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
>
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> Sent by: "Evidence based health (EBH)"
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