our team… a multidisciplinary approach
DESCRIPTION
Cerebrovascular Clinical Research Office (CCRO). Our Team… a multidisciplinary approach. Dr. J Mocco Neurosurgery. Dr. Michael Froehler Neurology. Stephanie Smith, MA, CCRP FEAT Project Lead. Emily Gilchrist, MPH Cerebrovascular Clinical Improvement and Research Coordinator. - PowerPoint PPT PresentationTRANSCRIPT
Our Team… a multidisciplinary approach
Dr. J MoccoNeurosurgery
Dr. Michael FroehlerNeurology
Bree Burks RN, MSN, CCRPManager-CCRO
Cerebrovascular Clinical Research Office (CCRO)
Stephanie Smith, MA, CCRPFEAT Project Lead
Jessica Marlin, CCRP Clinical Trials Specialist
Emily Gilchrist, MPHCerebrovascular Clinical Improvement and Research Coordinator
Diane Brown, RN, BSN, CCRPResearch Nurse Specialist III
Andrea Wimsatt Reed, MSData Collector
Dr. Howard KirshnerNeurology
Vanderbilt CCRO Expertise
Complex Data Capture and Analysis Currently lead coordinating center for 3 multicenter clinical trials Coordinating over 30 active clinical trials Adjudicating complex data sets Analyzing data to assess project milestones
REDCap Work closely with creator (Dr. Paul Harris) to implement new
functionality Create complex databases storing information for thousands of
patients used by institutions across the country
Streamlining Clinical Workflow Parallel clinical workflow for cerebrovascular patients in an effort
to standardize care (at VUMC and across the country) Experienced in implementing clinical improvement/best
practices driven by new evidence
Challenges with Our Current Data Retrieval Process
Data
Multiple Disciplines Involved
System Issues
DATA StarForms/EMR data is not outcomes specific
nor consistent across users
Data in EMR is not easily retrievable
Structured data in EDW is not user friendly
Data is reviewed after patients are discharged using billing and coding criteria
Challenges
Multidisciplinary Issues
Challenges
Need for uniformity
Objective, comprehensive perspective is
required
System Issues Abstractors often enter same medical records multiple times while
pulling reports Abstractors and Consultants cannot independently generate reports
(even routine reports) Coding drives patient selection sometimes weeks after point of care EDW is complex and data is limited, therefore cerebrovascular data
is abstracted manually 70-100 patients a month/approximately 70-90 minutes per patient Approximately 2 FTE’s a month for cerebrovascular data abstraction ONLY Approximately .7 FTE’s a month for defining patient population
Challenges
How could we repurpose that time in stroke alone to improve patient care?
What’s Missing
1. Real-time/Reliable Data
2. Streamlined Clinical Workflow
3. Streamlined Reporting Properties
4. Automated Dataset (ie: no more manual abstraction)
Proposal
• Create a new, automated data abstraction process from StarPanel that is outcome specific
• Pilot this process in one controlled clinical area• Cerebrovascular Disease/Stroke
Once finalized implement across
VUMC
Solution
1) Created in house/flexible
2) User-friendly
3) Robust analysis and reporting properties
4) Experience with Automation1) Research Derivative2) DDP
Automated Cerebrovascular Data Collection
Solution
Real-time Reliable Data Ability to impact care before discharge and
decrease failures VTE Prophylaxis Written educational materials
Daily snapshots of clinical workflow Recover time spent identifying patients’
true diagnoses from generic ICD-9 Codes
Solution
Streamlined Clinical Workflow Medical record templates are consolidated New templates are outcomes specific, reflective
of current best practice, and conducive with clinical workflow
Solution
Streamlined Reporting Properties• Flags missing values
• Determines “Failures” based on pre-determined criteria
• Logic can be built to capture any existing value and used repeatedly or amended
• Executes reports in seconds
Solution
Manual Abstraction Obsolete
Project Goals
Improving patient care at Vanderbilt
Reduce the burden of manual data abstraction
Increase efforts towards implementing new processes for quality, safety, and risk-prevention
Define CV patient population
Organize and prioritize new MR
templates
Update notes and forms
Pilot new forms/Delete alternatives
Map data pointsStarPanel → EDW → REDCap
Begin using REDCap to
generate reports
Build REDCap database
Define data
points
• Core measures• GWTG• Meaningful Use• Clinical needs• Research
needs• Per clinical
users• Collapse
current options
• Reformat for automation
• Mirror the MR with a calendar design
• Incorporate vitals, labs, and meds through the DDP
Implementation
• Review Current form• Identify data currently
captured and necessary additions
• Draft Template• Approval• Construction
End Product
DATA Single form reporting will create consistency in the EMR
Data in EMR will be easily retrieved due to standardization
Generating reports within the EDW based on ICD-9 codes will be unnecessary
Data is retrievable within 12-24 hours of entry into the EMR
Benefits
Multidisciplinary and System Issues Uniformity in data collection will create a system
benefitting multiple disciplines and departments System redundancies will be significantly reduced Abstractors and Consultants will be able to
independently generate reports Patient population will be predetermined eliminating
the need to verify ICD-9 codes against the EMR
Benefits
Recap
Improving patient care at Vanderbilt
Reduce the burden of manual data abstraction
Increase efforts towards implementing new processes for quality, safety, and risk-prevention