1. 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

2. Steven H Rappaport, MD
I have no relevant financial relationships

3. 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

4. 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 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

5. 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

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

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

8. 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

9. 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

11. 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

12. Documentation Support

13. Census Tracking and Alerting

14. 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

15. Message configuration

16. 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

20. Better Together
Research + Innovation
Including CRISP events