For almost three years decades, Regenstrief Institute investigators have successfully captured electronic medical information for clinical and research purposes. They have been leaders in the field of electronic medical record standards. They have built an operational, city-wide medical informatics network (consisting of Indianapolis? five major hospital systems). Building on these proven strengths, we propose to create an """"""""Indianapolis Pathology Informatics Network"""""""", supplementing these five major systems with Indiana?s Cancer Registry, the Veteran?s Health system, and a large pathology group. The included hospitals account for roughly 95 percent of the city?s hospitalizations and reported cancer cases. This population-based database will initially provide access to roughly 1.5 million pathology reports and 4.5 million tissue blocks. These data will be linked to hospital laboratory results, radiology reports, medication orders, discharge summaries, diagnostic codes, procedure codes, dates of encounters, and cancer registry data from all participating hospitals. We will base our described distributed system on those operating systems, database systems, programming languages , and software (open-source as available) that will facilitate low-cost and secure national implementation. We will allow for several different query methods of the resultant database, building a multi-tier system that will distribute queries to each of the SPRs, authenticate users, de-identify and encrypt all clinical information, and audit the entire process. We will collaborate with a well-established leading company (A-Life) and an expert in the field of NLP in order to automatically code pathology reports into UMLS. Pathologists from each of the six participating hospitals have agreed to commit time to coordinating activities and reviewing automatically coded data streams from their respective sites. Published experts in the fields of Internet communication, the Next Generation Internet, de-identification of patient data, and security issues will further ensure the success of this valuable project.
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