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

4. What is a busy physician to do?

5. Be confident.

6. Be concerned.

7. Be oblivious.

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

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.

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

34. To view individual pt data: To see previous AAPs, user clicks here

35. Pop-up appears: User clicks on desired PDF

36. Hyperlink opens applet:

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] )

46. e-AAP: High-level process flow: Disease mgmt component

47. Disease management component:

48. Treatment decisions in guidelines:

50. Treatment data in Applet: