Medical Record Summaries

Our goal for Cleo version 2 was to migrate Clearity’s patient medical record summaries from a Microsoft Access database to Cleo. In the process, we built medical record-specific objects to handle the specific needs of each class of medical record. To meet the foundation goals each medical record event has two display modes in a chronological list under the History tab. The “single” line display summaries the most important information, such as a CA-125 diagnostic procedure result, see Figure 1. The detailed display mode can be quickly accessed for any history event, by clicking on the Green “Open Panel” button on the left side of each history event box.

Figure 1
History Tab in Cleo Application “Single Line” Display Mode

History tab in Colabrativ’s Clinical Entry and Operations (Cleo) application displaying a fictitious ovarian cancer patient history in single line display mode. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

All history events have a common set of information about the event, including: date of the event, notes on the event and the source of the information. The source of the information can be: Medical Records, Pathology Reports, Imaging Records, Patient and Physician Communications. The source of the information can be uploaded into the history event, and are securely stored on an encrypted drive.

Both display modes have access to any medical record documents that have been uploaded in a history event. In the “single” line mode a file icon can be clicked on to download the medical record file. In the detailed display mode the full name of the file is a download link to the file, see Figure 2. Multiple files can be uploaded for any history event. This is commonly done for surgical records and their associated pathology reports.

Diagnostic Procedure

A diagnostic procedure, such as the determination of the patient CA-125 level, used to monitor ovarian cancer patient response to therapy. In addition to the basic information described above, a Diagnostic Procedure history event has information on the test used, and its result. If there is evidence for any change in the patient’s status then that information is collected, along with who made the determination that the patient status had changed.

Figure 2
Single Line and Detailed Displays of Diagnostic Procedure History Event

A fictitious ovarian cancer patient Diagnostic Procedure history event shown in single line display mode (A) and detailed display mode (B) in Colabrativ’s Clinical Entry and Operations (Cleo) application. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

Imaging Procedure

An Imaging Procedure history event has information on the procedure type, the Body Region imaged and the observations made from the images. Like Diagnostic Procedure events, an Imaging Procedures can have “Evidence For” any change in the patient’s status.

Figure 3
Detailed Displays of Imaging Procedure History Event

Imaging Procedure history event shown in detailed display mode in Colabrativ’s Clinical Entry and Operations (Cleo) application. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

Biopsy and Centesis

Both Biopsy and Centesis history events use the same panel structure. In addition to the basic information described above, these history events have information on the procedure used, and if there was evidence for any change in the patient’s status. In addition, the pathological analysis of any material collected, e.g. Cancer type, Histology, Stage and Grade can be entered. If the pathological analysis is the “Patient’s Staging Information Source”, then one can check this box and the patient’s Summary at the top of the history will be populated with this information. This option is also available for surgical events.

Figure 4
Detailed Displays of Biopsy History Event

A fictitious ovarian cancer patient Summary and Biopsy history event shown in the detailed display mode in Colabrativ’s Clinical Entry and Operations (Cleo) application. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

Surgery

Surgery history events are similar to Biopsies and Centeses, in that they all can have pathological analysis of any sample collected, e.g. Cancer type, Histology, Stage and Grade can be entered, and that information can be used to populate the patient’s Summary. They differ in that multiple procedures can be performed during a surgery, and they do not have “Evidence For” patient change in the status option.

Figure 5
Detailed Displays of Surgery History Event

Surgery history event shown in the detailed display mode with an uploaded medical record and pathology report in Colabrativ’s Clinical Entry and Operations (Cleo) application. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

Chemotherapy

Chemotherapy events contain information on the chemotherapy agents used and the cycles of chemotherapy that were performed. A typical chemotherapy cycle is three consecutive weeks of treatment, followed by a week off. The cycle information is traced using the first to last cycle. This allows for changes in treatment, such as dropping an agent after the first cycle and replacing it with a new agent on the second cycle or when a drug dose is lowered. Some patients are enrolled in clinical trials, in which one may not know what treatment the patient received, due to the blind nature of the clinical trial.

Figure 6
Detailed Displays of Chemotherapy History Event

Chemotherapy history event shown in the detailed display mode in Colabrativ’s Clinical Entry and Operations (Cleo) application. All of the personal information displayed in this figure is fictitious, and does not represent a real individual or their medical history.

Other History Events Supported

The other history events that Colabrativ’s Clinical Entry and Operations (Cleo) application support are shown below.

Cleo is the result of a close collaboration between Clearity and Colabrativ. The project was under the direction of Dr. Deborah Zajchowski, The Clearity Foundation’s Scientific Director. The goal of the project was to move Clearity’s operations from Microsoft’s Access to an enterprise system. The project has two phases. The first phase was to migrate patient, physician, specimen data and test results from Access to Cleo. As of today, this has been accomplished. In the second phase we will be migrating patient medical histories from Access to Cleo.

Analysis of a patient’s test results is performed by a third party application on a second server. The Clearity staff use Cleo to initialize analysis requests and archive data that was sent for analysis. Cleo sends the patient information to the analysis server in a de-identified form (removal of information from the data that could be used to identify an individual). The analysis is then compiled by the Clearity staff into a report that is sent to the patient and their physician. The report highlights clinical treatment options based on the patient’s tumor molecular profile that is generated from the test results.

If you are interested in learning more about Cleo, please contact us at Colabrativ, Inc.

Health Care Cost Reduction through Open Data

The goal for this Health Data Initiative was to spur health care innovation that will drive down the cost of healthcare by allowing everyone to have access to health care information while protecting privacy and maintaining confidentiality of the information. Mr. Park presented an example of how quickly such a scenario could come about. In February of 2011, Georgetown hosted a hack-a-ton. IN 8 hours, a group from Mia in Pittsburgh having no healthcare background, but with expertise in supply chain management built a working prototype of Food Oasis, an app to address the food desert problem. If you live in a food desert, you do not have access to healthy food. You can text a message to Food Oasis indicating the food you would like to purchase. The message gets sent to a web site where farmers’ markets and food coops can view the orders. These suppliers then aggregate the data and find the orders they can fulfill. They then text back to consumers when and where their orders can be picked up. Due to the low overhead, this turns out to be a cost effective way of resolving this problem.

You Have the Right to Your Medical Records

You absolutely have the rights to your medical records. In fact the head of the Department of Health and Human Services, check withing Todd for the name, has published an open letter stating that you have the rights to your own medical records.

Information at HealthData.gov

At healthdata.gov you can find information on:

I would encourage you to listen to the recording of Mr. Park’s talk on The Commonwealth Club of California web site. He covered many more health case related and open data topics during the hour he talked and answered audience questions.