My first AMIA meeting and I'm finding it filled with all sorts of goodies. There's lots of tweeting going on, too. (Go to TweetChat with hashtag #AMIA2010 to keep up.)
▼ AMIA 2010 Susan Dentzer, Editor Health Affairs
2010.11.14
▼ "Golden Age" of PPACA (?)
• compared Greek myth of Ae____ to Obama
▼ Open up goldmine of data to public
• CHDI website www.hhs.gov—open
• use data to shape community responses to childhood obesity... Children's Optimal Health
▼ [] l/u Health Affairs 2010 Nov 29:2047
• rapid-cycle improvement of medical home care @Geisnger
• reductions in risk-adjusted chronically ill hospital admission and readmission rates
▼ Three Aims
• 1. Better Health
• 2. Better health care
• 3. Better value
▼ IOM study on variations
• look at var in HC spending, pt diversity, MD decisions on what care to give and evidence
▼ Shared decision making by pts
• ACA provision
• even informed pts don't exercise their options well
• preference-sensitive care
▼ Quotations
• Quotes by George Carlin, Churchill on American People
• Quote by Jerry Garcia re Somebody has to do something and it is pathetic that it must be us
▼ Informatics Issues in HIEs
20101114 Rob Kolodner, Session chair
▼ Development and use of a Medication history Service Associated with a health information exchange: Architecture and Preliminary findings
M. Frisse, Vanderbilt Center for Better Health; L. Tang; A. Belsito, M. Overhage, Regenstrief Institute
• Memphis HIE in use 4.5 yrs... still a pilot going to full force
• 48% had full med hx; getting retail pharmacies online made a big different
• 36% pt not located
• $4 generics good for pts, bad for accurate HIE data
▼ Emergency Medical Services: the frontier in health information exchange
JT Finnell, M. Overhage, Regenstrief Institute
• Project: push HIE data out to EMS staff in 2 counties in Indiana (Siren by Medusa), using ruggedized tablet PC
• Uses LN, FN DOB Gender, can add zip and SSN optional
• Pushes back a pdf with a bunch of data: med list, allergies, DNR status, NOK notification, PMH
• Started at 15% requests to 26% of field pts seen
• 14% of medics never used
• connectivity a problem
• 41% medics nearly always queried system
• 66% said data was important for providing care
• "truth serum" effect (we can look it up if you don't tell us the truth)
• Value with heavy utilizers and pts "found down"
▼ Private Medical Record Linkage with Approximate Matching
E. Durham, Y. Xue; M. Kantarcioglu; B. Malin, Vanderbilt University
• Vanderbilt -- Emory: Flaw in current model for sharing de-identified data
• If pts don't match, they can be overcounted
• prob with fragmented data (spelling, missing data, etc)
• Private Record Matching can improve this using a hash function to maintain privacy but compare individuals
• Steps:
• blocking (toss out some)
• field comparison
• similarity function measures degree of similarity using a comparison vector and into a record pair similarity score
• draw a line where scores above a number are considered a match
• record pair comparison and classification
• Fellegi-Sunter probability vectors: uses log function of an agreement weight and a disagreement weight for each field (eg, FN, LN, MOB)
• Sum the similarity scores across all fields
• Used a data corrupter function to mess up experimental data to see if they get rematched
• looked at accuracy vs runtime
• Main thing they did was to use approximate matching rather than binary matching, leading to increase in accurate matches
• Note: they used a centralized approach but hope to extend ot decentralized model.
▼ Continuity of Care Document (CCD) enables Delivery of Medication histories to the Primary Care Clinician
L. Simonaitis, A. Belsito, G. Cravens, C. Shen, J. Over- hage, Regenstrief Institute
• Used INPC (Indiana)... x1995, 6M pts, 3B data items
• Workflow
• pt to front desk... ADT clinic trigger sends CCD request
• printer prints med hx (CCD)
• MD reviews meds
• CCD is generated, pulling in data from SureScripts and MA, and put rx codes from dif stds in same CCD
• Results: used in 1 clinic over 9 docs and 4500 pts
• 90% of cases took less than 2 min
• med hx helped doc discover drugs they didn't know pt taking, controlled rx overuse, and med underuse
• docs usually did not show med hx to pts
• no change to MD workflow
• accommodates paper-based clinic
• [] XSLT transformation of CCD data very promising
