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Epic Research Advisory Council Meeting April 1, 2009 Epic as a Platform Launching  Decision Support Tools: Implications for Research and Population QI Yiscah Bracha, MS Minneapolis Medical Research Foundation Robert Grundmeier, MD The Children’s Hospital of Philadelphia
Improving Asthma Care in an Integrated Safety Net through a Commercially Available Electronic Medical Record ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
The Problem: ,[object Object],[object Object]
What is a busy physician to do?
Be confident.
Be concerned.
Be oblivious.
Medical informatics to the rescue! ,[object Object],[object Object],[object Object],[object Object]
Task-based decision support ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ASTHMA REGISTRY Asthma info for  Populations Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:   Asthma Decision Support & Epic:  Current model Electronic decision support for:   Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for  Populations interface engine interface engine
ASTHMA REGISTRY Asthma info for  Populations Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:   Asthma Current model and data warehousing: Electronic decision support for:   Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for  Populations ASTHMA REGISTRY Asthma info for  Populations interface engine interface engine
Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:   Asthma Current model and data warehousing: Electronic decision support for:   Which diagnostic imaging tech? interface engine interface engine IMAGING REGISTRY Imaging info for  Populations ASTHMA REGISTRY Asthma info for  Populations
Building the Warehouse: IMAGING REGISTRY Imaging info for  Populations ASTHMA REGISTRY Asthma info for  Populations
The Warehouse Dream: ASTHMA REGISTRY Asthma info for  Populations HIV REGISTRY HIV info for  Populations STENT REGISTRY Stent info for  Populations DIABETES REGISTRY Diabetes info for  Populations IMAGING REGISTRY Imaging info for  Populations COLONOSCOPY REGISTRY Colonoscopy info Populations
ASTHMA REGISTRY Asthma info for  Populations HIV REGISTRY HIV info for  Populations STENT REGISTRY Stent info for  Populations DIABETES REGISTRY Diabetes info for  Populations IMAGING REGISTRY Imaging info for  Populations COLONOSCOPY REGISTRY Colonoscopy info Populations The analytic dream:
Our analytic reality: ASTHMA REGISTRY Asthma info for  Populations HIV REGISTRY HIV info for  Populations DIABETES REGISTRY Diabetes info for  Populations IMAGING REGISTRY Imaging info for  Populations WHY?
Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:   Asthma ASTHMA REGISTRY Asthma info for  Populations The problem with the current model: Electronic decision support for:   Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for  Populations interface engine interface engine
Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:   Asthma ASTHMA REGISTRY Asthma info for  Populations Electronic decision support for:   Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for  Populations Hard to build…. Hard to maintain…. interface engine interface engine
Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for:  Asthma ASTHMA REGISTRY Asthma info for  Populations So much effort focused on interface*: Electronic decision support for:  Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for  Populations * Building complex decision support within Epic is just as much effort as interface interface engine interface engine
No resources for data mgmt: ASTHMA REGISTRY Asthma info for  Populations HIV REGISTRY HIV info for  Populations DIABETES REGISTRY Diabetes info for  Populations IMAGING REGISTRY Imaging info for  Populations
A low-cost alternative to current model: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Example: HIT Asthma Project ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],* Support based on NAEPP-3 Guidelines, August 2007
e-AAP Clinical Decision Support: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
