Getting and using data: MI2 supporting MCRN Steven H Rappaport, MD Clinical Informatics MedStar Institute for Innovation Good Afternoon For the past several years, Medstar’s Institute for Innovation has been helping the Medstar Cardiovascular Research Network with some of its most challenging data management needs. It is my pleasure to share with you today some of the results of those efforts

Steven H Rappaport, MD   I have no relevant financial relationships

Topics Patient tagging Big data / case finding Documentation support Census tracking and alerting Post-discharge patient communications Care coordination activity tracking In particular, I will be discussing -- tools that help with flagging patients and patient charts, for patients enrolled in research studies -- self-service capabilities to browse data to find patients who might qualify for research studies -- assisting in gathering research data as part of clinical documentation tasks -- monitoring hospital census to inform cath lab operations -- automating communications with patients after discharge -- and finding ami and chf patients who might benefit from care coordination after discharge, and supporting the workflow of these activities

Powered by Amalga Powerful, general purpose platform, supporting self-service as well as being readily extensible for providing new functionality Repository containing the majority of MedStar data, received in near-real time. Easy to connect data from multiple sources Ability to generate Event notifications, sent via email or as text message Robust data browsing capabilities that combines data across clinical and administrative domains Much of what I will show you has been enabled by Medstar’s use of Amalga, a powerful platform that brings together many of Medstar’s clinical and administrative information systems And building new functionality on top of this combined data set This includes EMR data, as well as data from cath lab, radiology, echocardiographic and registry management systems

Tagging Story: want a way to manually identify collections of visits or patients, and use those collections for driving reports, workflows and alerts Solution: general purpose system that allows users to apply permissioned tags to visits Tags can be applied by designated users Tags attached to visits are visible to designated users Enables: Showing lists of visits and/or patients who have specified tags Lists can bring in other data known about these patients for display and/or filtering Alerting when tagged patients have events, such as admissions Lets start with tagging MCRN staff had several needs. One was, while working in the electronic medical record, to know that a patient was enrolled in an MCRN trial. And then, as part of doing chart reviews, to document the status of the reviews and whether patients needed to be reported to registries. And third, to ensure patient bills were appropriately coded to reflect the research enrollment. Solution: use tagging system that allows designated users to see and apply tags to patient visits Users who don’t have permissions to a tag won’t know it has been applied to a patient, ensuring the privacy of the research data

Tagging uses Research patient flagging for activity alerts and billing support NCDR and PCI Review ECMO, LVAD and Heart Transplant patients Including CRISP events

Research patients, in house Also get alerts when tagged patients are admitted And can use tags to drive workflow of chart abstraction processes

Big Data / Case Finding Story: want a way to search for patients who meet specified criteria for QI / Research purposes Want to perform complex manipulations of identified cohorts Want to bring many domains of data into the identification process Desire for restricting display of PHI, and time limiting access, based on IRB requirements Solution: leverage standard Amalga capabilities for showing, filtering and analyzing cross-domain views of data Add overlay for time and content limiting what a user can see based on membership in a group Add tools for saving and manipulating static cohorts, and using the cohorts as filters Next area of need is in case finding Many researchers who are continually coming up with questions Questions can often be answered from data already in electronic systems But that data is often hard to access and especially to combine By using Amalga, which brings together data from many systems, this process can be simplified

Examples Cath and CT on same day, along with specified pre/post study labs, and diagnoses AMI/CHF patients with Medicare insurance who might benefit from care coordination Takotsubo patients: admission identification at WHC for research enrollment Echo after positive cocaine toxicity screen Venn-diagram cohort manipulation

Clinical Documentation Story: Desire for migrating from paper to electronic narrative notes for following research patients after a procedure Need for automated data collection as part of the note generation Solution: use combination of Amalga’s note generation tools and custom dialog Data collected is stored in clinical note and also available for merging with Aortic Valve Stenosis database Electronically signed and browsable both in Amalga and EMR Next area is clinical documentation Until recently, outpatient followup of research enrollees was done on paper. This was obviously error prone and hard to find, and required manual review for capturing research data

Documentation Support

Census Tracking and Alerting

Post-discharge communications Story: desire to send periodic communications to patients automatically after discharge, for customer service and care coordination purposes Solution: custom tools built in Amalga Used for post-cath, post-cardiac surgery, and post-AMI/CHF care coordination purposes

Message configuration

Care Coordination Support Story: need a way to find patients who might benefit from post-discharge care coordination in order to optimize outpatient management and avoid readmission Solution: Use standard Amalga dialogs for filtering inpatient census based on program requirements Custom tools in Amalga for supporting care coordinator workflow Documentation of calls with and services performed on behalf of patient Workflow support for driving when calls and/or tasks should be performed

Better Together Research + Innovation Including CRISP events