: Aspirin 18,773 23% 2.4% +++++
Fibrinolytics 58,000 18% 1.8% ++++
Beta blocker 28,970 13% 1.3% ++++
ACE inhibitor 101,000 6.5% .6% +
2nd prev: Aspirin 54,360 15% 1.2% +++++
Beta blocker 20,312 21% 2.1% ++++
Statins 17,617 23% 2.7% ++++
ACE inhibitor 9,297 17% 1.9% ++++
CHF: ACE inhibitor 7,105 23% 6.1% +++++
Beta blocker 12,385 26% 4% +++++
Spironolactone 1,663 30% 11% +++++
Acute Therapies the same things!
Heparin (UFH or LMWH)
GP IIb-IIIa Inhibitor
All receiving cath/PCI
Cardiac RehabilitationGoals for CRUSADE:Improve Adherence to ACC/AHA Guidelines for Patients with Unstable Angina/Non-STEMI
Evaluating the Process of Care
Circulation, JACC 2002 — ACC/AHA Guidelines update
Every 10% in guidelines adherence 11% in mortality
Peterson et al, ACC 2004
Trilogy in American Heart Journal
*Fibrinolysis-eligible pts who rec’d fibrinolysis
**Non-transfer pts who rec’d primary PCI since 1994
Genome and Mortality
100 – and Mortality
Funding ($ in billions)
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Reproduced from Moses et al., JAMA 2005;294:1333-42
** All R&D costs (basic research and preclinical development) prior to initiation of clinical testing
*** Based on a 5-year shift and prior growth rates for the preclinical and clinical periods
DiMasi et al. 2003
Burrill & Company
$ In US 2007 Millions
Full Cost Industry
Disease Registries—Granular, Detailed
Integrated at “enterprise level”
Health System A
Adaptable to all!
Health System B
To study the problem list vocabularies of large health care institutions - size, pattern of use and the extent to which they overlap with (or differ from) each other
To identify a CORE (Clinical Observations Recording and Encoding) set of terms that are of high usage in most problem lists
High coverage of usage
Small number of concepts
Linkable to standard terminologies
Supports a standard mechanism for adding local extensions
It will be shameful is some portion of that $34 billion allocation is not devoted to finalizing a core terminology that is agreed to by all sectors
How do we resolve the “Tower of Babel” of data from EHRs, PHRs, registries, databases, literature, and clinical trials?