Scott P Narus

University of Utah, Salt Lake City, Utah, United States

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Publications (41)42.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Institutional Review Boards (IRBs) are a critical component of clinical research and can become a significant bottleneck due to the dramatic increase, in both volume and complexity of clinical research. Despite the interest in developing clinical research informatics (CRI) systems and supporting data standards to increase clinical research efficiency and interoperability, informatics research in the IRB domain has not attracted much attention in the scientific community. The lack of standardized and structured application forms across different IRBs causes inefficient and inconsistent proposal reviews and cumbersome workflows. These issues are even more prominent in multi-institutional clinical research that is rapidly becoming the norm. This paper proposes and evaluates a domain analysis model for electronic IRB (eIRB) systems, paving the way for streamlined clinical research workflow via integration with other CRI systems and improved IRB application throughput via computer-assisted decision support.
    Journal of biomedical informatics. 06/2014;
  • Journal of Biomedical Informatics. 01/2014;
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    ABSTRACT: How can health sciences librarians and biomedical informaticians offer relevant support to Clinical and Translational Science Award (CTSA) personnel? The Spencer S. Eccles Health Sciences Library and the associate vice president for information technology for the health sciences office at the University of Utah conducted a needs assessment. Faculty and staff from these two units, with the services of a consultant and other CTSA partners, employed a survey, focus groups, interviews, and committee discussions. An information portal was created to meet identified needs. A directive white paper was created. The process employed to plan a virtual and physical collaborative, collegial space for clinical researchers at the university and its three inter-institutional CTSA partners is described. The university's model can assist other librarians and informaticians with how to become part of a CTSA-focused infrastructure for clinical and translational research and serve researchers in general.
    Journal of the Medical Library Association JMLA 01/2013; 101(1):4-11. · 0.99 Impact Factor
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    ABSTRACT: The sharing of personally identifiable information across organizational boundaries to facilitate patient identification in Utah presents significant policy challenges. Our objective was to create a focus area maturity model to describe and evaluate our progress in developing a policy framework to support a statewide master person index (sMPI) for healthcare and public health operations and research in Utah. We used various artifacts, including minutes from policy guidance committee meetings over a span of 18 months, a report from Utah's Digital Health Services Commission, and a draft technical requirements document to retrospectively analyze our work and create a focus area maturity model describing the domain of policy needed to support the sMPI. We then used our model to assess our progress and future goals. The focus area maturity model provides an orderly path that can guide the complex process of developing a functional statewide master person index among diverse, autonomous partners. While this paper focuses on our experience in Utah, we believe that the arguments for using a focus area maturity model to guide the development of state or regional MPIs is of general interest.
    Online journal of public health informatics. 01/2013; 5(2):210.
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    ABSTRACT: Accurate interpretation of gene testing is a key component in customizing patient therapy. Where confirming evidence for a gene variant is lacking, computational prediction may be employed. A standardized framework, however, does not yet exist for quantitative evaluation of disease association for uncertain or novel gene variants in an objective manner. Here, complementary predictors for missense gene variants were incorporated into a weighted Consensus framework that includes calculated reference intervals from known disease outcomes. Data visualization for clinical reporting is also discussed.
    Genome Medicine 05/2012; 4(5):48. · 3.40 Impact Factor
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    ABSTRACT: The rapid advance of gene sequencing technologies has produced an unprecedented rate of discovery of genome variation in humans. A growing number of authoritative clinical repositories archive gene variants and disease phenotypes, yet there are currently many more gene variants that lack clear annotation or disease association. To date, there has been very limited coverage of gene-specific predictors in the literature. Here the evaluation is presented of "gene-specific" predictor models based on a naïve Bayesian classifier for 20 gene-disease datasets, containing 3986 variants with clinically characterized patient conditions. The utility of gene-specific prediction is then compared with "all-gene" generalized prediction and also with existing popular predictors. Gene-specific computational prediction models derived from clinically curated gene variant disease datasets often outperform established generalized algorithms for novel and uncertain gene variants.
    Journal of the American Medical Informatics Association 03/2012; 19(2):207-11. · 3.57 Impact Factor
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    ABSTRACT: We designed and implemented an electronic patient tracking system with improved user authentication and patient selection. We then measured access to clinical information from previous clinical encounters before and after implementation of the system. Clinicians accessed longitudinal information for 16% of patient encounters before, and 40% of patient encounters after the intervention, indicating such a system can improve clinician access to information. We also attempted to evaluate the impact of providing this access on inpatient admissions from the emergency department, by comparing the odds of inpatient admission from an emergency department before and after the improved access was made available. Patients were 24% less likely to be admitted after the implementation of improved access. However, there were many potential confounders, based on the inherent pre-post design of the evaluation. Our experience has strong implications for current health information exchange initiatives.
