Use of a data warehouse at an academic medical center for clinical pathology quality improvement, education, and research

BACKGROUND

Pathology data contained within the electronic health record (EHR), and laboratory information system (LIS) of hospitals represents a potentially powerful resource to improve clinical care. However, existing reporting tools within commercial EHR and LIS software may not be able to efficiently and rapidly mine data for quality improvement and research applications.

MATERIALS AND METHODS

We present experience using a data warehouse produced collaboratively between an academic medical center and a private company. The data warehouse contains data from the EHR, LIS, admission/discharge/transfer system, and billing records and can be accessed using a self-service data access tool known as Starmaker. The Starmaker software allows users to use complex Boolean logic, include and exclude rules, unit conversion and reference scaling, and value aggregation using a straightforward visual interface. More complex queries can be achieved by users with experience with Structured Query Language. Queries can use biomedical ontologies such as Logical Observation Identifiers Names and Codes and Systematized Nomenclature of Medicine.

RESULT

We present examples of successful searches using Starmaker, falling mostly in the realm of microbiology and clinical chemistry/toxicology. The searches were ones that were either very difficult or basically infeasible using reporting tools within the EHR and LIS used in the medical center. One of the main strengths of Starmaker searches is rapid results, with typical searches covering 5 years taking only 1-2 min. A "Run Count" feature quickly outputs the number of cases meeting criteria, allowing for refinement of searches before downloading patient-identifiable data. The Starmaker tool is available to pathology residents and fellows, with some using this tool for quality improvement and scholarly projects.

CONCLUSION

A data warehouse has significant potential for improving utilization of clinical pathology testing. Software that can access data warehouse using a straightforward visual interface can be incorporated into pathology training programs.

Adequacy of powered vs manual bone marrow biopsy specimens: a retrospective review of sequential marrow aspirates and biopsies in 68 patients

OBJECTIVES

To evaluate the quality and quantity of the bone marrow aspirates and biopsy specimens obtained with a powered system in comparison with the standard manual method.

METHODS

The Pathology Laboratory Information System was reviewed for patients who had previously undergone bone marrow biopsies performed by both the OnControl Bone Marrow System and the manual method. A total of 136 cases (68 patients) were reviewed for adequacy and compared using an unpaired t test.

RESULTS

The core biopsy specimens obtained by the OnControl system were significantly longer compared with those obtained by the manual system (16.9 vs 14.4 mm, P = .0036). However, the core biopsy specimens obtained by the manual method had on average more evaluable marrow elements (66% vs 40%, P < .0001), and the manual method was superior in 46 of the 68 cases when the length of evaluable marrow was calculated (9.7 vs 7 mm, P = .0049).

CONCLUSIONS

Our findings show that longer core biopsy specimens are obtained by the OnControl Bone Marrow system but that the manual method is still superior when the percentage and length of evaluable bone marrow are analyzed.