**Transcript of Cyberseminar**

**VIReC Corporate Data Warehouse**

**A Practical Guide to Using the Corporate Data Warehouse LabChem Data: VA Informatics and Computing**

**Presenter:  Gowtham A Rao, MD, PhD**

**June 20, 2013**

**A Practical Guide to Using the Corporate Data Warehouse LabChem Data: VA Informatics and Computing**

**June 20, 2013**

*This is an unedited transcript of this session. As such, it may contain omissions or errors due to sound quality or misinterpretation. For clarification or verification of any points in the transcript, please refer to the audio version posted at www.hsrd.research.va.gov/cyberseminars/catalog-archive.cfm or contact:**virec@va.gov*

Moderator:I am pleased to welcome today’s speaker, Dr. Rao.

Dr. Rao:Thank you everyone. Thank you for this opportunity to present my experience on conducting research using the VA Corporate Data Warehouse Lab Chemistry Data. I’m a third-year medical resident in training, and during my training I have used the VA resources for research purposes. VIReC requested that I provide a simple and practical guide on how to use the new LabChem data.

This presentation is a summary of my experience. Please understand that there may be alternate or even better interpretations on how to use – how to best use LabChem data. This is what has worked for me. I have designed this presentation to be a primer to a new researcher who wants to use this new data source. The structure of this presentation is as follows, I will provide progressively more complex information as we advanced through the slides. Initially I will talk about, what this LabChem data is. Then, we will dive into what is in it, and finally and most importantly, how do we use it?

The last few slides will be an example of a use case scenario of how we may identify the tests we want, and use the results of the tests for our purposes. Before we proceed, there are a few things I would like you to know. Generally, there are two types of users of VA data; research users, and operational users. Operational users are administrative, clinical or support staff who need to use VA CDW data to meet their respective VA roles. They have direct or full access to CDW data. 

Research users, on the other hand, have project specific access and each project has to be approved by the Institutional Review Board of record, and at the oversight organizations. So please remember, research users have project specific access, while operational users have full access. This presentation is directed towards the research audience. However, it is also applicable to operational users. I will present multiple screenshots or images throughout the presentation. For simplicity, I have chosen to present the operational view.

Researchers will have to make some minor modifications to make this presentation work for you, and I will describe those modifications. Second, research users may obtain access to CDW data either on the VINCI, or the non-VINCI platforms. This presentation is applicable to both types of research users. The screenshots are using the VINCI Microsoft Server Management Studio software tool. Depending on your access and how it is configured, you may have access to the data through SAS, or other software tools. The concepts I’m presenting are generalizable to all of these tools, or environments. 

Moderator:And I’m going to start off with a poll question here. We are wondering, have you used DCW Lab Chemistry Data before? Just select yes, or no. I’m going to give you a few more seconds to respond to the question here. Thank you for those of you who have responded. And are results here are, about two-thirds of the audience have not used CDW Lab Chemistry Data, and about one-third have. Thank you to everyone for responding.

Dr. Rao:OK. So, it sounds like about a quarter, maybe a little bit more than a quarter of the audience have used the CDW Lab Chemistry Data. That is very good. So, let’s now begin the first section of the presentation to understand what the CDW Lab Chemistry Data is. Now, the CDW Lab Chemistry Data is an extract of chemistry, hematology, toxicology, serology, and other related lab tests starting from around 1999. It should contain all of the lab data available on the Vista servers. And it is consolidated into one file, the Chem.LabChem file.

It is updated frequently. The other three files are listed here; the Dim.LabChemTest, Dim/LOINC, Dim.NationalVALabCode are metadata that help to characterize the LabChem data. Metadata is the term used to describe data about data. So, the Dim files contain additional information to characterize the Chem.LabChem file. This is a screenshot of the Microsoft Sequel Server Management Studio Software, as seen from inside the VINCI platform. 

This is a relational data management software and is shown connected to one of the VA servers, the vhacdwrb01.vha.med.va.gov. There are other servers that may hold CDW data. Formations [PH] are managed using your VA sign on credentials. Under the list of databases, one database is the CDW Work database. When you expand the view section of this database, you will see a number of files. Almost every one should have – should see and have access to the Dim schema. That is the metadata, such as the Dim.LabChemTest, Dim.LOINC and Dim.NationalVALabCode.

