Outline Background EHR-CTMS Integration Research Tools Leveraging - - PDF document

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Outline Background EHR-CTMS Integration Research Tools Leveraging - - PDF document

Jun 20, 2023 319 likes •569 views

1/6/2017 Leveraging the EHR and Other Technologies for Research at Yale Tesheia Johnson, MBA, MHS Allen Hsiao, MD, FAAP Deputy Director, Chief Operating Officer, YCCI Chief Medical Information Officer Associate Director for Clinical Research,

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Leveraging the EHR and Other Technologies for Research at Yale

Allen Hsiao, MD, FAAP Chief Medical Information Officer Associate Professor of Pediatrics & of Emergency Medicine Tesheia Johnson, MBA, MHS Deputy Director, Chief Operating Officer, YCCI Associate Director for Clinical Research, Yale School of Medicine

Outline

 Background  EHR-CTMS Integration  Research Tools Leveraging EHR

 Serious Adverse Event Alerts  Research Decision Support/ MLMs in Epic  Engaging Research Subjects with the Patient Portal  Research Data from Epic EHR

 Other Technologies

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Yale New Haven Health System Yale University & School of Medicine

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YSM & YNHH Legacy Environment c. 2010

BH Cerner Clinical Enterprise SDK Revenue Cycle GH Meditech Enterprise Picis OR YNHH Eclipsys/Allscripts Sunrise IP and Oncology OP GE OR/Anesthesia Links ED GE Centricity Ambulatory Soft Lab SDK Revenue Cycle

HSR Medipac Quadramed Sunquest YMG Paper GE Centricity Ambulatory Sunrise Ambulatory OP Oncology NEMG Varied Yale Health AllScripts McKesson Pharmacy Epic Care Inpatient Epic Care Ambulatory Prelude (Registration) Cadence (Scheduling)

Resolute- Hospital Billing

Identity (HIM) Willow (Pharmacy)

Cardiant/Cupid (Cardiology)

Stork (Obstetrics) Beacon (Oncology) My Chart (Patient Portal)

ASAP (Emergency Dept) OpTime/Anesthesia (Periop)

Phoenix (Transplant)

Resolute-Professional Billing

Kaleidoscope (Ophthalmology)

Radiant (Radiology) Clarity (Reporting) CPM-RC 2016 Adds: Beaker (Lab) ICON (Infection Control) Welcome (Kiosks) Helix (Star) Data Warehouse

Capsule BMDI

Bed Management, EVS, Transport

Healthy Planet

Epic EHR Unifies System and School

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Critical Indicators Yale-New Haven Bridgeport Greenwich Northeast Medical TOTAL Total Licensed Beds**

1,541 383 206 N/A 2,130

Inpatient Discharges*

78,529 18,208 12,538 N/A 109,275

Outpatient Encounters*

1,187,405 277,043 289,860 402,000* 2,156,308

Net Patient Service Revenue*

$2.4B $439 M $349 M $123 M $ 3.3B

Medical Staff***

4,080 1,150 601 660 6,491

Employees

12,428 2,619 1,636 1,050 20,292****

Clinical/ Epic EHR Footprint

Going liv e a t La w rence + Mem oria l, licensed for 28 0 bed s a nd p rov id e p a tient ca re to m ed ica l, surgica l, p ed ia tric, reha b, p sy chia tric a nd obstetrica l p a tients.

Yale School of Medicine:

 6th in total NIH funding among medical schools  4th in total NIH funding per full-time faculty member  Research funding FY16: $593.1 M, with more than $333M coming from

NIH

 Total faculty:1,565 teaching (ladder) faculty

 713 research faculty  1,578 postgraduate fellows  28 basic science and clinical departments, 7 centers, and School of Public Health

 ~5,000 Active human subjects protocols  3,411 active patients on 1,491 active therapeutic studies, as of January 5th

A Little About Us

8

Research Footprint

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Research Flow – Prior to February 2014

Now: Integrated Standards Based EHR-CTMS Environment

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Yale Clinical Research Dashboard

Subject: ADVERSE EVENT INFORMATION Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: Hospital Service: Emergency Medicine Type of Event: ED Arrival STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701

From: Epic Sent: Friday, August 03, 2016 9:31 AM To: Study PI; Study Coordinator Subject: ER or In-Pt status notification for research pt.'s

