Benefits case study: 'Patient Reported Outcome Measures (PROMs)' outputs
Presentation
1. Inferring Collaborations of Care
Providers Participating in Trauma
Services Via Utilization of EMR
Data
VANDERBILT UNIVERSITY, DEPARTMENT OF BIOINFORMATICS
DR. YOU CHEN, PHD
MATTHEW DRAPER
2. Significance
•Overarching mission of this research is improving patient centered care at VUMC
•Are the correct care teams in place to treat the correct patients at the right
time?
• For each patient is there a network of care providers in the hospital to treat the
patients specific needs?
•Do/can the care provider networks change overtime?
•What can EMR utilization data tell us about these networks of care providers?
3. Background
•Currently, the standard in most hospital environments is pay-for-service work
flows
• Leads to higher costs in patient centered care because of inefficient and ineffective
care providing teams originating from pay-for-service environments
•Addressing this problem is a pay-for-value strategy to bundle payments
proportionally for a group of care providers
• These kinds of systems have rarely measured the cost of care teams across
institutions in a systematic manner
•To address this my research has focused on the composition of roles and the
strength of collaborative relations in VUMC EMR trauma data
5. Methodology
•Matlab and Gephi software packages to manipulate and visualize the data
•First step was creating a matrix of binary values relating the users to the patients
•Each 1 corresponds to a user who has performed an action on a patient
•The matrix on the right represents users who share patients
•Also created labels for each user-user relation corresponding to their service, id, role,
classification, and provider type
• '3130_Student Program/SURGERY/Med - Comprehensive Pain Service Consult Request_Resident'
p1 p2 p3 p4 p5
u1 1 0 0 0 0
u2 1 0 0 0 0
u3 1 0 0 0 0
u4 1 0 0 0 0
u5 1 0 0 1 0
u1 u2 u3 u4 u5
u1 59 40 11 24 51
u2 40 491 86 92 422
u3 11 86 251 41 224
u4 24 92 41 140 125
u5 51 422 224 125 4485
6. 3130_Student Program/SURGERY/Med - Comprehensive Pain Service Consult Request_Resident
560_//Rehab_
3635_Student Program/SURGERY/Problem list_Resident
4615_/OPHTHALMOLOGY/Problem list_
2415_/INTERNAL MEDICINE/Procedure Note - Neurosurgery_
2775_Student Program/EMERGENCY MEDICINE/Srg - Orthopedics Consult Request_Resident
5457_//Vanderbilt LifeFlight Patient Transport Record_
399_/DEPT OF OTOLARYNGOLO/Anesthetic Care Record_
2172_//Rehab_
843_Student Program/EMERGENCY MEDICINE/Srg - Face Consult Request_Resident
2384_//Consultation Note - Adult Otolaryngology_
3271_//Rehab_
1851_//WOCN Consultation Progress Note_
5662_//WOCN Progress Note_
1853_//WOCN Progress Note_
1801_//WOCN Progress Note_
4229_Internal Medicine/MED-GASTROENTEROLOGY/Adult Nutrition Support Consultation_Physician
5506_//Final Spine Recs_
952_//Anesthetic Care Record_
4297_//Rehab_
5133_Internal Medicine//Respiratory Care_Fellow
909_//Respiratory Care_
4117_Student Program/EMERGENCY MEDICINE/Srg - Neurosurgery Consult Request_Resident
329_//EEG REPORT_
295_//Progress Note - Neurology_
2366_//Plastic/Cosmetic Surgery New Patient Consultation_
4647_Surgery/DEPT OF PLASTIC SURG/Plastic Surgery Scheduling Form_Physician
