Creation, Maintenance and Distribution of Logical Observation Identifiers Names and Codes (LOINC®)

February, 2003 through January, 2008 

Funding source: NIH-National Library of Medicine

The Regenstrief Institute has been a leader and active participant in medical informatics standards development. Regenstrief investigators organized the first medical informatics effort in 1984[32], wrote the ASTM and HL7 chapters for orders and observation reporting, were the lead authors of the unified (USAMP) data HL7 data model[33], the HL7 version 3 data types[34], and the proposed HIPAA claims attachments documents. IU/Regenstrief Institute initiated the LOINC® vocabulary standards for observations which have been adopted by the largest commercial laboratories and most Federal agencies (CDC, DOD, HCFA). Fellows will have opportunities to develop research projects related to any of the above.

Indiana Program of Excellence in Biomedical Computing

September 1, 2002 through August 31, 2005

Funding source: NIH - NIGMS

Reserachers at the Indiana University School of Medicine (IUSM), the department of computer science at Indiana University Purdue University Indianapolis (IUPUI) and the Regenstrief Institute (RI), have joined to propose a Program of Excellence in Biomedical Computing.  They will work toward a full program in biomedical computing excellence whose scope will include research, development and dissemination of tools, systems and standards to support the collection, management and analysis of phenotypic (clinical and outcomes information) and genotypic (proteomic and genomic data and/or biologic specimens) for the purpose of biologic discovery.

Regenstrief Medical Informatics Research Fellowship

July 1, 1997 through June 30, 2002 and

July 1, 2002 through June 30, 2007

Funding source: NIH - National Library of Medicine

This fellowship program is designed to prepare post-doctoral fellows for academic careers in medical informatics. Research fellows will obtain a broad array of general research skills, improve writing skills, learn the responsible conduct of research, and the structure content and design of medical information systems. Each fellow will be expected to gain competency in a modern programming language so that they can understand the strengths and limits of the systems with which they work.

Each fellow chooses to focus on one of the following three areas of enhancement: (1) high performance computing and communications, (2) health services research, or (3) cancer informatics. By the end of their second fellowship year, fellows will have performed a clinical epidemiologic project, designed and conducted a developmental research project, performed their own data analyses, and written papers to be submitted to peer-reviewed publications.

Indianapolis Shared Pathology Informatics Network (SPIN)

August 13, 2001 through July 31, 2006

Funding source: NIH - National Cancer Institute

We have been awarded funding to extend the data collecting approach used in the INPC project and direct it toward cancer research. The NCI's idea is to allow cancer researchers to query standardized electronic clinical record information in order to identify tissue blocks that could be used to test specific biologic hypotheses. The five Indianapolis hospital systems have agreed to add pathology reports, discharge summaries, operative notes, radiology reports and inpatient medication records to the data set they are storing in these INPC vaults. The Indiana State Department of Health department will provide tumor registry data available under appropriate privacy constraints. The University of Pittsburgh, another collaborator, will provide access to a subset of this data as well.

Syndromic Surveillance Data Exchange and Analysis

September 30, 2003 through September 29, 2006

Funding source: NIH - National Library of Medicine

Using actual data from two different cities, we will develop and characterize pattern recognition algorithms that operate on deidentified data in order to protect patients' privacy, and utilize this data to precede diagnoses to recognize disease outbreaks with sufficient specificity to warrant a public health response.  The overall approach would be to utilize established pattern recognition algorithms developed at Children's Hospital in Boston, and modify them as needed to accommodate use of deidentified data.  Then we will compare the detection characteristics of the algorithm using identifiable data and deidentified data in order to determine the effect of using deidentified data.

Use of Logical Observations, Identifiers, Names and Codes (LOINC®) to Standardize the Electronic Exchange of Public Health Data

September 30, 2001 through September 29, 2006

Funding source: Centers for Disease Control and Prevention

The Logical Observations Identifiers Names and Codes (LOINC®) database is a young, but successful, "Open Source" database that contains codes, names and other attributes for identifying tests, measurements, report titles, questions and other clinical observations. These funds will support LOINC development, including: 1) The continued expansion and refinement of LOINC codes; 2) Various enhancements to the RELMA mapping program including the provision of remote Internet access to its functionality via a Citrix server and tools for maintenance of preferred units and hierarchies; 3) Enhancement of LOINC educational materials including provision of training information on the web and exploration of the shipping of displays to association meetings; 4) Enhancement of the LOINC database including the development of preferred units; and, 5) the enhancement of the codes included in the LOINC database with a special focus in the first year on genetic tests, especially those related to cancer risk and etiology.

Improved Patient Safety With Information Technology

September 30, 2001 through September 29, 2004

Funding source: Agency for Healthcare Research and Quality

The overall objectives for this project are to detect errors of omission and commission for selected conditions using information systems and (using the same information system) reduce the errors. Our four specific aims are: 1) Identify "indicators" of medical errors of omission and commission in patients using a primary care practice based research network's clinical information system, in effect creating a mandatory reporting system; 2) Analyze the "indicators" using root cause analysis and multidimensional exploratory data analysis techniques; 3) Measure the effectiveness of two specific changes in the delivery system in a crossover design randomized, controlled trial; and, 4) Expand the conditions we are focusing on and transition the processes developed to the IUMG-PC quality improvement team. 

Improving Safety by Computerizing Outpatient Prescriptions

September 30, 2000 through December 31, 2004

Funding source: Agency for Healthcare Research and Quality

Patient safety is at the forefront of critical issues in health care. Medications are the single most frequent cause of adverse events, and in the inpatient setting adverse drug events (ADEs) are common, expensive, injurious to patients, and often preventable. In addition, inpatient physician order entry greatly decreases medication error rates. However, relatively little is known about the frequency of ADEs in the ambulatory setting, how to monitor for outpatient ADEs, or on the impact of prevention strategies such as computerization of prescribing supplemented by decision support.

