Mod­i­fy­ing the EHR to ease re­search

Modern Healthcare - - BEST PRATICES - By Steven Ross John­son

When Dr. Demetrius Maraganore left the Mayo Clinic in 2009 to take over as chair­man of NorthShore Univer­sity Health­Sys­tem’s neu­rol­ogy depart­ment, he brought more than a decade’s worth of data from his Na­tional In­sti­tutes of Health-funded study of Parkin­son’s dis­ease treat­ment. He hoped to con­tinue his work in eval­u­at­ing qual­ity-im­prove­ment mea­sures.

At Mayo, re­search team mem­bers hand-wrote pa­tient in­for­ma­tion on 72-page forms dur­ing doc­tor vis­its; phone in­ter­view­ers hand-wrote in­for­ma­tion on a 25-page eval­u­a­tion form to as­sess risk fac­tors. This re­quired hir­ing a large team of study co­or­di­na­tors, data-en­try clerks and oth­ers to help col­lect in­for­ma­tion. He ex­pected that would be nec­es­sary at NorthShore too.

But his new col­leagues sug­gested an al­ter­na­tive ap­proach—con­fig­ur­ing NorthShore’s elec­tronic health-record sys­tem to make it eas­ier to gather needed in­for­ma­tion for re­search pur­poses dur­ing the pa­tient-care process. The goal was to meld the his­tor­i­cally sep­a­rate clin­i­cal and re­search data sys­tems and slash the added ex­pense of du­pli­cate data en­try.

The Food and Drug Ad­min­is­tra­tion has said sin­gle-point data cap­ture could pro­duce more com­plete, ac­cu­rate and timely data, speed dis­cov­ery and dis­sem­i­na­tion of ther­a­peu­tic ad­vances, and boost the num­ber of doc­tors will­ing to par­tic­i­pate in clin­i­cal re­search.

“Ev­ery trans­ac­tion in health­care is hap­pen­ing in the (EHR),” Maraganore said. “If we can har­ness that tech­nol­ogy to cap­ture clin­i­cal in­for­ma­tion of the high­est qual­ity, that ob­vi­ously would be very ap­peal­ing.”

So Maraganore and the staff got to work to see if NorthShore’s EHR sys­tem could col­lect pa­tient data that would be use­ful for both clin­i­cians and re­searchers. By June 2010, they had de­vel­oped their first struc­tured clin­i­cal doc­u­ment sup­port (SCDS) toolkit, an ap­pli­ca­tion pro­gram­ming in­ter­face they built into the Epic Sys­tems EHR. The sys­tem al­lowed clin­i­cians to bet­ter track care for their Parkin­son’s pa­tients and en­abled re­searchers to col­lect pa­tient data to track pat­terns re­lated to the dis­ease.

“That was kind of a eureka mo­ment for us,” Maraganore said. “We re­al­ized that this same tool could be de­ployed for other neu­ro­log­i­cal dis­or­ders.”

He and his col­leagues ex­panded the project to de­velop tool­kits for nine ad­di­tional neu­ro­log­i­cal dis­or­ders: brain tu­mors, epilepsy, mi­graine, mem­ory dis­or­ders, mild trau­matic brain in­jury, mul­ti­ple scle­ro­sis, neu­ropa­thy, rest­less leg syn­drome and stroke. They added an­other project to as­sess risk fac­tors for the onset of Alzheimer’s dis­ease.

The project in­volved mem­bers of NorthShore’s de­part­ments of neu­rol­ogy and health in­for­ma­tion tech­nol­ogy and its Cen­ter for Bio­med­i­cal Re­search In­for­mat­ics. The team worked to cre­ate an EHR sys­tem that would stan­dard­ize of­fice vis­its to cap­ture pa­tient data that could be used to de­velop pa­tient safety and qual­ity met­rics. The tool­kits are de­signed to cap­ture up to 1,000 fields of data per of­fice visit.

The team sought to cre­ate a data sys­tem that would be part of the rou­tine clin­i­cal work­flow. It was de­signed to limit the time for a med­i­cal as­sis­tant or nurse to col­lect data from a pa­tient to 15 min­utes; neu­rol­o­gists could take up to an hour to make their as­sess­ment.

Re­searchers used the tool­kits to en­roll pa­tients in a DNA biobank­ing ini­tia­tive. Based on the pa­tient in­for­ma­tion en­tered, the sys­tem prompts the physi­cian dur­ing the of­fice visit to try to en­roll the pa­tient. An elec­tronic no­tice is sent to the re­search team let­ting them know whether the pa­tient has con­sented to par­tic­i­pate in the trial.

As of April, eight SCDS tool­kits have been used sev­eral thou­sand times dur­ing rou­tine of­fice vis­its, ac­cord­ing to a study by Maraganore and col­leagues pub­lished on­line in Septem­ber in the jour­nal Neu­rol­ogy Clin­i­cal Prac­tice.

Maraganore couldn’t give a cost­sav­ings es­ti­mate for the ini­tia­tive. But he said the project has im­proved the qual­ity of care and data qual­ity, and may re­duce costs. Quar­terly qual­ity-im­prove­ment re­ports are gen­er­ated to help iden­tify op­por­tu­ni­ties to im­prove pa­tient safety and out­comes.

NorthShore has ex­panded the project by of­fer­ing the tool­kits to neu­rol­ogy de­part­ments at other sys­tems to share in­for­ma­tion, broaden re­search data­bases and en­cour­age more re­search col­lab­o­ra­tion. “The work we’ve done pro­vides a roadmap for how other neu­rol­ogy prac­tice groups can … make clin­i­cally mean­ing­ful use of their (EHR),” Maraganore said.

James Hendler, di­rec­tor of the Rens­se­laer In­sti­tute for Data Ex­plo­ration and Ap­pli­ca­tions, said ini­tia­tives such as the one at NorthShore are the tip of the ice­berg when it comes to the po­ten­tial of EHR sys­tems to ease re­search and im­prove qual­ity of care. But there are lin­ger­ing pri­vacy is­sues that will re­quire leg­isla­tive reme­dies. “The po­ten­tial for sav­ings and to im­prove health­care qual­ity is huge,” he said.

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