3216_//Rehab_
1670_Student Program/ORTHOPEDICS/Consultation Note_Resident
3624_Internal Medicine/MED-INFECTIOUS DISEA/Brief Neurosurgery Note_No Provider Type
737_Student Program/SURGERY/Ophthalmology Progress Note_Resident
4153_Student Program/INTERNAL MEDICINE/Plastic/Cosmetic Surgery New Patient Consultation_Resident
4829_Student Program//Problem list_Resident
2761_Ophthalmology/OPHTHALMOLOGY/History & Physical - Ophthalmology_Resident
4646_Surgery/DEPT OF PLASTIC SURG/Operative Report_Physician
2139_Internal Medicine/MED-CARDIOLOGY/Transthoracic Echocardiogram_Physician
2611_//Rehab_
889_Internal Medicine/INTERNAL MEDICINE/Problem list_No Provider Type
5003_//Problem list_
3172_//Problem list_
1243_//Rehab_
677_//philipView (Auto Export)_
1014_Nurse Practitioner/MED-GASTROENTEROLOGY/Adult Nutrition Support Consultation_CRNP
5683_//Medication Record - Controlled substance_
4299_Student Program/DEPT OF ORAL SURGERY/Discharge Instructions_Resident
4924_Pediatrics/PEDIATRICS/Problem list_Physician
1628_Student Program/DEPT OF NEUROSURGERY/Problem list_Resident
1671_Student Program/ORTHOPEDICS/Consultation Note - Vascular Surgery_Resident
1419_Student Program/SURGERY/Brief Vascular Note_Resident
2919_//Respiratory Care_
3969_Emergency Medicine//Srg - Neurosurgery Consult Request_Resident
24_Student Program/ORTHOPEDICS/Consultation Note_Resident
1598_Student Program//Problem list_Resident
3359_//Problem list_
4124_//Problem list_
5887_//Administrative - Authorization (Release of Medical Information)_
1877_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthes
SIOLOGY/Anesthesia - Pre-operative Evaluation_Anesthesiologist
5323_//Photography - Treatment_
5458_//PACU Orders_
5351_//WOCN Progress Note_
2504_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
5684_//PACU Orders_
1990_Student Program/DEPT OF ORAL SURGERY/Consultation Note - Oral and Maxillofacial Surgery_Resident
1278_Nurse Practitioner/SURGERY/Continue Medical Hold_CRNP
631_//IP SLP Cognitive Communication TBI Evaluation_
4660_//Rehab_
697_Student Program/ORTHOPEDICS/Orthopaedics Brief Operative Note_Resident
5464_//Order - Emergency Medicine
5671_//Vanderbilt LifeFlight Patient Transport Record_
5524_//PACU Orders_
5625_//Administrative - Transportation (Certification)_
2033_Anesthesiology/ANESTHESIOLOGY/Anesthesia - Pre-operative Ev
2687_Orthopaedic Surgery/ORTHOPEDICS/Operative Report_Physician
4580_//Problem list_
1472_Nurse Practitioner/DIV OF TRAUMA SURGEO/Complex Care: Nursing Note_CRNP
3069_Anesthesiology/ANESTHESIOLOGY/BICU Attending Note_Anesthesiologist
781_//Respiratory Care_
621_Plastic Surgery/DEPT OF PLASTIC SURG/Progress Note_Phy
2258_Student Program/MED-INFECTIOUS DISEA/Consultation Note - Pharmaceutical Services (Pharmacokinetics)_Fellow
2695_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
129_//EEG REPORT_
4671_General Acute Care Hospital/OPHTHALMOLOGY/Ophthalmology Discharge Plan_Resident
5081_Nurse Practitioner/DIV OF TRAUMA SURGEO/Core Measures_CRNP
2993_Student Program/ORTHOPEDICS/Consultation Note - Orthopaedics_Resident
812_Internal Medicine/MED-CARDIOLOGY/Transthoracic Echocardiogram_Physician
3246_//Transthoracic Echocardiogram_