    Applied clinical informatics. 01/2012; 3(3):290-300.
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    ABSTRACT: Microbiology study results are necessary for conducting many comparative effectiveness research studies. Unlike core laboratory test results, microbiology results have a complex structure. Federating and integrating microbiology data from six disparate electronic medical record systems is challenging and requires a team of varied skills. The PHIS+ consortium which is partnership between members of the Pediatric Research in Inpatient Settings (PRIS) network, the Children's Hospital Association and the University of Utah, have used "FURTHeR' for federating laboratory data. We present our process and initial results for federating microbiology data from six pediatric hospitals.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2012; 2012:281-90.
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    ABSTRACT: Integrating clinical data with administrative data across disparate electronic medical record systems will help improve the internal and external validity of comparative effectiveness research. The Pediatric Health Information System (PHIS) currently collects administrative information from 43 pediatric hospital members of the Child Health Corporation of America (CHCA). Members of the Pediatric Research in Inpatient Settings (PRIS) network have partnered with CHCA and the University of Utah Biomedical Informatics Core to create an enhanced version of PHIS that includes clinical data. A specialized version of a data federation architecture from the University of Utah (“FURTHeR”) is being developed to integrate the clinical data from the member hospitals into a common repository (“PHIS+”) that is joined with the existing administrative data. We report here on our process for the first phase of federating lab data, and present initial results.
    AMIA Annual Symposium Proceedings; 01/2012
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    ABSTRACT: Clinical research, being patient-oriented, is based predominantly on clinical data— symptoms reported by patients, observations of patients made by healthcare providers, radiological images, and various metrics, including laboratory measurements that reflect physiological functions. Recently, however, a new type of data—genes and their products—has entered the picture, and the expectation is that given clinical conditions can ultimately be linked to the function of specific genes. This new approach is a fruit of the pre-genomic era. That era, which lasted from 1990 to 2003, was defined by the Human Genome Project effort to sequence the nucleotides that make up the human genome and identify its ~25,000 genes. Since all humans have a unique nucleotide sequence, the data produced by this project represents not the genome of a single individual, but the aggregate genome of a small number of anonymous donors. Completion of the effort ushered in the post-genomic era, characterized by the availability of the human genome as well as the complete genomes of numerous reference organisms. How genomic information feeds into clinical research is the topic of this chapter. We first review the molecules that form the “blueprint of life” and discuss the surrounding research methodologies. Then we discuss how genetic data are clinically integrated. Finally, we relate how this new type of data is used in different clinical research domains.
    01/2012; , ISBN: 978-1-84882-447-8
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    ABSTRACT: To evaluate the medical professionals and medical students perceived usefulness of an emergency medical card (EMC) and a continuity of care (CoC) report, in enhancing CoC. The study reviewers included medical professionals from outpatient clinics at Intermountain Healthcare and fourth-year medical students from the University of Utah. Three cases we randomly extracted from a database of patients who had added new care information at the time. EMCs and CoC reports were populated for the cases, and information then de-identified. Using patient information in the electronic medical record (EMR), reviewers evaluated if the EMR information was adequate to support medical decisions made on the patient's diagnosis, medications, laboratory tests, and disposition. The reviewer assessed if the EMC and CoC report information would influence the medical decisions made. An online survey was used to assess the reviewers' perception on the usefulness of the two documents. On average, 94% of the reviewers perceived the EMC to be useful in enhancing medical decision making at the point of care, and 74% found the CoC report to be useful. More specifically, the two documents were found to be useful in decreasing encounter time (100% each), increasing overall knowledge of healthcare providers (100% each), influencing decision on the treatment (94% each), and new laboratory test orders (87% and 90%, respectively). The EMC and CoC report were found to be useful methods for transporting patient healthcare information across the healthcare continuum. The documents were found more specifically to be useful for effective decision making, improving efficiency and quality of care, at the point of care.
    International Journal of Medical Informatics 06/2011; 80(6):412-20. · 2.06 Impact Factor
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    Oren E Livne, N Dustin Schultz, Scott P Narus
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    ABSTRACT: We present a software architecture that federates data from multiple heterogeneous health informatics data sources owned by multiple organizations. The architecture builds upon state-of-the-art open-source Java and XML frameworks in innovative ways. It consists of (a) federated query engine, which manages federated queries and result set aggregation via a patient identification service; and (b) data source facades, which translate the physical data models into a common model on-the-fly and handle large result set streaming. System modules are connected via reusable Apache Camel integration routes and deployed to an OSGi enterprise service bus. We present an application of our architecture that allows users to construct queries via the i2b2 web front-end, and federates patient data from the University of Utah Enterprise Data Warehouse and the Utah Population database. Our system can be easily adopted, extended and integrated with existing SOA Healthcare and HL7 frameworks such as i2b2 and caGrid.