The Brigham and Women's and Partners HealthCare System and the Regenstrief Institute and Indiana University propose to collaborate by building on their individual strengths in direct provider order entry, detection and characterization of ADEs and careful evaluation of interventions to change physician behavior. First, working together, we will build on our individual previous work in detection of actual and potential adverse events to create a consistent, generalizable method for detecting ADEs in the ambulatory setting. Second, we will study the impact of basic computerized prescribing in the ambulatory setting in a comparative trial with paper-prescribing. Third, we will identify a common set of rules for advanced decision support related to prescribing that we will implement in our individual order entry systems. We will then carry out a randomized, controlled trial of these decision-support rules using common outcome measures and design.

Specific Aims:

• Implement a computerized, outpatient ADE detection system at both sites.
• Use computerized outpatient prescribing to reduce preventable ADE rates in a diverse array of outpatient settings.
• Use advanced decision support within computerized prescribing to reduce the frequency of preventable ADEs, medication errors, and potential ADEs.

I3: The Indiana IAIMS Initiative

September 15, 2004 through September 14, 2008

Funding Source: NIH - National Library of Medicine

The goal of the Indiana (IAIMS) Initiative (I3) is to create an integrated, Indianapolis MSA (Metropolitan Statistical Area) wide clinical data and knowledge information management system that serves the needs of patient care, public health, education, policy generation and research.  The information management system will be used by patients, health care providers, public health officials, educators, policy makers and researchers.  The system will be an extension of the Indiana Network for Patient Care (INPC) system that has been operational for over five years.

Central Indiana Healthcare Collaboration

July 21, 2004 through July 20, 2005

Funding Source: Foundation for eHealth Initiative (FeHI) Connecting Communities for Better Health

CIHC plans to evolve a population based electronic medical record which will serve the needs of patient care, public health, health services research, clinical trials and medical informatics research.  In order to serve these disparate purposes, the data are standardized as they are generated and stored in a repository as well as made available to standardized processing modules that scan for public health outbreaks, identify adverse drug events and feed data to office EMRs, for example.

Indiana State Department of Health Public Health Emergency Surveillance System (PHESS)

July 12, 2004 through June 30, 2008

Funding Source: Centers for Disease Control and Prevention/ISDH

Because of Regenstrief Institute Inc.'s long-term experience with and expertise in electronic clinical data capture, standard clinical vocabularies, clinical terminology mapping, HL7 messages, system interfacing, its long term history of successful linking of many hospitals in Indiana, and its understanding of public health and biosurveillance needs, the Indiana State Department of Health ("ISDH") contracted with Regenstrief Institute Inc. to develop, maintain and operate a system for capturing hospital emergency department admission data and transmit it to the ISDH Public Health Emergency Surveillance System ("PHESS").

A Center of Excellence in Medical Informatics to Provide an Advanced Infrastructure for Human Research: A Catalyst for Indiana Research

August 2004 through August 2006

Funding Source: Indiana 21st Century & Technology Fund

We propose a 21st Century Center of Excellence for bioinformatics to build an information infrastructure for medical research based on our success in the clinical care domain.  This infrastructure will integrate many sources of clinical data and specimen resources, and will simplify the work processes of the clinical researcher.  We will build tools to improve and speed access to these resources, expand the available sources of disease and outcomes data, provide access to large collections of de-identified specimen collections such as the State archive of dried blood spots, and develop technology to expand the scope of de-identified research and the subject recruitment process.

Value of New Drug Labeling Knowledge for e-Prescribing

September 8, 2004 through August 31, 2007

Funding Source: Agency for Healthcare Research and Quality

In this project we will study the value that the upcoming FDA mandated electronic drug labeling HL7 standard will bring to existing and emerging Computerized Provider Order Entry (CPOE) systems and e-prescribing tools on the example of the Regenstrief Medical Gopher CPOE system and on a newly developed completely HL7 standards-based open-source e-prescribing tool used for delivering decision support enabled safe prescribing assistance to practitioners in diverse healthcare settings (including small and rural).  User and patient satisfaction surveys will evaluate perceived value.

Value of Health Information Exchange in Ambulatory Care

September 30, 2004 through September 29, 2007

Funding Source: Agency for Healthcare Research and Quality

We will refine an established economic model of health information exchange (HIE), create a "laboratory" in which we can test that model and, finally, test the model's predictions in a randomized controlled trial.  We will use an existing HIE (the Indiana Network for Patient Care) as the foundation for this project.  In addition, we have engaged several payers in this project in order to provide part of the data but also to lay the foundation for changes in reimbursement models based on the findings.

An Evolving Statewide Indiana Information Infrastructure

September 30, 2004 through September 29, 2009

Funding Source: Agency for Healthcare Research and Quality

This project builds on existing statewide initiatives of the Indiana State Department of Health (ISDH), the State's Medicaid program and Indiana University School of Medicine.  We will work to achieve our region's goals by building on these established local and regional health information infrastructure initiatives.  We have been very active in sharing our learning points with others across the country through presentations, testimony and publications and believe we can provide an excellent example for other states.

Privacy-Preserving Data Integration and Sharing

September 15, 2004 through September 14, 2007

Funding Source: National Science Foundation

This project will involve basic research in data management and data security techniques, directed by the specific needs of medical research on large data sets.  Regenstrief Institute and Purdue University researchers will collaborate to ensure that the outcomes of this research are relevant to the wider research community.