1194_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
1503_Student Program/EMERGENCY MEDICINE/Med - Respond, Emergency Dept Consult Request_Resident
4807_Dentist/DEPT OF ORAL SURGERY/<Photos> Photos_Anesthesiologist
1254_Student Program/SURGERY/Problem list_Resident
2464_Student Program/ORTHOPEDICS/Consultation Note_Resident
2721_Surgery/DIV OF TRAUMA SURGEO/History & Physical_Physician
528_Orthopaedic Surgery/ORTHOPEDICS/Brief Ortho Note_Resident
5004_Orthopaedic Surgery/ORTHOPEDICS/Operative Report_Physician
1826_Military Health Care Provider/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
4626_Student Program/DEPT OF OTOLARYNGOLO/Vascular Consultation_Resident
4477_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
4415_Dermatology/MED-DERMATOLOGY/Respiratory Care_Physician
1099_//Rehab_
3041_//IP SLP Cognitive Communication TBI Evaluation_
32_Student Program/EMERGENCY MEDICINE/Med - Comprehensive Pain Service Consult Request_Resident
2523_//Rehab_
4041_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesio
799_Neurological Surgery/DEPT OF NEUROSURGERY/Operative Report_Physician
1371_Nurse Practitioner/DIV OF TRAUMA SURGEO/Continue Medical Hold_CRNP
4000_Nurse Practitioner/PEDIATRICS/Anesthetic Care Record_CRNP
2183_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
3759_Student Program/SURGERY/Med - Comprehensive Pain Service Consult Request_Resident
1284_//Anesthetic Care Record_
2915_//Problem list_
4519_//Consultation Note - Pharmaceutical Services (Pharmacokinet
2479_Student Program/DEPT OF ORAL SURGERY/Consultation Note - Oral and Maxillofacial Surgery_Resident
2290_//Rehab_
5218_Student Program/DEPT OF OTOLARYNGOLO/Discharge Summary_Resident
548_//Med - Physical Medicine Consult Request_
3592_//Core Measures_
2696_Otolaryngology/DEPT OF OTOLARYNGOLO/Progress Note - Oral and Maxillofacial Surgery_No Provider Type
3824_Internal Medicine/MED-CARDIOLOGY/Transthoracic Echocardiogram_Physician
1335_Student Program/ORTHOPEDICS/Brief Ortho Spine Note_Resident
480_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
104_Family Medicine/FAMILY PRACTICE/Anesthetic Care Record_No Provider Type
2021_//Rehab_
3182_Physical Medicine & Rehabilitation/REHABILITATION/Consultation Note - Physical Medicine & Rehabilitation_Physician
116_//Rehab_
3896_//research note_
279_Nurse Practitioner/DIV OF TRAUMA SURGEO/Srg - SICU Critical Care Consult Request_CRNP
3026_Anesthesiology/DIV OF TRAUMA SURGEO/History & Physical_Physician
4741_Student Program/DEPT OF PLASTIC SURG/Consultation Note - Oral and Maxillofacial Surgery_Resident
1749_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
2526_Student Program/ORTHOPEDICS/Pre-Op History and Physical_Resident
4702_Student Program/DEPT OF PLASTIC SURG/Plastic/Cosmetic Surgery New Patient Consultat
265_Specialist/MED-CARDIOLOGY/Transthoracic Echocardiogram_Physician
887_//Problem list_
4399_Family Medicine/FAMILY PRACTICE/Respiratory Care_No Provider Type
111_Pediatrics/PEDIATRICS/Srg - Orthopedics Consult Request_Physician
1926_//Respiratory Care_
4799_Student Program/OPHTHALMOLOGY/Ophthalmology Brief f/u Note_Resident
1810_Pathology/PATHOLOGY/Anesthetic Care Record_No Provider Type
1214_Student Program/ANESTHESIOLOGY/Anesthesia - Pre-op
