One Patient, One Record: Big data from small places

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Presentation transcript:

One Patient, One Record: Big data from small places Dr William L Clifford CMIO, Northern Health Authority

Presenter Disclosure Presenter: William Clifford No current affiliation with any commercial organization. CMIO, Northern Health Medical Director, Health Data Coalition. Honorary Board Member, Applied Informatics for Health Society. Co-chair, Health Information Standards Standing Committee Member, provincial IMIT Standing Committee Board member, PGDoFP Site Lead Informatics, Prince George Family Practice Residency Program

Including what they plan to do “Faithful record of what clinicians have heard, seen, thought and done” Rector, Nolan & Kay, 1991 Foundations for an electronic medical record Including what they plan to do The fundamental basis of the record

Interoperability – IEEE Definition “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.”

Northern Core Clinical Data Set Preferred language (ISO) Preferred gender Race & ethnicity (CDC) Education level (ISCED) Occupation (ISCO-88) Living arrangements Socio-economic (BC DoFP poverty toolkit) Procedures (SNOMED CT) Long-term medications (DIN&ATC) Immunizations (DPD/ATC & PH) Health concerns Problem list – 5,000 SNOMED CT reference set mapped to ICD9-10 Risk for condition & risk factor (SNOMED CT) Unmet needs (Camberwell) Adverse reactions Risk – agent (Multum) and reaction (SNOMED CT) Events

Northern Core Clinical Data Set Continued Laboratory results (LOINC) Common clinical measures (LOINC where possible – PHQ9, GAD7, Palliative Performance Scale, Pain10 etc. ) Medical Imaging (SNOMED CT) Function (ICF) Medical Devices (Health Canada) Data quality support and review (“the placemat”) Care plan (CONTsys, Old@Home, HL7) Preferences (including consent, advance directives and therapeutic precautions Goals & targets Planned Actions Resources Barriers Team (connections) Associated parties (Power of Attorney, substitute decision maker, spouse etc.)

Some Elements of the Universal Schema Demographics Occupation Ethnicity Observations Measurable including laboratory results Non-measurable (e.g. cyanosis) By history (e.g. insomnia) Imaging reports Procedures/interventions Health Issues Medication list Prescriptions & other instructions/orders (e.g. exacerbation plan) Family history Encounters Care plan elements Billing (fees suggest services provided) 23/11/2018

Choreography versus Orchestration (Jazz versus Symphony)

Core Data Set and Data Quality

The emerging benefits of electronic medical records in community based-based care, PwC, 2013

Use of information in Primary Care (Commonwealth Fund Report) Proportion of primary care doctors who

What is my attachment? What is attachment in my community?

Where am I with respect to my peers?

How Did We Get to Here?

Northern Blended Funding Model Uses EMR data to determine complexity (health concerns, socioeconomic status and physical / mental functioning measurements)

Learning Health System - ONC