    Journal of Medical Systems 05/2011; 35(5):1211-24. · 1.78 Impact Factor
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    ABSTRACT: Previous investigation at our resident-teaching, family medicine clinics determined that >80% of adult patients have body mass index (BMI) recorded in the electronic medical record. The quality of this measure, however, is not known. The objective of this study was to determine the accuracy of documented BMI. We used an observational study design to determine the means by which clinic staff obtain height and weight values from patients. We found that staff only obtained 35.4% of these measurements according to protocol. The major reason for noncompliance with protocol was that shoes were not removed for the measurements. Our investigation indicated that providers, quality improvement teams, and researchers should not assume the accuracy of the recorded BMI. Future investigation is warranted to improve the quality of these measurements in the outpatient setting.
    Journal for Healthcare Quality 05/2011; 33(3):28-36.
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    ABSTRACT: To evaluate the patients' opinion on the usefulness of the electronic medical card (EMC) and continuity-of-care report in enhancing quality of care, and to assess the effects of the patient-entered data on the quality of data in the electronic medical record (EMR). A structured survey assessed patients' opinion on the usefulness of the EMC and continuity-of-care report. The accuracy of EMR data involved comparing the patient-entered data in the continuity-of-care report with the healthcare-provider-entered data in the EMR. The analysis assessed whether the EMR information was consistent with the patient-entered data. A data completeness evaluation compared data entries in the EMR collected before and after the use of continuity-of-care record application. One hundred and thirty-three patients used the application, of which 76% who had actually used the EMC and continuity-of-care report to seek medical care and/or update EMR information were surveyed. Age was associated with the reported usefulness of the documents. Few users (16%) printed the continuity-of-care reports to take to their healthcare providers for data updates and fewer (9%) to correct errors in the EMR. Overall, 68% of patients found the documents to be useful. Patients reported that the EMC and continuity-of-care report were useful in enhancing quality of care. They were able to identify missing or erroneous data in the EMR data, making them an important source of quality control for their information in the healthcare-provider-maintained EMR.
    International Journal for Quality in Health Care 02/2011; 23(1):60-7. · 1.79 Impact Factor
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    ABSTRACT: Integrating clinical data with administrative data across disparate electronic medical record systems will help improve the internal and external validity of comparative effectiveness research. The Pediatric Health Information System (PHIS) currently collects administrative information from 43 pediatric hospital members of the Child Health Corporation of America (CHCA). Members of the Pediatric Research in Inpatient Settings (PRIS) network have partnered with CHCA and the University of Utah Biomedical Informatics Core to create an enhanced version of PHIS that includes clinical data. A specialized version of a data federation architecture from the University of Utah ("FURTHeR") is being developed to integrate the clinical data from the member hospitals into a common repository ("PHIS+") that is joined with the existing administrative data. We report here on our process for the first phase of federating lab data, and present initial results.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2011; 2011:994-1003.
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    ABSTRACT: Human subjects are indispensable for clinical and translational research. Federal and local agencies issue regulations governing the conduct of research involving human subjects in order to properly protect study participants. Institutional Review Boards (IRBs) have the authority to review human subject research to ensure concordance with these regulations. One of the primary goals of the IRB oversight is to protect research participants' privacy by carefully reviewing the data used and disclosed during a study. However, there are major challenges for IRBs in the typical research process. Due to the information disconnect between the data providers (e.g., a clinical data warehouse) and the IRB, it is often impossible to tell exactly what data has been disclosed to investigators. This causes time-consuming, inefficient, and often ineffective monitoring of clinical studies. This paper proposes an integrated architecture that interconnects a federated healthcare data query platform with an electronic IRB system.
    AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium 01/2010; 2010:291-5.
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    ABSTRACT: To describe the design and implementation procedures for an emergency medical card (EMC) and a continuity of care (CoC) report using the continuity of care record (CCR) standard. We also describe studies to evaluate the effectiveness of these documents in CoC. We convened weekly planning, design, development, implementation, and evaluation meetings, involving 25 outpatient clinics at Intermountain Healthcare. The CCR standard schema and documentation from American Society for Testing and Materials were used to develop the data model. An outside consultant provided further advice on committee-approved designs. We then developed a functional design document for the CCR application implementation. Healthcare professionals (medical doctors and physician assistants) and fourth-year medical students will simulate the will simulate the EMC and CoC report use and assess their usefulness in CoC. The reviewers will review three randomly selected patient cases, using patient information in the electronic medical record, EMC and CoC report. A structured questionnaire with Likert scale will assess the reviewers' perceptions of the documents' usefulness in medical decision making. Other studies will compare patient- and HCP-entered data to evaluate the effect of patient-entered data on the quality of HCP-entered data and assess user-satisfaction with the documents' usefulness in CoC. An automated CCR application compliant with the CCR standard was developed and integrated in an already implemented patient portal at the Intermountain Healthcare clinics. Patients use the application to view, add, modify their information and use the data plus EMR data to create EMC and CoC report. The CCR standard can be used to implement an application to enable patients to not only view but add or modify personal health records, and create, print and share paper EMC and CoC report with HCPs. The documents can be created using HCP-maintained EMR data, in addition to patient-entered data as is currently the norm.
