From Data to Implementation and Back Again: Lessons from VA’s Emerging Learning Health System Maria Souden, PhD Associate Director, VA Information Resource Center AcademyHealth Annual Research Meeting 27 June 2017
A Learning Health System is one where … “ science, informatics, incentives , and culture are aligned for continuous improvement and innovation , with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral byproduct of the delivery experience.” 2
Iterative cycles of a Learning Healthcare System 3
Elements of the Supporting Infrastructure 1) well-developed digital infrastructure to capture and store administrative and clinical information 2) mature data utility that can turn this diverse set of information into usable knowledge to guide decisions at every level of the health system 1) considers science, informatics, incentives, and culture 2) supports continuous improvement and innovation 4
Today’s panel Lessons Learned about Supporting Data Literacy for a Learning Healthcare System Maria Souden, PhD Big Data Phenomics in the VA Mary Whooley, MD From Learning to Doing: Identifying, Implementing, and Spreading Promising Practices in the VA Healthcare System George L. Jackson, PhD, MHA The Partnered Evidence-based Policy Resource Center: Building the VA Learning Healthcare System Steven D. Pizer, PhD Discussant Steve Fihn, MD, MPH 5
VA Data Region 2 Region 1 V1 MOSS V12 V2 V20 Farm MOSS V15 Region 4 MOSS RDW Farm V19 Farm RDW V5 V3 RDW V23 V16 V4 Region 3 V21 V18 V17 V22 V6 SAS MOSS Grid V7 Farm MOSS VINCI BI SharePoint (MOSS) Farm Farm RDW CDW • Performance Point Services V11 V8 • Excel Services Enterprise GIS Apps • Reporting Services V10 V9 (AITC) • Analysis Services PMAS • Collaboration Services • Team Foundation Services Annually: • 1.6 billion outpatient encounters, 9 million hospital admissions • 3.2 billion clinical orders; 5.6 billion lab tests, 1.5 billion prescriptions filled • 165 million radiology procedures • 2 billion text notes (unstructured), hugely enriched with a lot of information Typical day: • 420,000 patient encounters, 2.4 million lab results , 553,000 pharmacy fills
7 The VA’s Corporate Data Warehouse (CDW) • Relational database containing VHA administrative and clinical data • Most data dates to fiscal year 1999 • Central to business management , population health management , quality improvement , research , and health system innovation • Comprises 50+ data “domains,” including: – Inpatient and Outpatient Records – Inpatient and Outpatient Pharmacy – Lab Tests and Results – Enrollment information • Units of analysis vary by table, ranging from drug to diagnosis to inpatient stay to consult to prescription refill
8 Opportunities Challenges
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Supporting “data literacy” • Work with and document the data • Educate data users through: – Factbooks, Technical briefs, User Guides, Statistical Snapshots – Cyberseminars & tutorials • Disseminate resources through: – Websites & Communication portals – Listservs – HelpDesk – Newsletter: Data Issues Brief
Lesson 1: Context is critical, and not always obvious • Research and quality improvement use of data is secondary to its original purpose • Requires in-depth understanding of how the data were generated and transformed • Know what you have and what it means 12
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14 Lesson 2: Need for a broad knowledge pipeline • Beyond “institutional” knowledge • Support diversity of questions, uses, and applications of data • Keep up with complexity, change, growth 14
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16 LHS Lesson 3: People are part of the infrastructure • Explicate tacit knowledge- expertise residing in people • Data reuse can be nuanced- don’t know what you don’t know • Knowledge distributed across organization 16
17 HSRData Listserv • Email-based question-answering community of ~1,300 VA data users • Membership spans disciplines, functions, offices • Posts have increased fourfold since CDW came into broad use (30 120/month) • Average 2.9 answers per question • Thoughtful and valued community resource • But lacking knowledge organization and affordances for reuse of information shared. 17
Next-generation HSRData Forums - better supporting the Learning Healthcare System 18
Categorize and group information Highlight who knows what 19
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