let’s talk informatics · let’s talk informatics turning health care data into value- ......

Let’s Talk Informatics

Turning health care data into value-based information and knowledge:

What are the top 6 strategies in Primary Health Care?

Tara Sampalli: Director of Research and Innovation, Primary Health Care and Chronic Disease Management

Ashley Harnish: Health Services Manager, Primary Health Care and Chronic Disease Management

Kylie Peacock: Patient Advisor, Primary Health Care and Chronic Disease Management

Dr. Matt Grandy/Sarah Sabri: Physician Lead, CPCSSN and Physician, Dalhousie Family Medicine Clinic, Primary Care/Data Manager, CPCSSN

February 23, 2017Bethune Ballroom, Halifax, Nova Scotia

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Please be advised that we are currently in a controlled vendor environment for the

One Person One Record project.

Please refrain from questions or discussion related to the

One Person One Record project.

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Informatics…

utilizes health information and health care technology to enable patients to receive best treatment and best outcome possible.

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Clinical Informatics…is the application of informatics and information technology to

deliver health care. AMIA. (2017, January 13). Retrieved from https://www.amia.org/applications-infomatics/clinical-informatics

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Series learning objectives At the conclusion of this activity, participants will be able to…▫ Identify what knowledge and skills health care providers will

need to use information now and in the future.▫ Prepare health care providers by introducing them to

concepts and local experiences in Informatics.▫ Acquire knowledge to remain current with new trends,

terminology , studies, data and breaking news.▫ Cooperate with a network of colleagues establishing

connections and leaders that will provide assistance and advice for business issues, as well as for best-practice and knowledge sharing.

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Conflict of Interest Declaration

• We do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device, health care informatics organization or other for-profit funder of this program.

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Session learning objectives At the conclusion of this presentation, participants should

be able to…▫ Understand what knowledge, skills, resources and

considerations are essential for health care providers to convert data and information to useful knowledge.

▫ To reflect upon the importance of stakeholder engagement in clinical informatics projects.

▫ Learn from multiple perspectives and experiences about importance of data and information in health care.

▫ Learn about Primary Health Care strategies in information management.

▫ Learn about role of research in bringing value to point of care and quality.

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Why is data and information important in health care?

• Better communication• Timely identification –

high risk, high users• Support point of care

decision making• Reduce duplication of

care• Improve outcomes• Improve service

delivery• Support quality,

education and research.

Data

Information

Evidence

Knowledge

Decision

Impact

Better information

Better decisions

Better outcomes

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What is data in healthcare?Data in health care

80% of health care data is still unstructured

What data is actually bringing value?

What else are we not considering as data?

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Data source: IBM presentation 2015

What do we do with data?

Retrospectivereporting

Enterprise-wide insights

Proactive interventions

Dynamic learning environment

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Big Data Analytics – data integration opportunities

Big Data

Capture Data

Any clinicalworkflow

All patient dataincluding narrativesAll patient databases

Understand everything

Use data to bring value

Make data meaningful

Optimize workflowSupport service and businessPlanning processes

Better patient careComprehensive and standardizepatient recordsInformed decision making Real time access to relevant dat

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• Geographic Information Systems (GIS) are spatial data management systems

• Disease surveillance to plan for access and relevant services

• Billing data, transportation, location of services

GIS and health services planning – data integration opportunities

GreaterEfficiency

ImprovedOutcomes

Improvedaccess, experience

of careSmarter allocation

of resources

Population health analyticsBetter operational insightsProjections of supply and demand

Data quality and static data!

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Gudea 2005Perspect Health Inf Manag.

Processing invalid data produces useless results!

Confounders-Disparate data impinging on the repository-Inaccuracies-Low data quality-Lack of standards

Is garbage in truly garbage out? 13

How are we overcoming challenges and some current limitations?Primary Health Care journey

Data

Wisdom

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Intro PHC (1 or 2 slides)Wellness

Promotion, Chronic Disease

Prevention & Risk Factor

Management

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Importance of information in Primary Health Care• Starfield et al. (2005) defined

primary care as the specialty thatsees any patient with anycombination of problems.

• Primary care's characteristics asfirst-contact care, comprehensiveand coordinated care

• Access to data is not only importantbut required to understand thecomplete picture of the patient▫ ability to integrate and align data from disparate

sources

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What influences system- level transformations?

Modified schematic from Charnes et al.

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Six value-based strategies – Primary Health Care approach

1. What do we really want to know? – from various perspectives, know your value streams

2. Understanding what you have – know your current state for the value streams identified

3. Engaging stakeholders in a conversation around how best to use it, conversation around meaning and value – working together

4. Developing a strategy – your future state 5. Applying towards planning and service delivery –

improvement cycles6. Align with quality and research – continuous learning

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What do we want to know?

What is our current state?

Will our proposed changes bring value to key stakeholders?

Plan for future state?

Implement and evaluate

Align with quality and research

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What have we started to achieve?• Understand what type of data and

information can bring value to various stakeholders

• Truly understand our data sources –booking and registration systems, questionnaires, patient charts, indirect care processes, qualitative

• Looking towards what else could be data and how best to capture them

• Ways to integrate diverse sources to develop meaningful knowledge

• Sustainable knowledge

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Ashley HarnishHealth Services Manager, Primary Health Care and Chronic Disease Management Portfolio

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Objectives

▫ Discuss how leaders cultivate a culture of continuous quality improvement through use of informatics and data literacy

▫ Reflect on assumptions we have about informatics, why do we collect data?

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Administrative Perspective to Clinical Informatics

• Why collect data?• Data is a tool▫ For whom? ▫ Accessibility ▫ Timeliness▫ Culture▫ Transparency

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Administrative Perspective to Clinical Informatics

• Why collect data?• Data is a tool▫ For whom? ▫ Accessibility▫ Timeliness▫ Culture▫ Transparency

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Case Study – Care by Design25

Value-Based StrategiesHSM Perspective1. Know your value stream2. Know your current state3. Engage stakeholders – work together4. Develop strategy for future state5. Attention to improvement cycles6. Invest in continuous learning/CQI

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Kylie PeacockPatient Advisor, Primary Health Care and Chronic Disease Management Portfolio

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Data is For Everyone (Including Patients!)

Personal health experiences with data- Living with type 1 diabetes = DATA ALL DAY EVERYDAY- MyHealthNS

Reluctance to data - What are some challenges patients have with data?

Not your typical data and information- Are we asking the right questions?- What data and information is important to patients?

Why is data important?- How can we bring value to data?- How can we translate data into meaningful knowledge?- How can we improve better use of data in healthcare?

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Isabel’s Experience with Data

“My son (a teen) has to track all kinds of stuff…I have to find ways to help/motivate him to do it. Whatever is out there is either junk, too hard, or not appropriate for the diversity of what we’re tracking…Never mind the fact that he (and I) would just prefer to get on with our lives. We haven’t found anything that tracks even one aspect of these well, and it’s vital we do all of them.”

“We’ve also had amazing experiences with data that have lead to three key things: identifying a health problem, being referred to a specialist, and being fast-tracked to a specialist because we kept track of my son’s sleep with the Fitbit.”

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Nova scotia primary health care system 2016/2017 baseline reportHow did I get involved?

Purpose of Baseline Report

Criteria for selecting indicators

Data sources for indicators

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Patients as partners• Canadian Institutes of Health Research (CIHR) Strategy for

Patient-Oriented Research (SPOR) - Patient Engagement Framework

• Goal of SPOR: patients, researchers, health care providers and decision-makers to actively collaborate to build a sustainable, accessible and equitable health care system and bring positive changes in the health of people living in Canada.

• Patient Engagement: Meaningful and active collaboration in governance, priority setting, conducting research and knowledge translation.