825_//Braden Assessment_
903_Nurse Practitioner/DIV OF TRAUMA SURGEO/Discharge Summary/Note - Trauma_CRNP
3723_/OTHER/Pre-Admission Medication List_
2450_//OPERATIVE REPORT_
3075_Student Program/ANESTHESIOLOGY/Problem list_Resident
4556_//Braden Assessment_
3741_//Braden Assessment_
738_Nurse Practitioner/ANESTHESIOLOGY/Braden Assessment_CRNP
3999_//Braden Assessment_
1906_//Braden Assessment_
451_//Problem list_
2912_//Braden Assessment_
151_//Braden Assessment_
925_//Braden Assessment_
438_//Braden Assessment_
1890_//Rehab_
1742_Surgery/DIV OF TRAUMA SURGEO/Progress Note - Trauma_Physician
873_//Pre-Admission Medication List_
880_//Pre-Admission Medication List_
5038_//Discharge Summary/Note - Trauma_
3827_//Pre-Admission Medication List_
2292_//Immunization from AdminRx_
4359_//Braden Assessment_
2238_//Braden Assessment_
1719_//Braden Assessment_
4488_//Braden Assessment_
866_//Braden Assessment_
433_//Braden Assessment_
5254_//philipView (SINUS TACH)_
2041_//Braden Assessment_
5260_//philipView (3 BVT)_
5226_//philipView (SINUS)_
4869_Student Program/ANESTHESIOLOGY/Pre-Admission Medication List_Resident
1909_Student Program/DEPT OF NEUROSURGERY/Brief Neurosurgery Note_Resident
4033_/DIV OF ONCOLOGY/Pre-Admission Medication List_
884_//Respiratory Care_
4965_//Braden Assessment_
1758_//Braden Assessment_
4190_//Braden Assessment_
1743_Surgery/DIV OF TRAUMA SURGEO/Problem list_Physician
619_//Braden Assessment_
2844_//Braden Assessment_
1958_Student Program/OPHTHALMOLOGY/History & Physical - Ophthalmology_Resident
3620_//Pre-Admission Medication List_
4419_//IP SLP Bedside Swallow Evaluation_
1143_//Braden Assessment_
2652_Registered Nurse/ORTHOPEDICS/Ortho Trauma Preoperative Plan_CRNP
3966_//Pre-Admission Medication List_
724_//Home Health Communications_
3392_//Pre-Admission Medication List_
4_//OPERATIVE REPORT_
3564_//Immunization from AdminRx_
4467_//Pre-Admission Medication List_
3622_Nurse Practitioner/NURSING FACULTY PRAC/Braden Assessment_No Provider Type
1450_//Braden Assessment_
5247_//philipView (SINUS )_
647_//Problem list_
1109_Student Program//Braden Assessment_Resident
2683_//Braden Assessment_
2797_/OTHER/Braden Assessment_
1936_//Braden Assessment_
4365_Student Program/ORTHOPEDICS/Consultation Note - Orthopaedics_Resident
1489_//Braden Assessment_
5067_//Pre-Admission Medication List_
4973_//Immunization from AdminRx_
577_//Respiratory Care_
2651_//Braden Assessment_
475_//Braden Assessment_
1918_//Pre-Admission Medication List_
2646_//Pre-Admission Medication List_
5167_//Braden Assessment_
2304_//Pre-Admission Medication List_
4245_Emergency Medicine/EMERGENCY MEDICINE/Srg - Neurosurgery Consult Request_Resident
900_Orthopaedic Surgery/INTERNAL MEDICINE/Rehab_No Provider Type
5861_//Access/Transfer Report - Referral_
1388_//Problem list_
1407_//Rehab_
1805_Student Program/MED-CARDIOLOGY/Srg - Renal Transplant Consult Request_Fellow
2457_Pediatrics/PEDIATRICS/Discharge Summary/Note - Trauma_Physician
3459_//Rehab_
5237_//philipView (SINUS PR.12 QRS.08 QT.34)_
5530_//Vanderbilt LifeFlight Patient Transport Record_
3239_Student Program/DEPT OF ORAL SURGERY/Problem list_Resident
3199_Student Program/PEDIATRICS/Problem list_Resident