Epic-OnCore Integration: Banner

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Subject: ADVERSE EVENT INFORMATION Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: Hospital Service: Emergency Medicine Type of Event: ED Arrival STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701

From: Epic Sent: Friday, December 14, 2016 9:31 AM To: Study PI; Study Coordinator Subject: ER or In-Pt status notification for research pt.'s

Epic Serious Adverse Event (SAE) Alerts

Subject: ADVERSE EVENT INFORMATION Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: Hospital Service: Emergency Medicine Type of Event: ED Arrival STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701

From: Epic Sent: Friday, August 03, 2016 9:31 AM To: Study PI; Study Coordinator Subject: ER or In-Pt status notification for research pt.'s

Epic Serious Adverse Event (SAE) Alerts

14,518 SAE Alerts to investigators since 2/ 2012

 7,827 unique encounters  3,486 unique patients

Investigators notified of:

 5,683 ED visits  3,965 inpatient admissions  763 ICU transfers  142 deaths

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Clinical & Research Decision Support with Epic …

Clinical & Research Decision Support with Epic Clinical & Research Decision Support with Epic

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Smoking Cessation MLM Example: 12,365 patients (Sep 2016):

 6119 Intervention & 6246 Control patients:  2020 (33%) Int vs. 1752 (28%) Control had nicotine orders placed  2457 (40%) Int vs. 130 (2%) Control had T

  • bacco use disorder on

problem list

 1717 (28%) Int vs. 0* (0%) Control successful referral to QuitLine  6102 (99%) Int vs. 0* (0%) Control message sent to PCP

Clinical & Research Decision Support with Epic

Database of volunteers

Cultural Ambassadors

Advertising and media

New clinical research recruitment call center

Approaches to Recruitment:

“ Help us discover” clinical research awareness campaign

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Update to “Notice of Privacy” and “Patient Acknowledgement and Financial A h i i ”

Leveraging all resources:

Utilizing Epic Data in a new way - Opt Out Text

Yale is an Opt-out System:

Information from your medical record and leftover blood and/ or tissue may be used for research and teaching purposes unless you

  • pt out. To opt out, you may choose to do so

in one of four ways:

1)

Email: optout@yale.edu

2)

2) Call 1-877-978-8348, option #3

3)

3) mychart.ynhhs.org

4)

4) Write: Office of Research Services Attn: Opt- Out Recruitment Yale School of Medicine P.O. Box 208054 New Haven, CT 06520- 8054

Leveraging IT & MyChart for Recruitment & Foll0w-up

MyChart tab for clinical research created March 2015

Yale is an Opt-out System:

Information from your medical record and leftover blood and/ or tissue may be used for research and teaching purposes unless you opt out. To opt out, you may choose to do so in one of four ways: 1) Email: optout@yale.edu; 2) Call 1-877-978-8348; 3) mychart.ynhhs.org; or 4) Write: Office of Research Services Attn: Opt-Out Recruitment Yale School of Medicine P.O. Box 208054 New Haven, CT 06520- 8054

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MyChart for Research: Help Us Discover

 1240 MyChart unique research volunteers since launch (3/15/15)

 All with no active advertisement

 590 screened for studies from these volunteers

 146 already participating in studies

 By comparison, 840 identified through “traditional” methods

EHR Patient Portal: Direct Study Recruitment

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EHR Reporting Used for Subject Identification

 Report set up

based on inclusion and exclusion criteria of study

Patient Notification: Email & Login Message

 Patients receive

email (based on preferences) noting new message in MyChart

 Upon login,

message about study appears at top:

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Patient Notification: Study Information & Response

 Clicking on icon

  • r message takes

patient to study information

 From here,

patients can easily log interest

  • r decline

Patient Education: Fully Integrated Study Information

 Patients can

expand window for more information

 Can also embed

hyperlinks to website for education and

  • ther info
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Messaging is Important

 Initial proposed language:

“Based on your medical record, you have been identified as potentially eligible for these studies.”

 T

  • :

“You are receiving this message because the Yale New Haven Epic medical record system has done a search based on medical conditions that you may have. No one has looked at your record and no information has been shared with any research doctor or research team member. This search was made by a computer.”