• Patient - Oriented Research: Refers to a continuum of research that engages patients as partners, focusses on patient-identified priorities and improves patient outcomes. This research, conducted by multidisciplinary teams in partnership with relevant stakeholders, aims to apply the knowledge generated to improve health care systems and practices.

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Dr. Matt Grandy and Sarah SabriDalhousie Family Medicine

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MaRNet-FP• Maritime Family Practice Research Network• Established in 2005• Develop a network of family practices across Nova Scotia, New

Brunswick and Prince Edward Island • Enable community family physicians and nurse practitioners to

collaborate with academic family physicians to conduct primary care research

• Conduct and support primary care research in practice‐based settings that addresses questions of importance to Family Medicine

• Since 2010, MaRNet‐FP primary project has been CPCSSN

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CPCSSN• CPCSSN stands for Canadian Primary Care Sentinel Surveillance

Network• Our team:

• Principal Investigator: Dr. Mathew Grandy• Co‐ Investigator: Dr. Fred Burge • Data Manager: Sarah Sabri

• First pan‐Canadian primary care research Canadian multi‐disease electronic medical record surveillance system

• We collect health information from electronic medical records in the offices of participating family physicians

• MaRNet‐FP is one of the regional networks of CPCSSN

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CPCSSN Mission• Collect and maintain national epidemiological surveillance data

using EMRs to improve outcomes in primary health care• Contribute to a stronger national knowledge base in the area

of primary health care and chronic disease management• Improve the effectiveness and efficiency of primary health

care delivery and outcomes across the country.• Facilitate and encourage innovation and excellence in primary

health care research in all provinces and territories in Canada.• Create a knowledge exchange loop and promote knowledge

translation in primary health care research and surveillance.

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Current status across Canada

National stats as of June 2016

Clinics: 206 Providers: 1,180 Patients: 1,509,891

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CPCSSN in MaRNet-FP

MaRNet-FP stats as of Nov 2016

Clinics: 31 Providers: 80 Patients: ~125,000

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CPCSSN Data Elements• Provider details

• Patient demographics

• Problem list

• Procedures

• Laboratory results

• Billing diagnosis information

• Referral information

• Allergy/Intolerance

• Physical exam

• Risk factors

• Medications

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Quality improvement in CPCSSN• MaRNet‐FP Provides feedback reports to sentinels on a

regular basis on their EMR data • Reports are tailored to the type of clinical setting.

• Individual reports for solo practices, group practice report for collaborative settings, provincial and national reports.

• Reports include: • Prevalence of chronic conditions• CIHI primary prevention quality indicators• Chronic disease management (e.g. lipid and glucose

targets in DM, BP controls in HTM)• Screening indicators (dyslipidemia, hypertension)

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Knowledge Translation in CPCSSN

Research question

Research planning & design

Data collection & analysis

Feedback to physicians

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CPCSSN Data for Research Current research projects and collaborations

1. Developing a case definition for Congestive Heart Failure• In collaboration with CVH‐NS

2. Developing Prescribing Profiles for Nova Scotia Family Physicians using CPCSSN‐MaRNetFP data.• Calculation of DU90• Provide feedback to physicians• Assess the usefulness of such feedback

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Assisting local researchers• The data within the CPCSSN‐MaRNetFP database can be

served as data source platform for local researchers• Request from Dr. Ferhan Siddiqi (division of

Endocrinology) for his project: Patterns of microalbuminuria screening in patients with Diabetes in NS

• Dr. Piccinini project: Pregnancy weight gain and childhood BMI trajectories: A Nova Scotia cohort study using CPCSSN‐MaRNetFP data

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Thank you!

Questions / Comments

Please contact [email protected] if you want to learn more, collaborate or be involved in our health informatics initiatives in Primary Health Care

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The Let’s Talk Informatics series meet the criteria outlined in the Manipro+ Certification

guide for non-certified credits by providing content aimed at improving computer skills as applied to learning and access to information.

To receive a certificate of attendance for today’s session, there is a place for you to provide your

email address in the evaluation survey.

Thank you for attending today’s event.

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