Only operational users will have access to the Chem schema that is Lab.LabChem, and I have shown those on this picture. Throughout this presentation, I will be demonstrating how to query the Chem.LabChem data. Researchers don’t have direct access to Chem.LabChem data. Here is an example of how Chem.LabChem data may look for a researcher. On your project specific database, for example in my case, I have a research project database called ORD_Rao_2012 and there are some more numbers.

I have masked the numbers for privacy purposes. Under the view section of this database, my data manager has given me access to Dflt.LabChem. You see the arrow over there. To use the LabChem data for your project, you will have to systematically place in your code, the Chem.LabChem with the Dflt.LabChem. The actual name may be different for your project, so please check with your data manager, or your data-steward. 

In the previous slide, I showed you how the LabChem data was accessed through the Microsoft Sequel Management Studio. Here is an example of mapping the CDW LabChem data directly through SAS. If you desire this type of access, please work through the Data Manager, or your SAS administrator for mapping purposes. Appropriate justifications may be required. The Chem.LabChem file has more than five billion rows, billion with a B. Each row represents one lab test with one lab result, corresponding to one time point for one individual.

One lab test, one result, one time point, one individual. It is extracted from the Vista file 63 and 63.04. We will go into more details into what variables are contained in this file, in the next section. Dim.LOINC. This is the metadata we talked about. LOINC is a universal standardized convention for naming, or coding lab tests. Conceptually I equate LOINC to be something like a 39 code, an internationally standardized coding convention.

The Dim.LOINC file represents the VA’s implementation of LOINC. This is the main key table that will help you to identify a lab test on the Chem.LabChem file. We will look deeper into this in the next section. The next metadata file was the Dim.LabChem test. This contains the lab test names as seen by a provider at the time of ordering a test, or while displaying the results on either the Vista system, or the CPRS system. These lab test names are not standardized, and subject to local and regional variations.

Still, they may be used as key tables to identify lab tests by linking them back to the Chem.LabChem file. We will also look into this in more detail. The next metadata file is the Dim.NationalVALabCode. The National VA Lab Code identifies each lab test with either a workload code, National VA Lab Code, and a LOINC. This is an effort to standardize the local lab tests names, and this is how LOINC codes are mapped to the lab tests. The workload codes – the workload codes are used by local, regional and national VA entities for obtaining summary information on utilization of lab tests. Heidi?

Moderator:We have a second poll question for everyone here. Our question; what best describes your role as a user of the CDW Lab Chemistry Data? Researcher, clinician, administrator/policymaker, or Other (including non-VA). Your role may be split a little bit, if you could just pick the one that would best describe you, that would be fantastic. And here are our – here are the results. About 52 percent are researchers, 11 percent clinicians, 18 percent administrator, or policymaker, and 20 percent other. Thank you everyone for your responses.

Dr. Rao:OK. Great. So it sounds like the majority are researchers. There are also a few operational users. So let’s go into the next section of the presentation to review what each one of these individual data sources contain, like a more deep dive into the data. Here is a screenshot of – of a code returned to query the Chem.LabChem data. The SQL code is the green colored program in the background. It labels all of the variables present in the Chem.LabChem table. There are about 20 different variables, and we don’t need to know what they all are. 

From a practical perspective, a researcher who wants to use a particular lab result for research needs five pieces of information. Whose lab test is this? That is the patient ID. What lab test is this? A lab name. What time was this lab test done? What specimen was used for the lab test? And what is the result of the lab test? And these are the variables that I think are important, to get into these five components. So let’s get into a little bit more detail.

Here I have changed the SQL code by just selecting from the 20-plus variables, the variables that we really need. Let’s look at the code in the background. You will see LabChemTestSID, Patient SID, LabChemSpecimenDateTime, LabChemResultValue, LabChemResultNumericValue, Specimen, LabChemLocationSID, and LOINCSID. Let’s focus on the patient identifier first. In the VA you may identify an individual patient using multiple forms of IDs. The most common ones that we are familiar with, is the Social Security number and the scrambled Social Security number.

The recommended form of identifier is the PatientICN number, as both the Social Security number and the scrambled Social Security number have some inconsistencies. Every patient should have one Social Security number, one scrambled Social Security number, and one PatientICN number. The PatientSID number, on the other hand, a single patient may have multiple, different SID numbers. To uniquely identify a patient, you will have to use a PatientSID as a foreign key, and join it to a crosswalk file that contains PatientSID as well as their corresponding SSN/scrambled SSN or PatientICN number, depending upon your needs.

