Extracting Data with the Informatics Program: A Case Study with Dr. Amresh Hanchate

April 2021 | By Luke Morales

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When asked for a brief overview of the Informatics program, Brian Ostasiewski, Informatics Program Director, laughed and said he’d just worked out a summary answering the same question for a recent presentation: “The informatics program seeks to facilitate researcher’s access to data, improve Biomedical Informatics capabilities of researchers and foster collaborations across our networks.”

 

Facilitating access to data happens through the Translational Data Warehouse (or TDW)—a comprehensive research data warehouse integrating clinical data from the WakeOne system and other research information from multiple data sources. Beyond this, Ostasiewski says the Informatics team is always incorporating new datasets into the TDW to better serve data to researchers. "One thing about [WakeOne’s] Epic,” Ostasiewski says, “it's tailored for working with one patient at a time...and trying to answer population-based questions is difficult. So, we work on primarily getting additional datasets into the TDW from various systems—even externally—to expand what researchers have access to.”

Additional to these data services, the Informatics Program works to improve Biomedical Informatics capabilities for researchers through education offerings and through sharing programming code and tools (175 people used the i2b2 Data Puller tool created by the Informatics Program). “The data puller allows people to get aggregate data in minutes rather than going through a full data request process.” Ostasiewski says. But for newer users, ones that may not be certain of their exact data needs, Ostasiewski says they can submit a manual data request through the Informatics Program’s coordinators via Data Extraction Services on the CTSI website.

Translational Data Warehouse (TDW) The TDW is a comprehensive research data warehouse integrating clinical data from the WakeOne system and from other data sources. Currently the TDW consists of clinical data which includes demographics, diagnoses, procedures, medications, lab results, vitals, and visit details from the medical record (historical and current). Data can be used for retrospective chart reviews and analysis, identify patients for recruitment, or to pull aggregate numbers for cohort identification and build projected enrollment tables.

Dr. Amresh Hanchate, Health Services Researcher

When Amresh Hanchate, PhD, Wake Forest Professor of Social Sciences and Health Policy, joined the institution two years ago, he spoke with Ostasiewski and Informatics Associate Program Leader Brian Wells, MD, PhD, to ensure his data needs would be met. As a health services researcher, Dr. Hanchate evaluates healthcare policies and clinical interventions, with a focus on vulnerable populations. As Dr. Hanchate says, when a medical breakthrough becomes available, “how do you actually get it to the people who need it? Is there overutilization, or is there underutilization? So that's what health services research is about: who has access.”

 

Dr. Hanchate’s primary tools? “I work a lot with what is called observational data,” he says, “the data that comes about from doctor’s visits, going to their pharmacy, or going into the hospital... these data are submitted by providers for reimbursement.” These data sets are called claims data and are widely available through Medicare, Medicaid and other sources.

Turning to the Informatics Program

While claims data offer a powerful view of a state or national healthcare picture, they are limited in the specificity. As Hanchate says, “On the one hand the claims data are attractive, but they don't have the level of detail that the Epic data has. So, while there is a role for both these datasets, and I am definitely on the side of promoting Epic data among clinicians...” And this is where Dr. Hanchate’s turns to the Informatics Program.

Through i2b2, Dr. Hanchate can immediately access baseline data regarding Wake Forest’s patient population. As Dr. Hanchate says, “The nice thing about i2b2 is it kind of gives you some ability to get some of the counts of certain [patient populations] ...it's good for grant writing, getting a sense of how big the [data] sample is...”

When it came to larger, more intensive data needs, Dr. Hanchate turned to the data analysts of the Informatics Program. Dr. Hanchate explains this as he was writing a COVID-19 grant "to look at how the pandemic has affected diabetic patients in our system and their ability to manage their condition.” Hanchate’s goal was to identify patterns in diabetic patient's doctors’ visits and A1C levels over time during the pandemic. “This was a big enough sample that I don't think [self-service through] i2b2 would have worked. So, we put in a request for a more detailed data extraction.”

The Power of Informatics Consultation

This is where the Informatics team thrives, with data consultants helping refine and expand data queries to best match researcher’s needs. As Ostasiewski indicates, “There are different varieties of diabetics, there are diabetics without complications, with complications. There's A1C levels that can tell you that someone is likely a diabetic, even if it's not marked as a diagnosis in their chart.” Regardless of the planned query, the data consultation can help investigators explore all facets of the data available to them.

Dr. Hanchate is grateful for this service. Reminding his fellow investigators of the value of this collaboration, he says “...everyone's needs are going to be different. I'm kind of thinking back at my own request for the COVID grant I wrote, when we extracted the [diabetes] data it took us three to four tries. There were a variety of ways to approach the query, it’s complex so having the ability to discuss these options with data experts is extremely valuable.”

How do I get data?

For those interested in exploring available data, Ostasiewski says “I would encourage everybody to simply play with the i2b2 Data Puller tool. Exploring the ontology of things you can query, gives investigators a better idea of the data sets we have available. And pretty much anything that's there we can pull.” But if that isn’t the route one wants to go, Ostasiewski suggests “just have a half hour consult with us—to talk through the issues and let us figure out what's available, what's possible, what's not."

Interested in a consultation? Email CTSIdata@wakehealth.edu   Want to request data extraction? Submit a CTSI service request (and select Data Extraction) or email CTSIdata@wakehealth.edu today.   For more information and updates, visit the Data Extraction page at ctsi.wakehealth.edu/Informatics	Download the Informatics Program Infographic                                Download PDF