Integrated Investigator Notification: Patient Decision

 Simple click on

“I’m Interested” gets ball rolling

 “No, Thank You”

will suppress future notification for this study

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Integrated Investigator Notification: Expressing Interest

 Investigators will

  • nly learn of

patients who have expressed interest

Integrated Investigator Notification: In Basket Message

 Notifications are

easily managed via In Basket

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Integrated Research Recruitment: 2 Studies Now Live

Phase 2a Trial of Mood Disorder KOR Blocker (PI: Sanacora)

 157 patients identified and recruitment notifications sent out

 25 interested respondents, 22 declines  21of the 25 interested screened, 19 excluded, 2 enrolled (1 withdrew)  http://yalestudies.org/find/869.trial

Phase 2 Trial of Exenatide on Glucose Control Type I Diabetes (PI: Herold)

 35 patients identified and notified

 11 have responded with interest, 7 decline, 1 enrolled, 2 in active screening  http://yalestudies.org/find/149.trial

12 of the interested enrolled in other studies

Epic Data for Investigators

“If we did not have Epic, if we did not have [EMRs], if we were still on paper, it would have taken forever to get these results…”

  • Hanna-Attisha, MD, MPH

 Pediatrician who discovered Flint lead poisoning compared blood levels

in Epic records Jan-Sep 2013 vs. Jan-Sep 2015

 Percentage of children with high levels went from 2.4% to 4.9%

 In some areas, lead poisoning jumped from 4.0% to 10.6%

This is the data that allowed her to blow the whistle and uncover the water disaster in Michigan

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  • Star Schema EDW
  • Epic EHR data

49 Fact tables, 112 Dimension tables

  • Registries
  • SSA National Death Registry
  • External Claims
  • Benchmarking

“Caboodle” Clarity

  • Reporting DB
  • Relational architecture
  • 18000 Tables

Nightly ETL (8 hours)

Work In Progress to Enrich Helix Data

  • Provider/Faculty Table
  • Department Cost Center
  • Clinical Trials
  • Text Analytics
  • Medical Image Data Repository
  • Patient Population Profiles

v 11

Chronicles

  • Production DB
  • Cache architecture

Nightly ETL

Epic Data for Investigators

EHR/Data Ontologies

  • SNOMED
  • LOINC
  • RxNORM
  • ICD-10
  • CPT

 Jan-Sep 2013: 0.090% children w/ elevated lead  Jan-Sep 2015: 0.093% children w/ elevated lead

Example: Does New Haven also have growing lead problem?

Epic Data for Investigators: Slicer Dicer

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  • Epic EHR data

49 Fact tables, 112 Dimension tables

  • Registries
  • SSA National Death Registry
  • External Claims
  • Benchmarking
  • Epic Data w/ NLP
  • Genomics
  • Bedside Alarm
  • Streaming Vitals
  • mHealth Data
  • Allergy\ Weather
  • Traffic
  • Social Media
  • Twitter
  • Facebook
  • Google

Hadoop “Lake”

Nightly ETL Nightly ETL (scoop)

Helix data “scooped” as needed, all

  • ther feeds are live streams

v 11

Lot of hype but also a lot of potential to support Precision Medicine

Phenoty p ic + Genoty p ic + “Socioty p ic” d a ta

Clarity

  • Reporting DB
  • Relational architecture
  • 18000 Tables

Epic “Big Data” for Investigators Other Technologies: Research Evaluation System

 Innovation partnership with OnCore creator to create new

system to support research activities

 One‐stop‐shopping for investigator information:  How many publications?  How much and current grant funding?  What projects and how many?  Center program areas and membership?

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Research Evaluation System: Manage Investigators Research Evaluation System: Review & Search Grants

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Research Evaluation System: Publication Review Research Evaluation System: Manage Projects

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Research Evaluation System: Track Trainees

Our Integrated Environment:

EHR, CTMS, Evaluation & Analytics

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The Power of Collaboration to Influence Vendors

 50 CTSA sites have Epic EHR  31 CTSA sites have OnCore (including enterprise-wide and Cancer Centers)  24 CTSAs have both Epic EHR and OnCore as CTMS

CTSAs with Epic OnCore Sites

Research Technologies In Development

 T

elemedicine via MyChart

 mHealth & EHR integration

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Future of Research?

Direct to Patient Study Recruitment Rich mHealth Data "Digital Donations” to Investigators Virtual Visits & Consents Patient Reported Outcomes Digital Research Collaboration

  • Geography less important
  • Sharing of tools & data
  • Portable/replicable EHR build
  • Multi-site Data Warehouses
  • More, richer, data than ever
  • Information science key

Questions?