Enhancing the Representational Power of i2b2 through Referent Tracking

The Informatics for Integrating Biology and the Bedside (i2b2) software platform has proven successful in leveraging clinical enterprise data for the identification of cohorts of patients satisfying certain demographic, phenotypic and genetic criteria in support of further studies. An unanswered question thus far is whether i2b2 search criteria could include characteristics of assertions themselves, e.g. diagnoses, rather than what the assertions (observations) are about, e.g. diseases. This would allow, for instance, to find cohorts of patients for which different providers have been in disagreement about what condition the patient is suffering from. Previous research has shown that this requires more explicit detail about, and unique identification of, two sorts of entities: those that directly or indirectly contribute to the coming into existence of such observations and those that are either explicitly mentioned or merely implied in the assertions. Our research here demonstrates that i2b2's modifier system can be used to represent the relationships between observations and their explicit or implied referents on the one hand, and between relevant referents themselves on the other hand, both in combination with the storage of explicit unique instance identifiers for these observations and referents in i2b2's fact table. While this approach adheres to i2b2's base functionality and implementation specifications, it makes explicit ambiguities and confusions that would otherwise remain undetected.