A research team led by faculty in the University of Iowa College of Public Health recently received a new grant to study patterns of information sharing among health care professionals in EHR systems.
The project, led by Xi Zhu, PhD, an associate professor of health management and policy, will examine EHR-based communication in virtual care teams and the relationship between EHR communication networks and quality of care. The research is funded by the Agency for Healthcare Research and Quality.
“Electronic health records systems have been widely adopted throughout the US health care system, and they are changing the way health care professionals deliver care and communicate with each other,” Zhu says. “Today’s health care professionals often work as virtual care teams—a variety of practitioners providing care to the same patients, but working at different times and locations—all connected through the EHR. Yet, it’s not clear how the EHR is impacting communication and teamwork among them and how those factors might affect the quality of care that patients receive.”
This new project will seek to develop methods for measuring the communication that takes place within EHR networks, and then examine associations between EHR communication and patient outcomes, such as hospital readmissions, emergency department visits, and mortality.
Recently published results of a related pilot study demonstrate the feasibility of tapping EHR data to measure and examine communication networks in virtual care teams, Zhu says. Furthermore, the pilot project indicates that variations in electronic communication networks are associated with clinical differences in a sample of cancer patients.
“We are very excited about the potential of this research to generate new evidence to support health IT interventions for team-based care delivery,” Zhu says.
— Source: University of Iowa College of Public Health
Researchers who analyzed data in the EHRs of children seen by hematology/oncology specialists at three large medical centers have developed an algorithm to accurately identify appropriate pediatric oncology patients for future clinical studies. By expediting and refining the selection of patients for research, the researchers aim to ultimately improve outcomes for a variety of pediatric cancers.
“Accurately identifying patient cohorts is key to designing better research,” says study leader Charles A. Phillips, MD, a pediatric oncologist at Children’s Hospital of Philadelphia (CHOP). “Because not every patient in large datasets would be appropriate for a clinical study, having a tool to separate signals from the noise will help researchers leverage data to design pragmatic, real-world studies in patients with a range of different cancers. For instance, we could better evaluate nausea medicines or detect factors that influence the rates of infections in patients with central line placements.”
Phillips and colleagues published their study in Pediatric Blood & Cancer.
The study team analyzed EHR-derived data in PEDSnet, a national pediatric clinical research network, from 2011 to 2016 at three large pediatric hospital systems: CHOP, Children’s Hospital Colorado, and Seattle Children’s Hospital. The EHR data included diagnoses, procedures, medications, laboratory tests, and provider specialties.
In contrast to the narrowly defined eligibility requirements and smaller numbers of patients in clinical trials testing drugs in specific subtypes of cancers, Phillips says, studies of supportive care issues in patients with a broader range of cancer diagnoses may draw on already available data in EHR, but accuracy in patient selection is crucial.
“We found that over half of the children referred to an inpatient or outpatient clinic with a leukemia or lymphoma diagnosis in their charts did not actually have cancer,” Phillips says. Some of the patients were survivors with a remote history of cancer, others were seen to rule out a cancer diagnosis, others were miscoded on the charts.” He adds that a single, isolated diagnostic code may not be reliable, in contrast to multiple diagnoses.
Therefore, in this study, Phillips and colleagues created a “computable phenotype,” automating their search algorithm to check off a series of boxes: starting with at least three visits to a pediatric hematologist-oncologist (27,450 patients), then at least one leukemia or lymphoma diagnosis, which narrowed the number to 4,535. A further screen required the three specialist visits, at least two diagnostic codes, and at least two administrations of chemotherapy, which winnowed the total to 1,825 patients. The final group of 1,825 was the computable phenotype curated cohort—suitable as a clinical study group.
When reviewers analyzed that cohort’s full medical records in masked reviews, the computable phenotype showed 100% sensitivity and 99% to 100% specificity in accurately classifying the patients as having pediatric leukemia or lymphoma.
“This algorithm can accurately and efficiently narrow down the number of medical charts researchers need to review to identify a patient cohort for subsequent clinical studies,” Phillips says. Although he adds that further studies may be needed to refine the algorithm to meet their study-specific needs, it offers a potential new tool to clinical researchers in improving outcomes for children with leukemia or lymphoma, who represent about 40% of all US pediatric cancers.
— Source: Children’s Hospital of Philadelphia
The Electronic Healthcare Network Accreditation Commission (EHNAC), a nonprofit standards development organization and accrediting body for organizations that electronically exchange health care data, recently announced Edward Hafner of Change Healthcare Operations and Jason Wallis of Availity have joined the organization’s governing body. Hafner and Wallis, whose terms run through 2022, join a team of 13 EHNAC commissioners from both private and public organizations to assist in the governance of the Commission.
“The EHNAC Board of Commissioners is driven by some of the most prominent and well-respected thought-leadership shaping the health care ecosystem, representing the interests of several stakeholders including electronic health networks, health information exchanges, health plans, providers, and health IT vendors,” says Lee Barrett, CEO and executive director of EHNAC. “We look forward to the valuable leadership that Ed and Jason bring to EHNAC as we continue to establish standard criteria/best practices and accredit organizations that electronically exchange health care data for security, confidentiality, accountability, and efficiency. Their guidance, along with that of their fellow commissioners, is crucial in today’s world where protecting patient data from the ever-evolving cybercriminal is paramount and a key to ensuring stakeholder trust.”
Hafner is a senior strategist within the medical network at Change Healthcare Operations. Before joining Change Healthcare, he was general manager of TIBCO’s Multi-Enterprise Connectivity Group that included business-to-business products, health care solutions, and managed file transfer products. Prior to TIBCO’s acquisition of Foresight, Hafner served as Foresight’s chief technology officer and was instrumental in the development of its HIPAA and ICD-10 solutions.
Hafner is active within WEDI as a five-term board member and currently cochairs its data exchange work group. Other health care technology industry involvement includes AFEHCT, cochair of HCCO Certification, and CAQH’s CORE initiative. In addition to his involvement with health care, he has served other industry initiatives including retail, pharmaceutical, grocery, paper, and automotive.
Wallis serves as vice president of payer solutions at Availity. Before joining Availity in 2018, he served as senior vice president of data and network operations with Experian Health, overseeing the organization’s clearinghouse and data strategy. Through technology and process improvements, he led initiatives to reduce costs and improve data quality, providing richer, value-added content to clients. Wallis also served at a leadership capacity for Experian Health’s Patient Access and Content Network business units, where he provided strategic and technical insight to drive product development and sales.
Wallis began his career in software development, which led him to the HIT space and to technology leadership at Passport Health (later acquired by Experian). At Passport he led product and technical teams responsible for several product suites and guided the design and architecture of solutions to meet customer’s needs and provide a unique user experience. After the Experian acquisition, he led the merging of clearinghouse teams and expanded his role to include product line ownership and strategy as vice president of content network.
For more information on EHNAC’s officers and commissioners, visit the EHNAC website.
— Source: The Electronic Healthcare Network Accreditation Commission