4320_//Pre-Admission Medication List_
3781_//Problem list_
1795_Student Program//Discharge Summary/Note - Trauma_Resident
3145_Student Program//Brief Ortho Note_Resident
3618_Internal Medicine/MED-ONCOLOGY/Problem list_Physician
5421_//Vanderbilt LifeFlight Patient Transport Record_
4016_Student Program/PEDIATRICS/Srg - Ophthalmology Consult Request_Resident
2299_//Problem list_
3616_Surgery//Plastic/Cosmetic Surgery New Patient Consultation_Resident
2841_//Pre-Admission Medication List_
711_Student Program/ORTHOPEDICS/Consultation Note - Orthopaedics_Resident
2511_Student Program/SURGERY/Med - Cardiology, General Consult Request_Resident
4512_//Pre-Admission Medication List_
1436_Nurse Practitioner/DIV OF TRAUMA SURGEO/Core Measures_CRNP
3003_//Srg - Orthopedics Consult Request_
1459_//Problem list_
4541_Nurse Practitioner/NEUROLOGY/Progress Note - Neurology_CRNP
3314_//Problem list_
3103_//Problem list_
2834_Pediatrics/PEDIATRICS/Problem list_No Provider Type
4896_//Respiratory Care_
2113_//Rehab_
325_Student Program/DEPT OF OTOLARYNGOLO/Otolaryngology Consultat
5217_Student Program//Ortho Spine Final Recs_Resident
5085_//Problem list_
720_Anesthesiology/ANESTHESIOLOGY/Anesthesiology Preoperative Evaluation_Anesthesiologist
118_//Problem list_
5536_//PACU Orders_
135_//Problem list_
5148_//Problem list_
5859_//Vanderbilt LifeFlight Patient Transport Record_
945_Anesthesiology/ANESTHESIOLOGY/Acute Pain Service Procedure Note_Anesthesiologist
4618_Surgery//Problem list_Resident
4917_//Rehab_
984_Optometrist/EMERGENCY MEDICINE/Problem list_Resident
77_//Problem list_
3223_Orthopaedic Surgery/ORTHOPEDICS/Operative Report_Physician
1356_Urology/DEPT OF UROLOGY/Operative Report_No Provider Type
3344_Pediatrics/PEDIATRICS/Problem list_No Provider Type
2967_Student Program//Problem list_Resident
2699_//WOCN Progress Note_
1929_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
3614_//Problem list_
3078_//Problem list_
1301_Student Program//Otolaryngology Consultation_Resident
1806_Student Program/MED-CARDIOLOGY/Problem list_Fellow
3348_Internal Medicine/EMERGENCY MEDICINE/Rehab_No Provider Type
5251_//philipView (AFib)_
2099_//Rehab_
2022_//Respiratory Care_
4886_Anesthesiology//Acute Pain Service Procedure Note_Resident
5216_Student Program//Orthopaedics Brief Operative Note_Resident
4714_//Problem list_
1820_//Problem list_
1458_//Consultation Note - Pharmaceutical Services_
1252_//Rehab_
3006_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
4360_//Rehab_
4752_//Problem list_
2657_//Braden Assessment_
5202_Student Program/OPHTHALMOLOGY/History & Physical - Ophthalmology_Resident
178_Orthopaedic Surgery//Orthopaedics Brief Operative Note_Resident
3151_Pediatrics//Srg - Orthopedics Consult Request_Physician
4026_Student Program/PEDIATRICS/Med - Comprehensive Pain Service Consult Request_Resident
3754_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
4629_//Rehab_
5074_Specialist/INTERNAL MEDICINE/Brief Spine Note_No Provider Type
898_//Operative Report_
1253_Student Program/SURGERY/Srg - Neurosurgery Consult Request_Resident
1922_Student Program/EMERGENCY MEDICINE/Srg - Orthopedics Consult Request_Resident
1165_Student Program/DEPT OF NEUROSURGERY/Brief Neurosurgery Note_Resident
