Project Title

PHIS+: Augmenting the Pediatric Health Information System with Clinical Data

Shortened Title

PHIS+

Publication Date

2013

Author Information

Ron Keren MD, MPH
Director, Center for Pediatric Clinical Effectiveness
Associate Professor of Pediatrics
Children's Hospital of Philadelphia

Abstract

The objective of the PHIS+ project is to build on the existing infrastructure provided by Children’s Hospital Association (CHA)--a business alliance networking 43 of North America’s leading children’s hospitals--to augment its existing database with laboratory and radiology data for children seen in the ambulatory and inpatient departments of 6 large children's hospitals. The existing database, called the Pediatric Health Information System (PHIS), is a comprehensive pediatric database containing clinical and financial details of more than six million patient cases. The enhanced database, called PHIS+, will provide a rich data source for academic clinicians to answer in real time the comparative effectiveness questions that affect hospitalized children, thereby significantly enhancing the quality and scope of pediatric comparative effectiveness research.

Specific Aim #1: To develop the infrastructure to accurately and reliably link laboratory results and radiology reports from 6 CHA-member children’s hospitals with comprehensive administrative data from PHIS to create the PHIS+ database.

Specific Aim #2: To conduct four pediatric comparative effectiveness studies using PHIS+.

EHR/EMR System or Vendor

Epic, Cerner, In-house system (Primary Children’s Medical Center)

Healthcare Settings

Inpatient facilities, Emergency departments, Academic medical centers

Data Types

Electronic Health/Medical Records (EHR or EMR), Diagnostic data, Claims

Geographic scope type

National

Locations of Focus

Philadelphia, PA Pittsburgh, PA Boston, MA Seattle, WA Salt Lake City, UT Cincinnati, OH

Population Network Size

Below is the approximate number of laboratory, microbiology and radiology unique results from 2009 across all six hospitals. We plan to collect data from 2007-2011 and beyond. Result Totals Laboratory 18,222,853 Microbiology 239,525 Radiology 819,460

Informatics Platform/Tools

Federated Utah Research and Translational Health electronic Repository (FURTHeR)

Major Partners

The Children’s Hospital of Philadelphia (CHOP) Children’s Hospital of Pittsburgh Children’s Hospital Boston Cincinnati Children’s Hospital Medical Center (CCHMC) Primary Children’s Medical Center (PCMC) Seattle Children’s Hospital Children’s Hospital Association (CHA) The University of Utah Department of Biomedical Informatics

CER/PCOR Study Priority Populations

Low-income groups, Minority groups, Children, Individuals with disabilities, Individuals who need chronic care, Individuals who need end-of-life care, Individuals who live in inner-city areas, Individuals who live in rural areas, Arthritis and nontraumatic joint disorders (Muscle, bone, and joint conditions), Functional limitations and physical disabilities, Infectious diseases, including HIV/AIDS, Peptic ulcer disease and dyspepsia (Digestive system conditions), Pulmonary disease/asthma (Breathing conditions)

Treatment Comparators

We will perform four CER projects using the PHIS+ database. The key comparators for each study are listed below:

Pneumonia: The key comparators will be different empiric antibiotic therapies for community-acquired pneumonia. They will be categorized into major classes according to the American Hospital Formulary System as follows: aminopenicillins, second-generation cephalosporins, third-generation cephalosporins, and macrolides.

Osteomyelitis: The key comparators will be antibiotic regimens that do not cover methicillin-resistant Staphylococcus aureus (MRSA) vs. those that do cover MRSA for osteomyelitis.

GERD: The key comparators will be surgical fundoplication vs. gastro-jejunal (GJ) tube placement for children with severe neurologic impairment, (NI) and medically refractory gastro-esophageal reflux disease (GERD).

Appendicitis: The key comparators will be PICC-based IV-only antibiotic therapy vs. combined IV and oral antibiotics (without a PICC line) for the treatment of complicated appendicitis.

Outcome(s) of Interest

Pneumonia: The primary outcome will be the development of pneumonia-associated complications following administration of empiric antibiotic therapy.

Osteomyelitis: The primary outcome will be treatment failure, defined by the presence of any one of the following conditions: 1) a change in initial antibiotic coverage because of inadequate coverage against a subsequently identified pathogen; 2) failure of improvement in CRP within the first 5 days of initial therapy; 3) repeated imaging showing progression of disease; 4) development of chronic osteomyelitis as evident by a) the need for prolonged or additional medical or surgical treatment after 6 weeks of treatment and/or b) inpatient or outpatient follow-up imaging or laboratory findings indicating disease progression after 6 weeks of treatment; or 5) readmission due to disease recurrence or persistence within 6 months from discharge.

GERD: The primary outcome for this study will be the reflux related hospitalizations.

Appendicitis: The primary outcome will be treatment failure, defined as readmission to the inpatient setting or ED within 30 days of the operation.

Acknowledgement of Funders

PHIS+ is funded by grant R01 HS019862 from the Agency for Healthcare Research and Quality (AHRQ).

Additional Information

A multi-disciplinary team developed a new data model for mapping of microbiology results to a common terminology.

A multi-disciplinary team is developing natural language processing algorithms to classify radiology study results (e.g., presence of pneumonia on chest x-rays and presence of PICC lines on chest x-rays).

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