Domain

Learning Health System

Type

Case Study or Comparative Case Study

Theme

effectiveness; population; operations

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

Objectives:

We aimed to develop and validate a personalized and interactive health visualization module in order to enhance communication between healthcare providers and patients to promote cardiovascular health (CVH) and prevent or manage cardiovascular disease.

Method:

By leveraging data visualizations and relying on tight integration with our commercial electronic health record (EHR), we designed SPHERE (Stroke Prevention in Healthcare Delivery EnviRonmEnts), a data-driven risk assessment instrument that enables seamless point-of-care interactive risk profiling for primary care physicians and their patients. We employed a composite CVH score, modified from the AHA’s Life’s Simple 7™ prevention campaign, and designed an interactive visualization tool to engage patients and improve patient-clinician communication. We performed user acceptance testing to ensure the tool was relevant and actionable for physicians, while also being meaningful for non-clinicians. We piloted SPHERE among academic medical center primary care providers serving an urban, low socio-economic status patient population and catalogued strategies and solutions to successfully deploy such a tool.

Findings:

User acceptance testing revealed that providers in our study rarely order fasting glucose, one of the recommended parameters for the CVH score. While Life’s Simple 7™ reflects the established practice of using fasting glucose to assess for diabetes, our physicians had already adopted the use of hemoglobin A1c (HbA1c), as recently recommended by the American Diabetes Association. We verified this by querying EHR data; in fact, 100% of our 160-person baseline cohort had missing values for fasting glucose. Given our findings, we modified SPHERE to utilize HbA1c in the composite CVH score calculation.

The final tool met all the specified requirements: we created an EHR-integrated application that leverages existing clinical data to provide a real-time representation of the patient’s CVH status, and promotes discussion between healthcare providers and patients. Moreover, the interactivity feature provides immediate feedback about the impact of individual behavior changes on CVH.

Lessons Learned:

The informatics and public health lessons we uncovered while evaluating and refining SPHERE are critical to the success of such interventions. In addition to modifying the tool to be clinically relevant for our physicians, we uncovered issues relating to data capture in the EHR, technical differences across our academic medical center, and usability and workflow obstacles. While challenging, harmonizing clinical practice, public health, and information systems for such purposes can truly impact healthcare delivery and patient outcomes. Our tool is one example of how we can harness the power of the EHR to bring evidence-based public health interventions into primary care clinics, reduce risk for chronic disease and conserve valuable healthcare resources.

Conclusion:

By tethering a visualization tool to the EHR and implementing it in a minimally obtrusive manner, we can bring public health into primary care clinics. Automating health profiling and displaying visual cues to patients and physicians within the EHR may promote behavior change and improve cardiovascular health across our entire patient population. The tight integration of clinical practice, data capture, evidence generation and feedback in this work is essential in order to realize the full potential of a learning healthcare system.

Acknowledgements

This work was supported by a grant from Pfizer, Inc.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Facilitating EHR-based Communication and Understanding in a Learning Healthcare System

Objectives:

We aimed to develop and validate a personalized and interactive health visualization module in order to enhance communication between healthcare providers and patients to promote cardiovascular health (CVH) and prevent or manage cardiovascular disease.

Method:

By leveraging data visualizations and relying on tight integration with our commercial electronic health record (EHR), we designed SPHERE (Stroke Prevention in Healthcare Delivery EnviRonmEnts), a data-driven risk assessment instrument that enables seamless point-of-care interactive risk profiling for primary care physicians and their patients. We employed a composite CVH score, modified from the AHA’s Life’s Simple 7™ prevention campaign, and designed an interactive visualization tool to engage patients and improve patient-clinician communication. We performed user acceptance testing to ensure the tool was relevant and actionable for physicians, while also being meaningful for non-clinicians. We piloted SPHERE among academic medical center primary care providers serving an urban, low socio-economic status patient population and catalogued strategies and solutions to successfully deploy such a tool.

Findings:

User acceptance testing revealed that providers in our study rarely order fasting glucose, one of the recommended parameters for the CVH score. While Life’s Simple 7™ reflects the established practice of using fasting glucose to assess for diabetes, our physicians had already adopted the use of hemoglobin A1c (HbA1c), as recently recommended by the American Diabetes Association. We verified this by querying EHR data; in fact, 100% of our 160-person baseline cohort had missing values for fasting glucose. Given our findings, we modified SPHERE to utilize HbA1c in the composite CVH score calculation.

The final tool met all the specified requirements: we created an EHR-integrated application that leverages existing clinical data to provide a real-time representation of the patient’s CVH status, and promotes discussion between healthcare providers and patients. Moreover, the interactivity feature provides immediate feedback about the impact of individual behavior changes on CVH.

Lessons Learned:

The informatics and public health lessons we uncovered while evaluating and refining SPHERE are critical to the success of such interventions. In addition to modifying the tool to be clinically relevant for our physicians, we uncovered issues relating to data capture in the EHR, technical differences across our academic medical center, and usability and workflow obstacles. While challenging, harmonizing clinical practice, public health, and information systems for such purposes can truly impact healthcare delivery and patient outcomes. Our tool is one example of how we can harness the power of the EHR to bring evidence-based public health interventions into primary care clinics, reduce risk for chronic disease and conserve valuable healthcare resources.

Conclusion:

By tethering a visualization tool to the EHR and implementing it in a minimally obtrusive manner, we can bring public health into primary care clinics. Automating health profiling and displaying visual cues to patients and physicians within the EHR may promote behavior change and improve cardiovascular health across our entire patient population. The tight integration of clinical practice, data capture, evidence generation and feedback in this work is essential in order to realize the full potential of a learning healthcare system.