Hi Jim,
Thank you, This is how I was hoping the results could be used for as
improved outcomes in conjunction with evidence based care processes. I like
the concept of genomics inclusion a lot, in fact I wondered if this was
possible. I am interested in the diabetes and how you brought them into
effective care, this is really such an important contribution and the
cardiovascular intervention improvements are huge.
I understand people emphacizing the qualitative aspect and their fears in
this regard but I see a lot of people where critical information is just
missing and that makes any kind of intervention less effective and more
costly in time and resources plus I think identifying patterns of successful
care and rejecting those that look good in the lab but don't work in real
life would help everyone.
I appreciate this information and your response,
Amy
-----Original Message-----
From: Evidence based health (EBH)
[mailto:[log in to unmask]] On Behalf Of Jim Walker
Sent: 06 November 2011 10:39 PM
To: [log in to unmask]
Subject: Re: Evidence-Based Medicine in the EMR Era
Hi Amy.
First, to the very far from easy--granting the accuracy of what Marguerite
says:
For most useful analytics, we combine information from the EHR and 12 or so
other databases (including claims) into a data warehouse, where all but the
simplest analytics are performed. The normalization of this data is a
painstaking process. Recommendations are then fed back into the EHR, the
only interface that most of our clinicians use. (Our Keystone Beacon
Community has developed a community data warehouse to which different
organizations contribute their data to support shared care processes across
five rural Pennsylvania counties.)
Second, most of our analytics begin with evidence-based care processes, not
trolling for correlations. (Kaiser has the numbers for doing this more
effectively.) Beginning with process measures that have been validated as
leading to improved outcomes (e.g., retinal exams for people with diabetes),
we create care processes to assure that the interventions are offered to
patients 100% of the time. Then we measure process performance and patient
outcomes looking for correlations (or lack thereof) to guide process
refinement.
For example, our cardiovascular surgeons identified 38 interventions they
believed to have been demonstrated to reduce complications in patients
undergoing elective CABG. At the outset, our patients got them 69% of the
time (better than national benchmark). Within 3 months of re-designing the
process and fitting the EHR to support the team, we were at 95%. We have
been above 98% for the last 2 or 3 years. Outcomes such as return to work,
rate of wound infections, etc. have tended to improve, some of them
statistically significantly. Correlations between individual interventions
and outcomes are performed regularly, with adjustments in interventions
based on the results.
Using this approach in our patient-centered medical home, we have decreased
all-cause admissions in a population of 22,000 Medicare patients.
We currently are using this approach with 15-20 acute problems (e.g.,
cataract surgery) and another 15-20 chronic problems.
We also scan the database (primarily EHR data) for, e.g., patients with GFR
< 60 but without any record of assessment or management of CKD and patients
with HbA1c > 7 and no management of diabetes. We have identified thousands
of such patients and brought them into effective care processes.
We have collected 100,000+ blood samples for genomic analysis to be
correlated with EHR records regarding, e.g., age, gender, problem list, and
response to various drugs.
If I'm talking past your question, please let me know
Best regards.
Jim
James M. Walker, MD, FACP
Chief Medical Information Officer
Geisinger Health System
The best way to predict the future is to invent it.
- Alan Kay
>>> "[log in to unmask]" 11/05/11 10:13 AM >>>
Dear Jim and Marguerite,
Could you elaborate on this? Easy would be awesome but effective with
benefits is even better! My imagination has been sparked by all this and
although it could be an IT nightmare at this point maybe it is an
information goldmine. Banks etc mine data relentlessly for their own ends to
good advantage, it makes sense to Find ways this data could be useful to
progress science and help people
Amy
Amy Price PhD
Empower 2 Go
Building Brain Potential
Http://empower2go.com
Sent from my iPad
On 5 Nov 2011, at 09:57, Jim Walker wrote:
> Thanks, Marguerite.
> It is very far from easy, but you and we do it all the time with
> considerable benefits.
> Jim
>
> James M. Walker, MD, FACP
> Chief Medical Information Officer
> Geisinger Health System
>
> The best way to predict the future is to invent it.
> - Alan Kay
>>>> Marguerite Koster 11/04/11 4:29 PM >>>
> Hi -
>
> Kaiser's decision to remove Vioxx from its regional formularies occurred
>
> before the implementation of the organization's EMR. I should add that
> EMR's are still in their infancy, and usually built as clinical
> management
> systems, rather than systems for robust data extraction and analysis.
> People sometimes have the notion that extracting data from an EMR is an
> easy process. Far from it, though, especially if you want a clean and
> accurate dataset. There are also issues with data that is only
> available
> from EMRs in text format.
>
> Marguerite
>
> NOTICE TO RECIPIENT: If you are not the intended recipient of this
> e-mail, you are prohibited from sharing, copying, or otherwise using or
> disclosing its contents. If you have received this e-mail in error,
> please notify the sender immediately by reply e-mail and permanently
> delete this e-mail and any attachments without reading, forwarding or
> saving them. Thank you.
>
>
>
>
> "Djulbegovic, Benjamin"
> Sent by: "Evidence based health (EBH)"
>
IMPORTANT WARNING: The information in this message (and the documents
attached to it, if any) is confidential and may be legally privileged. It is
intended solely for the addressee. Access to this message by anyone else is
unauthorized. If you are not the intended recipient, any disclosure,
copying, distribution or any action taken, or omitted to be taken, in
reliance on it is prohibited and may be unlawful. If you have received this
message in error, please delete all electronic copies of this message (and
the documents attached to it, if any), destroy any hard copies you may have
created and notify me immediately by replying to this email. Thank you.
Geisinger Health System utilizes an encryption process to safeguard
Protected Health Information and other confidential data contained in
external e-mail messages. If email is encrypted, the recipient will receive
an e-mail instructing them to sign on to the Geisinger Health System Secure
E-mail Message Center to retrieve the encrypted e-mail.
|