Now that we know how to uniquely identify an individual patient, let’s look at how to identify a lab test. There are two variables that you may use to identify a lab test. The LOINC – the LOINCSID, and the LabChemTestSID. Let’s first talk about the LOINCSID. The LOINCSID is the foreign key that you may use to join to the metadata table, Dim.LOINC. Just a tip, this is an important tip and I want you to try to follow me here. Any variable that has an SID on the end is either a primary key or a foreign key.

For example, in the Chem.LabChem, the primary key is the LabChemSID. LabChemSID. SID is not shown in this screenshot, but was present in one of the previous screenshots that had the 20-plus variables. The primary key of a table will have a name that is similar to the table name. For example, the LabChem table has a primary key called, LabChemSID. The LOINC table has a primary key called, LOINCSID, and so on, and so forth.

In the metadata table – I’m sorry, in the LabChem file, LabChemTestSID is a second variable that you may use to identify a lab test. The first variable was the LOINCSID. The second variable is the LabChemTestSID. LabChemTestSID is the foreign key that you will link to Dim.LabChemTest metadata files. It contains the non-standardized lab test names. Next, after identifying the patient identifier and the lab test name, let’s move to the third component, which is the time. I use the LabChemSpecimenDateTime as the time variable for my queries.

This variable is supposed to represent when the specimen was collected from the patient. This is not when the results were reported, or the time the test was done, but when the specimen was collected from the patient. So, it is more biologically meaningful, and I recommend the use of this time variable for your research purposes. Now, the fourth component, or the most important component is obviously the – the actual lab result. There are two important variables here; the LabChemResultValue, and LabChemResultNumericValue.

Let’s talk about the LabChemResultValue first. LabChemResultValue is the result that matches exactly with as it is reported in the Vista, or the CPRS system. It is human understandable, but may not be machine understandable. That is, you cannot do any computation on this variable. You cannot get an average level of serum creatinine, for example. Variables are entered in alphanumeric format that may have some misspellings. For example, a text entry for positive may be reported as portative, POS, possitive with an additional S and so on, +1, +.

The second result variable is the LabChemResultNumericValue. This is derived from the LabChemResultValue and it’s in numeric format. It is both human understandable, and machine understandable. You may – you are able to do computation on this, such as you are able to obtain the average serum creatinine. If there is any alpha characters in the lab results value, this is null in the LabChemResultNumericValue. So you will lose information such as test-based – text-base entries, including the words positive, negative, +1, so on.

When wording these text based result values into computable numeric results, it depends on your threshold of tolerance for error and interpretation. I have done this for my research projects, and I think this discussion of interpreting the null values is beyond the scope of this presentation, but I am more than happy to discuss the process of result standardization offline. Then, there are two additional variables of importance; the specimen, and LabChemLocationSID.

Specimen variables tell us the specimen type that was collected from the patient. It could be urine, serum, blood, CSF, others. Unfortunately, the entries are not standardized, and are subject to spelling errors and nonconventional names. The LabChemLocationSID is supposed to represent the location the test was performed. I consider this particular component beyond the scope of this presentation and won’t be discussing it any further.

So this brings us to the final section. Now that we have understood what variables are present in the respective files, how do we actually use it? Let’s go deeper into – into the data source. Now I have presented a screenshot earlier, and we agreed at that time that there are five main components to achieve our research goals; Patient ID, lab name, time, specimen and result. The patient ID component is clear. We just have to do a crosswalk of the PatientSID, to either a Social Security number, scrambled Social Security number, or PatientICN.

I want to focus – I want to start out with the lab name, identifying a particular lab name. Let’s first start with LOINCSID. LOINCSID is the – the foreign key that may be joined with Dim.LOINC. This is a screenshot of the Dim.LOINC metadata table. There are many variables, but the main variables are the LOINCSID, LOINC, and LOINCIEN. The LOINCSID is the primary key for this table. Let’s talk about the structure of the LOINC itself.

LOINC is a standardized way of coding lab tests. To understand more about the LOINC codes, I encourage you to go to www.loinc.org where that maintains a comprehensive list of all the LOINC codes. The general structure of a LOINC code is five numbers, a hyphen, and then another number. It’s a six part variable. The last number after the hyphen, generally represents the type of method used for a particular lab test. 

CDW also maintains a variable called LOINCIEN. This is a derivative of LOINC. It is a five-part name where the hyphen and the last number is just dropped. I recommend that you use an external site to identify the LOINC codes for the lab tests that you are interested in. Remember that a single lab test may have more than one LOINC code. The site that I use to identify LOINC are, LOINC.org, and ahrq.org. AHRQ has made a list of top, most commonly used LOINC codes by test type. I highly recommend that you go through that.

Here are a few examples, but it’s not comprehensive. I’ve shown two LOINC codes that represent serum creatinine, and three LOINC codes that represent platelet count. This is a screenshot of the website LOINC.org. The bottom left has a list of common LOINC codes that is very useful. I recommend that you – to go through it. Here is an example of an SQL code to create a view that contains all of the LOINCSIDs for serum creatinine. As you can see the same LOINC code has a number of different LOINCSIDs. I have blurred them a little bit just for privacy purposes.

We can use the LOINCSID to join with the Chem.LabChem table so as to get the serum creatinine results. Let’s talk briefly about the data quality. In depth analysis of data quality is beyond the scope of this presentation. As of July 2011, two years ago, there were more than five billion unique rows of data in the Chem.LabChem table. Of these, more than 3.8 billion had a LabChem result numeric value, and almost all of the rows with a LabChemResultNumericValue had a valid LOINCSID. On the contrary, there were about 1.3 billion rows with a null for LabChemResultNumericValue.

This is because the results were some form of text entry that could not be converted into numeric value. Only a small fraction of this 1.3 billion had a LOINCSID. When you look at what test names are likely to have a LabChemResultNumericValue, they are the – they are the traditional numeric results, such as hemoglobin, serum creatinine, platelet counts, etc. These tests almost always have numbers in the results column. So the test – test results that have numbers in the results column are more likely to have a LOINCSID. Very, very highly likely.

On the other hand, when you look at test names that are more likely to have non-numeric results, such as hepatitis C genotype, or urine proteinuria, they have a very low LOINCSID. My interpretation is that test types that are traditionally reported as numbers, LOINCSID is very good in mapping. It’s probably not as good for results that are traditionally not numeric. Now this is based on 2011 statistics. In 2013, the mapping may have gotten better. So my recommendation is to create a view containing the LOINCSID for the lab test that you are interested in, and then just doing a join with Chem.LabChem.

And I recommend that you use this method exclusively for lab tests that are expected to have numeric results. And this should solve more than 95 percent of your needs. Now the second option for identifying the lab test names, is by using the metadata table, Dim.LabChemTest. Remember, this is the one that contains the unstandardized lab names, as it is generally shown through CPRS, or the Vista system. There’s a number of variables – this table has a number of variables as shown in the code in the background.

Let’s dive into this metadata table in more detail. The two variables of importance are the LabChemTestSID and the LabChemTestName. We can do a search, or text search for the unstandardized lab test names that we are interested in. So let’s see how that is done. Here we are continuing with an example of serum creatinine. This is a complicated option, and you will need to work with your clinical subject expert. You will have to be able to differentiate between similar sounding, but different lab test names. You will have to overcome problems such as misspellings, or abbreviations for the same test name.

In this example, I’m searching for serum creatinine, but there are tests like, creatinine clearance, creatinine kinase, BUN/creatinine ratio that I’m not interested in. So I have to write some sort of a search that eliminates the text results that I – the test names that I do not want, and keep the test names that I want. And this is an attempt at that, that is not complete. You will have the computer refine this until you meet your tolerance levels. This method is not easy, and may not be for everyone.

I recommend that you consider this method for rare tests with – where – which have non-numeric results, such as HIV, genotypes, hepatitis-C genotypes. You will have to use your judgment here, and determine your tolerance levels. Finally, let’s focus on identifying the specimen type. One of the major problems with the DSS lab results is that it does not report the specimen type. For example, albumin in DSS lab result file may represent serum albumin, or it may be urine albumin. There is no reliable way to differentiate between urine and serum albumin in DSS.

You may be able to overcome this limitation of DSS at least partly by using the CDW LabChem data. When I queried the unique ways in which specimen types were entered in the Chem.LabChem data, there were about 4,500 unique specimen names. Obviously, the human body does not have 4,500 unique types of specimens. The specimen names are – this is because specimen names are not standardized. Many times they are entered using unconventional descriptors, and thus the list keeps on building up.

I use this code – this method to recode the specimen type and it works for me. I recommend that you adopt this code for your purposes. This code reclassifies specimens into blood, serums, plasma, urine, CSF, feces or other specimens. If you’re looking for serum creatinine, you would want to restrict to serum. So we – we are now at the final section in our research example, to come up with a use case scenario.