e-AAP Administrative Support: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Launched as procedure order in Epic: Highlighted data transferred in URL. Clicking here launches applet..
Live data passed to Applet in URL: Web link defined by print group Launches web browser with “garbled” pt data in URL
Linking code required: Cache routine:  Delivers hyperlink Cache global: Provides configuration
1 st  screen user sees: User automatically logged in; audit trail initiated; patient data transferred directly from Epic.
Applet generates data.  Where do they go? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients ASTHMA REGISTRY Asthma info for  Populations Patient & user context thru URL Individual pt data: Saved to SQL server database (registry)
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients ASTHMA REGISTRY Asthma info for  Populations Patient & user context thru URL Population data: Relevant data extracted from Clarity, merged with Applet data in registry
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients ASTHMA REGISTRY Asthma info for  Populations Patient & user context Decision Support & Epic:  Alternative model
How are applet data retrieved? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
To view individual pt data: To see previous AAPs, user clicks here
Pop-up appears: User clicks on desired PDF
Hyperlink opens applet:
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients ASTHMA REGISTRY Asthma info for  Populations Patient & user context thru URL To view population data:
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients Imaging Applet   Imaging info for  Individual Patients ASTHMA REGISTRY Asthma info for  Populations Imaging Registry Imaging info for  Populations Patient & user context Patient & user context Multiple such registries possible:
Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients Imaging Applet   Imaging info for  Individual Patients ASTHMA REGISTRY Asthma info for  Populations Imaging Registry HIV info for  Populations Patient & user context Patient & user context ASTHMA REGISTRY Asthma info for  Populations Alternate model and data warehousing:
EHR Data Repository Information for Populations Local EHR Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients HIV APPLET   HIV info for  Individual Patients Patient & user context Patient & user context IMAGING REGISTRY Imaging info for  Populations ASTHMA REGISTRY Asthma info for  Populations Alternate model and data warehousing: Imaging Applet   HIV info for  Individual Patients
Imaging Applet   HIV info for  Individual Patients EHR Data Repository Information for Populations Local EHR Information for Individual Patients ASTHMA APPLET   Asthma info for  Individual patients Patient & user context Patient & user context No major interface to build or maintain! ASTHMA REGISTRY Asthma info for  Populations Imaging Registry Imaging info for  Populations interface engine interface engine
ASTHMA REGISTRY Asthma info for  Populations HIV REGISTRY HIV info for  Populations STENT REGISTRY Stent info for  Populations DIABETES REGISTRY Diabetes info for  Populations IMAGING REGISTRY Imaging info for  Populations COLONOSCOPY REGISTRY Colonoscopy info Populations Maybe we can!
Questions? Project supported by the  Agency for Health Research and Quality .  Contract No. HHSA290200600020, Task Order No. 5 The findings and conclusions are the responsibility of the authors, not the AHRQ. Clinical informatics at HCMC: Dr. Kevin Larsen  ( [email_address] ) Invoking applet from Epic: Dr. Robert Grundmeier  ( [email_address] ) Asthma details about applet: Dr. Gail Brottman  ( [email_address] ) Project direction & all other Qs: Yiscah Bracha, MS  ( [email_address] )
Extra Slides ,[object Object],[object Object],[object Object],[object Object]
Why not build it in Epic? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
e-AAP: High-level process flow: Disease mgmt component
Disease management component:
Treatment decisions in guidelines:
 
Treatment data in Applet:
 

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Epic As Platform For Clinical Decision Support. Implications For Qi And Research.

  • 1. Epic Research Advisory Council Meeting April 1, 2009 Epic as a Platform Launching Decision Support Tools: Implications for Research and Population QI Yiscah Bracha, MS Minneapolis Medical Research Foundation Robert Grundmeier, MD The Children’s Hospital of Philadelphia
  • 2.
  • 3.
  • 4. What is a busy physician to do?
  • 8.
  • 9.
  • 10. ASTHMA REGISTRY Asthma info for Populations Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma Decision Support & Epic: Current model Electronic decision support for: Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for Populations interface engine interface engine
  • 11. ASTHMA REGISTRY Asthma info for Populations Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma Current model and data warehousing: Electronic decision support for: Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for Populations ASTHMA REGISTRY Asthma info for Populations interface engine interface engine
  • 12. Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma Current model and data warehousing: Electronic decision support for: Which diagnostic imaging tech? interface engine interface engine IMAGING REGISTRY Imaging info for Populations ASTHMA REGISTRY Asthma info for Populations
  • 13. Building the Warehouse: IMAGING REGISTRY Imaging info for Populations ASTHMA REGISTRY Asthma info for Populations
  • 14. The Warehouse Dream: ASTHMA REGISTRY Asthma info for Populations HIV REGISTRY HIV info for Populations STENT REGISTRY Stent info for Populations DIABETES REGISTRY Diabetes info for Populations IMAGING REGISTRY Imaging info for Populations COLONOSCOPY REGISTRY Colonoscopy info Populations
  • 15. ASTHMA REGISTRY Asthma info for Populations HIV REGISTRY HIV info for Populations STENT REGISTRY Stent info for Populations DIABETES REGISTRY Diabetes info for Populations IMAGING REGISTRY Imaging info for Populations COLONOSCOPY REGISTRY Colonoscopy info Populations The analytic dream:
  • 16. Our analytic reality: ASTHMA REGISTRY Asthma info for Populations HIV REGISTRY HIV info for Populations DIABETES REGISTRY Diabetes info for Populations IMAGING REGISTRY Imaging info for Populations WHY?
  • 17. Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma ASTHMA REGISTRY Asthma info for Populations The problem with the current model: Electronic decision support for: Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for Populations interface engine interface engine
  • 18. Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma ASTHMA REGISTRY Asthma info for Populations Electronic decision support for: Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for Populations Hard to build…. Hard to maintain…. interface engine interface engine
  • 19. Clarity Information for Populations Epic Information on Individual Patients Electronic decision support for: Asthma ASTHMA REGISTRY Asthma info for Populations So much effort focused on interface*: Electronic decision support for: Which diagnostic imaging tech? IMAGING REGISTRY Imaging info for Populations * Building complex decision support within Epic is just as much effort as interface interface engine interface engine
  • 20. No resources for data mgmt: ASTHMA REGISTRY Asthma info for Populations HIV REGISTRY HIV info for Populations DIABETES REGISTRY Diabetes info for Populations IMAGING REGISTRY Imaging info for Populations
  • 21.
  • 22.
  • 23.
  • 24.
  • 25. Launched as procedure order in Epic: Highlighted data transferred in URL. Clicking here launches applet..
  • 26. Live data passed to Applet in URL: Web link defined by print group Launches web browser with “garbled” pt data in URL
  • 27. Linking code required: Cache routine: Delivers hyperlink Cache global: Provides configuration
  • 28. 1 st screen user sees: User automatically logged in; audit trail initiated; patient data transferred directly from Epic.
  • 29.
  • 30. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients ASTHMA REGISTRY Asthma info for Populations Patient & user context thru URL Individual pt data: Saved to SQL server database (registry)
  • 31. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients ASTHMA REGISTRY Asthma info for Populations Patient & user context thru URL Population data: Relevant data extracted from Clarity, merged with Applet data in registry
  • 32. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients ASTHMA REGISTRY Asthma info for Populations Patient & user context Decision Support & Epic: Alternative model
  • 33.
  • 34. To view individual pt data: To see previous AAPs, user clicks here
  • 35. Pop-up appears: User clicks on desired PDF
  • 37. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients ASTHMA REGISTRY Asthma info for Populations Patient & user context thru URL To view population data:
  • 38. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients Imaging Applet Imaging info for Individual Patients ASTHMA REGISTRY Asthma info for Populations Imaging Registry Imaging info for Populations Patient & user context Patient & user context Multiple such registries possible:
  • 39. Clarity Information for Populations Epic Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients Imaging Applet Imaging info for Individual Patients ASTHMA REGISTRY Asthma info for Populations Imaging Registry HIV info for Populations Patient & user context Patient & user context ASTHMA REGISTRY Asthma info for Populations Alternate model and data warehousing:
  • 40. EHR Data Repository Information for Populations Local EHR Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients HIV APPLET HIV info for Individual Patients Patient & user context Patient & user context IMAGING REGISTRY Imaging info for Populations ASTHMA REGISTRY Asthma info for Populations Alternate model and data warehousing: Imaging Applet HIV info for Individual Patients
  • 41. Imaging Applet HIV info for Individual Patients EHR Data Repository Information for Populations Local EHR Information for Individual Patients ASTHMA APPLET Asthma info for Individual patients Patient & user context Patient & user context No major interface to build or maintain! ASTHMA REGISTRY Asthma info for Populations Imaging Registry Imaging info for Populations interface engine interface engine
  • 42. ASTHMA REGISTRY Asthma info for Populations HIV REGISTRY HIV info for Populations STENT REGISTRY Stent info for Populations DIABETES REGISTRY Diabetes info for Populations IMAGING REGISTRY Imaging info for Populations COLONOSCOPY REGISTRY Colonoscopy info Populations Maybe we can!
  • 43. Questions? Project supported by the Agency for Health Research and Quality . Contract No. HHSA290200600020, Task Order No. 5 The findings and conclusions are the responsibility of the authors, not the AHRQ. Clinical informatics at HCMC: Dr. Kevin Larsen ( [email_address] ) Invoking applet from Epic: Dr. Robert Grundmeier ( [email_address] ) Asthma details about applet: Dr. Gail Brottman ( [email_address] ) Project direction & all other Qs: Yiscah Bracha, MS ( [email_address] )
  • 44.
  • 45.
  • 46. e-AAP: High-level process flow: Disease mgmt component
  • 48. Treatment decisions in guidelines:
  • 49.  
  • 50. Treatment data in Applet:
  • 51.  

Hinweis der Redaktion

  1. Yiscah