电子医疗记录的数据挖掘和减少健康差异

1ElectronicMedicalRecords-DataMiningandtheReductionofHealthDisparitiesNeilS.Calman,MDPresidentandCEOTheInstituteforFamilyHealth,NewYorkClinicalProfessorofFamilyMedicineTheAlbertEinsteinCollegeofMedicineofYeshivaUniversityOctober2008HawaiiPrimaryCareAssociationAnnualConferenceandQualitySummit2345TheGoal….Toexplainafewofthemanywaysthathealthinformationtechnology(HIT)canbeusedtopromotequalityhealthcareandendhealthdisparitiesTostimulateyoutoinvitemebackagainatatimewhenIamabletojoinyouinpersononyourbeautifulisland6Apologies….Theexamplesusedinthispresentationarenotspecifictothepopulationsthatyoucareforbutwilldemonstratetoolsthatareavailablenowtoimprovepreventivehealthcareandthemedicalofficevisit7ManhattanHealthCentersNYUFCFreeClinicAmsterdamCenterEast13thSt.FamilyPracticePhillipsFamilyPracticeSidneyHillmanFamilyPracticeWashingtonIrvingHighSchoolHealthCenterCarefortheHomelessateightsitesAliForneyCenterforHomelessAdolescents8BronxHealthCentersMt.HopeFamilyPracticeParkchesterFamilyPracticeUrbanHorizonsFamilyHealthCenter&RiverCenterforCounselingWaltonFamilyHealthCenterWestchesterAvenueCenterECHOFreeClinicDr.EricGayleBronxRegionalMedicalDirector9Mid-HudsonHealthCentersFamilyPracticeCenterofEllenvilleFamilyPracticeCenterofHydeParkFamilyPracticeCenterofKingstonFamilyPracticeCenterofNewPaltzFamilyPracticeCenterofPortEwenOBSpecialtyCareCenterofKingston10TheInstituteforFamilyHealth•15CommunityHealthCenters–•5Bronx,3Manhattan,•6Mid-HudsonValley•8homelesshealthcaresites•2Schoolbasedhealthprograms•3Dentalcenters•2CommunityMentalHealthCenters•2FreeClinics•250,000primarycarevisits•67,000patients11TheInstituteforFamilyHealth2FamilyPracticeResidencyTrainingprograms-oneruralunderserved,oneurbanunderserved34GrantProgramsincludingFEDERAL:HRSA,NIH,CDC,LOCAL:NYSDOH,NYCDOHMH,NYSOMH,NYSOMRDDPRIVATE:CommonwealthFund,NYCommunityTrust,AltmanFoundation,EnglebergFoundation,StarrFoundation,andothers•RegisteredPBRN•In-houseIRB12StaffandBudget•Over600staffmembers:–familyphysicians–internists,pediatricians–familynursepractitioners–psychiatrists–socialworkers–healtheducators–nurses–practiceadministrators–administrativestaff•Abudgetofapproximately48milliondollarsFederal330Grantis$2.95million(6.2%ofbudget)13TheInstitutehasbeenlivesinceSeptember2002onEpicSystems(Verona,Wisconsin)ElectronicHealthRecordandPracticeManagementSystem14HIE2008ClinicalDecisionSupport2003ProgressionofHITattheInstituteEHR/PMSImplementation2002PatientPortal2008QualityReporting/Improvement2004EHR=ElectronicHealthRecordPMS=PracticeManagementSystemHIE=HealthInformationExchange15UsingtheEHRtosupportpopulationbasedcareinCommunityHealthCenters11617LinkingCommunityHealthCenterEHRstotheNation’spublichealthsurveillancesystem21801234567891011121314151617ReleaseNumberofCasesSymptomOnsetSevereIllnessDaysTheBenefitofEarlyDetectionofSyndromest19SinglepatientvisityieldscomplexEHRdata•PatientAddress•Race/Age/Gender•Medicalhistory•ProviderLocation•Reasonforvisit•Problemlist•Temperature•Height/weight•Respirations•Procedures•Medications•Labresults•Diagnoses20EHRFever0.000.050.100.150.200.250.300.350.400.450.507/8/038/8/039/8/0310/8/0311/8/0312/8/031/8/042/8/043/8/044/8/045/8/046/8/04Percentageoffever/fluchiefcomplaints0.0000.0100.0200.0300.0400.0500.060PercentageofmeasuredtemperaturesBlue=ER“flu/fever”Purple=EHRFever100FRed=Flu“A”isolatesViolet=Flu“B”isolates210.000.050.100.150.200.250.300.350.400.450.507/8/038/8/039/8/0310/8/0311/8/0312/8/031/8/042/8/043/8/044/8/045/8/046/8/04PercentageofFevFluchiefcomplaints0.0000.0050.0100.0150.0200.025PercentageofcombinationsyndromeFeverANDrespiratorysyndromeBlue=ER“flu/fever”Brown=EHRT≥100oandRespiratorySyndrome22Institutepatientfeverspeaked13daysbeforeERvisitsforFeverandFlu–thisindicatesthathealthcenterdatamaybethefirst“signal”ofanimpendingepidemic.PatientsoftheInstituteforUrbanFamilyHealthInstitutefeverdatarespondedtoFluBoutbreak-EDdatadidnot232425UsingtheEHRtobringpublichealthinformationtothepointofcareinrealtime326PracticeAlertinEHRforthiscenteronlyifpatientpresentswithcough–matchedtoLegionellaordersettoassistproviderinDxandTxDOHsendsalerttocommunityreLegionellacasesinParkchestercommunityintheBronx2728293031DevelopingClinicalDecisionSupportsoveraBroadRangeofMeasures432ClinicalDecisionSupport–ImpactonVaccineAdministrationinAdults333410TakeNewYorkIndicators1.HaveaRegularDoctororOtherHealthCareProvider2.BeTobacco-Free3.KeepYourHeartHealthy4.KnowYourHIVStatus5.GetHelpforDepression6.LiveFreeofDependenceonAlcoholandDrugs7.GetCheckedforCancer8.GettheImmunizationsYouNeed9.MakeYourHomeSafeandHealthy10.HaveaHealthyBaby35MEASURES“HAVEAREGULARDOCTOR”Patientaccesstoprimarycarerates“BETOBACCO-FREE”Generaltobaccoscreeningrates(updated,verified)SmokingcessationtreatmentratesSmokingcessationmedicationsutilizationratesSmokingcessationquitrates“KEEPYOURHEARTHEALTHY”BloodpressurecontrolratesBMIScreeningratesLDLscreeningratesDiabeticmanagementrates(LDL,HgbA1C)CADmanagementrates“KNOWYOURHIVSTATUS”HIVtestingrates“GETTHEIMMUNIZATIONSYOUNEED”PneumovaxratesFluvaxrates“GETHELPFO