1 / 116

On-Demand Clinical Intelligence

On-Demand Clinical Intelligence. Clinical Looking Glass Training. Don’t just sit there! . Login and Change Password Open Internet Explorer Enter “ https://secure1.afms.mil/CLG ” in address Enter Username and Password

tamah
Download Presentation

On-Demand Clinical Intelligence

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. On-Demand Clinical Intelligence Clinical Looking Glass Training

  2. Don’t just sit there!  Login and Change Password • Open Internet Explorer • Enter “https://secure1.afms.mil/CLG” in address • Enter Username and Password • Under “Virtual Desktops” click on “SG-CLG” hyperlink for Citrix VDI Login • Enter “http://clgpoc.afms.mil/CLGNET” in address • Enter username: usually first initial+lastname • Enter generic password: clg123 • Change password • Save (toolbar at the bottom) • Log out

  3. Today • Introductions • Ground Rules • Why Clinical Looking Glass? • Introductory Training • HIPAA

  4. Welcome to the Future The Future of Clinical Business Intelligence Dr. Eran Bellin Vice President, IT Clinical Research and Development Montefiore Medical Center

  5. Ground Rules • Use cell phones outside • Follow me when teaching • There is time for hands on • Slow me down, ask questions

  6. CLG: Included Data Labs Meds Procs Diagnoses Death Orders

  7. Direct and Purchased Care

  8. CLG Value

  9. CLG Introductory Training

  10. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim and Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Study (Congestive Heart Failure) • Smart Reports

  11. CLG Core Concepts I Analysis Groups • Qualifying rules for inclusion • Index Date (I) • Patient specific start/enrollment date • Group Types • Cohorts – unique patients, 1 index instance per person • Event Collections – events, multiple index instances per person • 3) Sources • Event Canvas – most flexible • Smart Reports – subject specific • Upload – from non-CLG source • Analytic rules are non-qualifying • Method applied to one or more groups • Methods include: • Append study data • List / data grid • Crosstabs / pivots • Time to Outcome (survival) • Incidence Density • Time in Range • …more to come “Reusable research objects”

  12. Study = Groups X Analysis I I Next Visit Alerts % days A1C in control 5 yr visit hx per MD 2 yr history of HTN 2 year survival Male diabetics Female diabetics

  13. When Data Are Not Patient-Centric 1/1/2005 1/1/2007 1/1/2006 Patient # 1 0 Diabetes Control 2 0 0 = index date 3 0 (EG start therapy) 4 0 5 0 = outcome 6 0 (EG achieve lab value) 7 0 8 0 0 = patient experience 9 0 10 0 4 / 10 = 40% What % of new diabetic patients were controlled in the year 2005?

  14. Patient-Based Analysis of Diabetes Control Enrollment 2 Years 1 Year Patient # Diabetes Control 3 0 0 = index date 8 0 (EG start therapy) 9 0 1 0 = outcome 4 0 (EG achieve lab value) 7 0 0 = patient experience 5 0 10 0 2 0 (same data, re-sorted) 6 0 5 / 10 = 50% What % of new diabetic patients were controlled within 1 year?

  15. Cohort Paradigm: Patient-Centric • Subject specific follow-up periods • Contra-indications taken into account • Stop looking for outcome when patient is no longer at risk • Group summary is an aggregation of individual experiences • Epidemiologic methods are ideal for retrospective, observational studies

  16. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim and Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Study (Congestive Heart Failure) • Smart Reports

  17. Clinical Scenario:Bactrim & Hyperkalemia • Does Bactrim (trimethoprim/sulfamethoxazole) cause hyperkalemia? • What is the mechanism? • Which patients are at risk for developing hyperkalemia while on Bactrim? • Is it okay for patients taking other meds that increase potassium (ACE inhibitors, ARBs, etc.) to take Bactrim? • When should you check potassium? • What are antibiotic alternatives to Bactrim? • How should TMP/SMX be dosed in renal insufficiency? • Is it okay for patients taking meds that increase potassium to use salt substitutes? Trimethoprim and Hyperkalemia Trimethoprim is commonly used in combination with sulfamethoxazole (TMP/SMX cotrimoxazole, Bactrim, Septra, others) for the treatment of a variety of infections such as urinary tract infections. Although this medication has been available for many years, a recognized, but little-known adverse effect is hyperkalemia. This document discusses the clinical data, mechanism and risk factors for trimethoprim-induced hyperkalemia. Bactrim may cause hyperkalemia when combined with ACE ARBs • Is this happening in MHS? • Study Group: • Patients greater than 65 years old • Outpatient prescription for Bactrim during 2008 to 2011 • Outpatient prescription for an ACE ARB within 365 days before the Bactrim prescription • Comparison Group: • Patients greater than 65 years old • Outpatient prescription for a macrolide (ERYTHROMYCIN STEARATE, ERYTHROMYCIN BASE, CLARITHROMYCIN, AZITHROMYCIN) during 2008 to 2011 • Outpatient prescription for an ACE ARB within 365 days before the Bactrim prescription • Outcomes: • Potassium level of 5.5 or greater within 0 to 30 days of the Bactrim prescription start date.

  18. Login, Change PW, go to Study Designer • Open Internet Explorer • Enter “http://clgpoc.afms.mil/CLGNET” in address bar • Enter username: first initial+lastname • Enter generic password: clg123 • Change password • Save (toolbar at the bottom) • Open Study Designer (Analysis Menu) • Open Bactrim study Wait here

  19. Study Designer I Analysis Groups

  20. Demo • Study Designer overview • Results • Criteria • Group definition using: Skip to Exercise 1

  21. TTO Method Criteria Entry

  22. TTO Results - Demographics

  23. TTO Results – Target Event

  24. TTO Results – All Events

  25. TTO Results – Patient List

  26. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim & Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Cohort • Browse a Cohort: List Method • Build a Study (Congestive Heart Failure) • Smart Reports

  27. Exercise 1Modify a Cohort See handout In-Class Exercise: Bactrim 18 to 65 • Change Demographics to Age 18 to 65 • Re-build your cohort • Rename and rerun the study “antibiot acearb hyperk for cls” • Observe Results • What conclusion can be made about Bactrim in this younger population?

  28. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim and Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Study (Congestive Heart Failure) • Smart Reports

  29. Clinical Scenario 2Chronic Kidney Disease

  30. Demo: Replicate CKD Study at MHS • Create a cohort of patients>=18 years who had at least one admission with Chronic Kidney Disease during the year 2009 ANDhad a hemoglobin lab test done with a value>12g per deciliter around 90 days of the admission date AND received an inpatient med order of Epoetin Alfa within 30 days of the admission date. • Next create a comparison group with the same criteria except the patients who did NOT received the inpatient med order of Epoetin Alfa. • Then use time to outcome method to track primary end point events of mortality (6 months), readmission with MI, CHF and STROKE.

  31. Event Canvas Looks Like… [Earliest of EV1-CKD-ADMIT (And) ] EV1-CKD-ADMIT: [ All of [CKD : InpatAdmit] WHEN IN [YR2009] WITH [ageGTE18] ] AND EV2-HEM GT12 90 ARND: [ All of [HEM : LabTestDate] within 0 to 90 Days Around Event: EV1-CKD-ADMIT ] AND EV3-MED EPO 30 AFT: [All of [MED : MedOrderStartDate] within 0 to 30 Days After Event: CKD-ADMIT Cohort 1: CKD-W-HEM>12-WITH-MED Cohort 2: CKD-W-HEM>12-WITHOUT-MED • [Earliest of EV1-CKD-ADMIT (And) ] • EV1-CKD-ADMIT: [ All of [CKD : InpatAdmit] WHEN IN [YR2005] WITH [age>18] ] • AND • EV2-HEM: [ All of [HEM : LabTestDate] within 0 to 90 Days Around Event: EV1-CKD-ADMIT ] • AND • EV3-MED: [NOT All of [MED : MedOrderStartDate] within 0 to 30 Days After Event: CKD-ADMIT ]

  32. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim and Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Study (Congestive Heart Failure) • Smart Reports

  33. Clinical Scenario 3Congestive Heart Failure Exercise 2: Building a Study • Build a Cohort • Discharges in March 2012 with CHF • Add Two Methods • List • Add outcome: readmission • See handout: In-Class Exercise Two

  34. Learning Roadmap Level: Introductory • CLG Core Concepts • View Outcome Comparison Study • Modify a Cohort (Bactrim & Hyperkalemia) • Events, Attributes and Sets (Chronic Kidney Disease) • Build a Study (Congestive Heart Failure) • Smart Reports

  35. Smart Reports • Smart Reports in CLG are: • Focused reports usually oriented around a single subject • Utilize CLG objects (groups, sets) • Often have an operational orientation

  36. Diagnosis Summary Report • A focused report that shows • all diagnoses and associated procedures for a cohort of patients • for index event • and subsequent/prior events • A way to explore patterns of care • The coding of this care • indirect • purchased care

  37. Diagnosis Summary Report Inputs

  38. Demo Diagnosis Summary Report for a CHF Cohort

  39. Don’t Forget! • CLG Help • HIPAA guidance • Citing CLG • Performance Improvement vs. Research

  40. CLG Help • Online manuals • CLG User Manual • Ad hoc Reports • Events Definitions • Streaming Video • Manuals and videos are also available for download from the Web at: http://exploreclg.montefiore.org/clg-resources/becoming-a-clg-user/MHC-Resources.aspx • See http://exploreclg.montefiore.org for more information

  41. CLG and HIPAA CLG gives you access to most all patient data. Discuss: why is this risky? • HIPAA Protections: • Most analysis done with “limited data set” • Supervisor authorization required to access identifiers • You are challenged when requesting identifiers: • QI Project • IRB approved research • Patient worklist • Off-site use of CLG requires encryption tool • You are audited annually

  42. Citing CLG Dozens of posters and manuscripts enabled by CLG. Give CLG a shout out! Find methods verbiage in your training folder or request it from CLGMHSAdministrator.

  43. PI vs. Research What distinguishes Performance Improvement from Research? • In your Training Packet: • Registering PI Projects with QM Dept • The QI-Research Divide and the Need for External Oversight • Oversight of QI: Focusing on Benefits and Risks • (request from CLGMHSAdministrator if needed) • Institutional Review Board (IRB): • Special addendum needed if project accesses data via CLG

  44. Q & A

  45. Learning Roadmap ADVANCED Level: Advanced • Review of Introductory Concepts • Temporality in Groups • Event Collections • Upload Groups • Time to Outcome • Simple Mode • Advanced Mode • Time in Range • List Method • HANDS ON: Individual Clinical Questions

  46. Review: Map the CKD Study • Study Group: patients>=18 years who had at least one admission with Chronic Kidney Disease during the year 2005 AND had a hemoglobin lab test done with a value>12g per deciliter around 90 days of the admission date AND received an inpatient med order of Epoetin Alfa within 30 days of the admission date. • Comparison Group: same as study group but without Epoetin Alfa within 30days of the admission • Outcomes: mortality within 6mo, readmission within 6mo all cause, with MI, with CHF. Exercise: fill in the CLG Study Template handout

  47. CKD Events Diagram

  48. Study Designer I Analysis Groups

  49. Review: Map the CKD Study • Study Group: patients>=18 years who had at least one admission with Chronic Kidney Disease during the year 2005 AND had a hemoglobin lab test done with a value>12g per deciliter around 90 days of the admission date AND received an inpatient med order of Epoetin Alfa within 30 days of the admission date. • Comparison Group: same as study group but without Epoetin Alfa within 30days of the admission • Outcomes: mortality within 6mo, readmission within 6mo all cause, with MI, with CHF. Exercise: fill in the CLG Study Template handout

  50. CKD Events Diagram 2005 When In Admissions >= 18 Years Old Within Around 90 Days Admissions (90 Days Before & After) CKD Patients With Epoetin Alfa Lab Test Within 30 Days After Admissions Med Order Epoetin Alfa Effects of Epoetin Alfa on Hemoglobin Levels in CKD

More Related