    Methods of Information in Medicine 11/2009; 48(6):519-30. · 1.60 Impact Factor
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    Vojtech Huser, Scott P Narus, Roberto A Rocha
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    ABSTRACT: Provision of query systems which are intuitive for non-experts has been recognized as an important informatics challenge. We developed a prototype of a flowchart-based analytical framework called RetroGuide that enables non-experts to formulate query tasks using a step-based, patient-centered paradigm inspired by workflow technology. We present results of the evaluation of RetroGuide in comparison to Structured Query Language (SQL) in laboratory settings using a mixed method design. We asked 18 human subjects with limited database experience to solve query tasks in RetroGuide and SQL, and quantitatively compared their test scores. A follow-up questionnaire was designed to compare both technologies qualitatively and investigate RetroGuide technology acceptance. The quantitative comparison of test scores showed that the study subjects achieved significantly higher scores using the RetroGuide technology. Qualitative study results indicated that 94% of subjects preferred RetroGuide to SQL because RetroGuide was easier to learn, it better supported temporal tasks, and it seemed to be a more logical modeling paradigm. Additional qualitative evaluation results, based on a technology acceptance model, suggested that a fully developed RetroGuide-like technology would be well accepted by users. Our study is an example of a structure validation study of a prototype query system, results of which provided significant guidance in further development of a novel query paradigm for EHR data. We discuss the strengths and weakness of our study design and results, and their implication for future evaluations of query systems in general.
    Journal of Biomedical Informatics 07/2009; 43(1):41-50. · 2.13 Impact Factor
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    ABSTRACT: This paper presents the rationale for designing and implementing the next-generation of public health information systems using grid computing concepts and tools. Our attempt is to evaluate all grid types including data grids for sharing information and computational grids for accessing computational resources on demand. Public health is a broad domain that requires coordinated uses of disparate and heterogeneous information systems. System interoperability in public health is limited. The next-generation public health information systems must overcome barriers to integration and interoperability, leverage advances in information technology, address emerging requirements, and meet the needs of all stakeholders. Grid-based architecture provides one potential technical solution that deserves serious consideration. Within this context, we describe three discrete public health information system problems and the process by which the Utah Department of Health (UDOH) and the Department of Biomedical Informatics at the University of Utah in the United States has approached the exploration for eventual deployment of a Utah Public Health Informatics Grid. These three problems are: i) integration of internal and external data sources with analytic tools and computational resources; ii) provide external stakeholders with access to public health data and services; and, iii) access, integrate, and analyze internal data for the timely monitoring of population health status and health services. After one year of experience, we have successfully implemented federated queries across disparate administrative domains, and have identified challenges and potential solutions concerning the selection of candidate analytic grid services, data sharing concerns, security models, and strategies for reducing expertise required at a public health agency to implement a public health grid.
    BMC Medical Informatics and Decision Making 07/2009; 9:32. · 1.60 Impact Factor
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    ABSTRACT: This paper presents methods for identifying and analyzing associations among nursing care processes, patient attributes, and patient outcomes using unit-level and patient-level representations of care derived from computerized nurse documentation. The retrospective, descriptive analysis included documented nursing events for 900 Labor and Delivery patients at three hospitals over the 2-month period of January and February 2006. Two models were used to produce quantified measurements of nursing care received by each patient. The first model considered only the hourly census of nurses and patients. The second model considered the size of nurses' patient loads as represented by computerized nurse-entered documentation. Significant relationships were identified between durations of labor and nursing care scores generated by the second model. In addition to the clinical associations identified, the study demonstrated an approach with global application for representing the amount of nursing care received at the individual patient level in analyses of patient outcomes.
    Journal of Biomedical Informatics 03/2009; 42(4):702-9. · 2.13 Impact Factor

Publication Stats

177 Citations
42.17 Total Impact Points

Institutions

  • 2002–2014
    • University of Utah
      • Department of Biomedical Informatics
      Salt Lake City, Utah, United States
  • 2006–2012
    • Columbia University
      • Department of Biomedical Informatics
      New York City, NY, United States
    • Oregon Health and Science University
      • Department of Medical Informatics & Clinical Epidemiology
      Portland, OR, United States