I have chosen serum creatinine throughout this presentation, as it is one of the more common test names of interest. A creatinine test could be serum creatinine, a urine creatinine, or even a muscle creatinine. So, it is important to differentiate the specimen type. The code represented here uses a rare [sic] clause [sic] to restrict the specimen type and the test type. I have selected the LOINC codes from the website LOINC.org. The list of LOINC codes serum creatinine presented here is not comprehensive, but it is sufficient. And when I run this code, the results I get are shown below.

As you see in the results of the query, there are two result columns; LabChemResultValue, and LabChemResultNumericValue. The text entries of the LabChemResultValue, such as the pending, comment, pending, they are converted into NULL in the LabChemResultNumericValue. All the results appear to be within the expected range for serum creatinine, but on one to two. I have obviously masked the PatientSID and LabSpecimenDateTime variables because they are identifiable information and would be a violation of privacy laws, but when you query it, you will see them.

You should be able to adopt this logic, this type of code, to almost any lab test in the CDW LabChem and be successful in your research project. I recommend that you check the results range, and see if they are within the expected range. Finally, I wish you all good luck on your research roles, and if you have any questions, I have – I think we have sufficient time to answer them?

Moderator:Yes we do have a few questions, Dr. Rao. Here is the first one. If the lab test does not have a LOINC number in the source’s system, is the data being populated for CDW? Otherwise, if the LOINC code is missing and you search by LOINC code, you miss the test without it. Is this correct?

Dr. Rao:Can you repeat the question one more time, please? 

Moderator:Sure.

Dr. Rao:You’re breaking up.

Moderator:Sure. If the lab test does not have a LOINC number in the source’s system, is the data being populated for CDW? 

Dr. Rao:So the question I heard was, if there is a missing entry for LOINC code, will that data be – be retained in the CDW lab data file, or not? That’s a very good question, and I would think that the best person to answer that question would be one of the CDW data architects. I am an end-user, presenting my experience. I don’t know the answer to that question.

Moderator:OK. Here’s another one. Is the PatientICN the same as the Master Patient Index?

Dr. Rao:The PatientICN is a unique identifier that uniquely identifies each individual patient. I do not know if this is the same as the Master Index Number. I think there are some – literature available on VA internet on the interpretation of PatientICN.

Moderator:OK. How do you correct for SpecimenDateTime errors? For example, A.M. draws in Vista are the time that the draw – that the draw list was printed, not the time the specimen was drawn. How do you correct the SpecimeDateTime errors?

Dr. Rao:Can you repeat that one more time please?

Moderator:Sure. How do you correct for SpecimenDateTime errors. For example, A.M. draws in Vista are the time that the draw – that the draw list was printed, not the time the specimen was drawn. 

Dr. Rao:That’s a very good question too. I would assume there is – as a clinician, I would assume that the date stamp would represent the time period that is closest to the actual blood draw. But if – if the – if the actual time of blood draw is never captured, then it is never captured, we don’t have that information. And that would be a drawback.

Moderator:OK. Great. Thank you for that. LOINC is not a required field in Vista. What do you do about active lab tests that do not have a LOINC code?

Dr. Rao:The second option of querying by test names, doing a – doing a text search would be an option. There is a – I’ve used that option for rare tests, and test types that, like the hepatitis-C genotype that I showed you about. And I would recommend doing that type of search in that case.

Moderator:Great. Here’s another question. Why don’t you use LOINC codes, rather than test names?

Dr. Rao:That would be my first recommendation, to use the LOINC codes instead of the test names. Because test names are not standardized, and it may prove to be difficult to differentiate between similar sounding names through a text search.

Moderator:OK. Great. Thank you for that. Here’s another question. Can the example code be run in SAS instead of Microsoft Sequel?

Dr. Rao:Absolutely. The concept of that code is very similar. You can use either – if you have direct access to the SAS, you can draw in a SAS proxy [PH] Sequel, or a Sequel pass through to Sequel Server, or you may even use it adopted for a data step in SAS.

Moderator:OK. Thank you. Here’s another question. Are ranges for normal test values indicated in any table? How do we know if a test result is high, or low, or critical?

