AMIA 2010: Sunday

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.)

I typed some notes and thought I'd put them here (1) so I can find them again easy and (2) some folks may find them useful (thought maybe somewhat cryptic). (The odd formatting is from OmniOutliner; I've given up on fixing the font colors--the red means nothing--and the bullets don't line up right.)

▼ 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