Using patient lists to add value to integrated data repositories

Abstract

Patient lists are project-specific sets of patients that can be queried in integrated data repositories (IDR's). By allowing a set of patients to be an addition to the qualifying conditions of a query, returned results will refer to, and only to, that set of patients. We report a variety of use cases for such lists, including: restricting retrospective chart review to a defined set of patients; following a set of patients for practice management purposes; distributing "honest-brokered" (deidentified) data; adding phenotypes to biosamples; and enhancing the content of study or registry data. Among the capabilities needed to implement patient lists in an IDR are: capture of patient identifiers from a query and feedback of these into the IDR; the existence of a permanent internal identifier in the IDR that is mappable to external identifiers; the ability to add queryable attributes to the IDR; the ability to merge data from multiple queries; and suitable control over user access and de-identification of results. We implemented patient lists in a custom IDR of our own design. We reviewed capabilities of other published IDRs for focusing on sets of patients. The widely used i2b2 IDR platform has various ways to address patient sets, and it could be modified to add the low-overhead version of patient lists that we describe.

Keywords: Bio-repository; Honest broker; Integrated data repository; Meaningful use; Patient registry; i2b2.

Figure 1. Data flow examples for patient lists in an integrated data repository

There are two types of lists, one type (list_A) generated externally to the IDR, and the other type (list_B) generated from a query to the IDR itself. Hexagons number a sequence of events for each type of list. B.1 is a list-defining internal query, and B.2 is the creation of a list from that query. The A sequence shows creation of a list (A.1, A.2) from data external to the IDR, followed by a query about the list (A.3), and the return of results (A.4) from that query. The identities in the external list are coded by reference to data in the Master Patient Index. Coded ID’s and list membership variables are fed into the IDR, and list data (e.g., the list_A.member Boolean) can then be used by a study in queries to restrict returned data to only list members.