Dr. Rao:I would – I would recommend to work with your clinical subject-matter expert on identifying the critical thresholds for your particular lab tests. Critical thresholds may have changed over time. For example, the – I’ve done a lot of research with hepatitis-C. Hepatitis-C detectable threshold has been, depending upon the assay, 600 units, or 50 units, or even 10 units and even now as low as 5 units. So critical thresholds have varied with time, and it may be best to decide on your own what your thresholds are.

Moderator:OK, we have a couple of – a couple of attendees that asked this question, would you be willing to share your code with us? And what results you obtained from them?

Dr. Rao:I would...

[Crosstalk]

Moderator:A couple of people have asked this.

Dr. Rao:...yes I would be more than happy to do so.

Moderator:OK. Great. Thank you. Here’s another question, can LabChem values, like serum creatinine be linked?

Dr. Rao:I heard the question as, can LabChem values like serum creatinine be linked?

Moderator:Yes. That’s correct.

Dr. Rao:I guess, I would need to follow up and ask, linked to what? It’s – I – I don’t – I think there is – I think the question is not complete to give an answer.

Moderator:Actually they – they’ve included a second part. They said, be linked for an individual across time?

Dr. Rao:Absolutely. There are five – as I presented, there are five components to a lab test. One of the components is the patient ID. The second component is time, the third component is the lab test name. You can do – create your own query, which will have patient ID, time, test name, result over time, as a long table. And that will let you follow an individual lab result, serum creatinine, over time.

Moderator:Great. Thank you Dr. Rao.  Here’s another question. Do you use the component variable in the Dim.LOINC table? And, is it of good quality?

Dr. Rao:The Dim.LOINC table component variable should represent the component as described under LOINC.org website. Now the quality of it as in the VA system, I don’t know the answer to that question. The – the – if the component says that this is – this is – this particular test type on LOINC.org, that was the intent of coding. If the VA – in the VA if there is miscoding, then we can’t do anything about it. It’s an error. So I don’t know what is the penetration of error in this database.

Moderator:Thank you Dr. Rao. Here’s another question. What field contains the measurement units of the test results?

Dr. Rao:Can you repeat that one more time, please?

Moderator:Sure. What field contains the measurement units of the test results?

Dr. Rao:That’s a good question. Let me go back to the slide. So, there are variables here – can you get everybody to see the slide? I’m assuming they can. So, here you can see reference high, reference low, and abnormal flag. So this may be used to answer one of the previous questions. It may not be the best way to do it, but that’s an option. The reference units, there are many ways of doing it. The LOINC.org website will give you the reference range for a particular lab test. 

You may use that. I think there is another place that has the reference, and I don’t remember where it is, but there’s another source. So you’ve got two main sources. One is on this file where my arrow is. And then the second is on the LOINC.org website.

Moderator:Thank you for that. One attendee has asked, what is the best way to contact you if we would like to discuss topics that were outside of the scope of this presentation?

Dr. Rao:I would think just look me up on the VA Outlook email address, and send me an email and we can set up a time to talk.

Moderator:OK. There are a couple more. Should we keep going, Dr. Rao?

Dr. Rao:Absolutely.

Moderator:OK. Is there a separate unit field?

Dr. Rao:I don’t know the answer to that question.

Moderator:OK. Do the rest high, and rest low variables from the LabChem table work well as a range?

Dr. Rao:My personal opinion is not robust enough for me to use it. Because the same test has different reference high and reference low, depending upon the – the local VA lab that has done the results – done the test. So, the reagent used, the – the clinician’s determination, and so on and so forth. So I have not used that variable from Chem.LabChem file.

Moderator:Here’s another question. What are the date formats for LabChem specimen date/time, and admin date/time?

Dr. Rao:It’s a date/time variable. So it has date and time in it. I am sorry I don’t – probably don’t understand the question very well.

Moderator:That’s OK. We have another one. Do you know if the VA has plans to clean the LabChem database so that individual researchers don’t need to duplicate efforts?

Dr. Rao:The – that’s a very good question. That was something that I went through when I first started out. It’s – I think having a centralized data repository is in a good direction. Cleaning is a subjective – you know depending upon the individual researcher’s tolerance level and interpretation. What I interpret as positive based on the – the LabChemResultValue column may not be interpreted as positive by another researcher, or clinician.

So, standardizing it through expert opinion is – is a phenomenally difficult task, and it may happen in the future. But I don’t know of any plans of that sort. It just sounds extremely tough to do.

Moderator:Thank you for that. How widely scoped can data access requests be?

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