5389_//PACU Orders_
171_//Problem list_
2001_//Respiratory Care_
2908_Student Program/DEPT OF NEUROSURGERY/Neurosurgical Consultation Note_Resident
3173_Student Program/ORTHOPEDICS/Orthopaedics Brief Operative Note_Physician
3343_//Rehab_
4429_Student Program/ORTHOPEDICS/Orthopaedics Brief Operative Note_Resident
3829_//Respiratory Care_
3627_//Problem list_
1159_Orthopaedic Surgery//Orthopaedics Brief Operative Note_Resident
4462_Nurse Practitioner/DEPT OF PLASTIC SURG/Plastics NP Progress Note_CRNP
1227_Student Program//Problem list_Resident
5171_//Plastic Surgery Note_
2422_//Pharmacy Aminoglycoside Level Assessment_
2914_//Consultation Note - Pharmaceutical Services (Pharmacokinetics
3964_//Respiratory Care_
ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
3433_//Problem list_
5527_//PACU Orders_
693_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
5483_//Medication Record - Medication Administration Record (MAR)_
792_//Respiratory Care_
5262_//philipView (SINUS)_
4254_Surgery//Srg - Spine Consult Request_Resident
2727_Student Program//Progress Note - Oral and Maxillofacial Surgery_Resident
2513_//Problem list_
3559_//Problem list_
5472_//PACU Orders_
3905_Student Program//Anesthesia - Pre-operative Evaluation_Resident
2264_//Respiratory Care_
3785_//Braden Assessment_
3845_Nurse Practitioner/SURGERY/Medical Hold Order_CRNP
5098_//Pharmacokinetics Service Consultation_
389_Student Program//Problem list_Resident
890_//Problem list_
787_Nurse Practitioner/DIV OF TRAUMA SURGEO/Transitional Care Team Nurse Practitioner Note_CRNP
3691_//Rehab_
5172_//Progress Note - Plastic Surgery_
995_//Orthopaedics Brief Operative Note_
2676_Student Program/ORTHOPEDICS/Consultation Note - Orthopaedics_Resident
1866_Dentist//Consultation Note - Oral Surgery_Resident
4289_Emergency Medicine/EMERGENCY MEDICINE/Srg - Neurosurgery Consult Request_Resident
3143_Internal Medicine/MED-CARDIOLOGY/Transthoracic Echocardiogram_Physician
2302_Internal Medicine/MED-GASTROENTEROLOGY/Consultation Note - Pharmaceutical Services (Pharmacokinetics)_No Provider Type
3798_//Respiratory Care_
1092_Nurse Practitioner/DIV OF TRAUMA SURGEO/Surgical Intensive Care Unit Consultation_CRNP
3856_Surgery/DIV OF TRAUMA SURGEO/<Laboratory> Laboratory_Physician
3119_Student Program/SURGERY/Med - Psychiatry, Adult Ward Consult Request_Resident
4796_//TSN_
4923_Pediatrics/PEDIATRICS/Med - Neurology Consult Request_Physician
2121_Physician Assistant/OTHER/Ortho Trauma Preoperative Plan_No Provider Type
5780_//Emergency Department Nurse Triage_
948_//<Photos> Photos_
5233_//philipView (SINUS RHYTHM)_
3059_Nurse Anesthetist, Certified Registered/ANESTHESIOLOGY/Anesthesiology Preoperative Evaluation_CRNA
4894_Anesthesiology/ANESTHESIOLOGY/Anesthetic Care Record_Anesthesiologist
8. Future Outlooks
•Perform further analysis on care provider networks
• Analyze the relationships between communities of care providers, evaluate the community designs
• Weekly comparative analyses of network structures and degree distributions
•Continue working on the project under Dr. Chen during the school year
9. Thanks To
•Dr. You Chen
•Dr. Cindy Gadd
•Rischelle Jenkins
•DBMI Staff
•Other summer interns
