Neil Friedman, MBChB and Vinay Vaidya, MD
Over the past two decades, digital health has emerged as a key driver of healthcare safety, quality and efficiency. Fueled by the Institute of Medicine (IOM) study, Crossing the Quality Chasm (2001), and reinforced by the subsequent Health Information Technology for Economic and Clinical Health Act (2009), health information technology has been identified as a critical component of digital health. Notably, the IOM identified health informatics as one of five core competencies needed to meet the needs of the 21st Century healthcare systems (Health Professions Education: A Bridge to Quality; 2003).
Health informatics is essentially the development and application of information technology systems to problems in health care, research and education.1 In the clinical realm, it has found use in clinical decision making, identifying gaps in clinical care, improving and monitoring patient safety and quality metrics, and assisting in chronic disease management, amongst numerous other uses. By leveraging digital health technology, healthcare systems offer the potential to facilitate more integrated and personalized healthcare.
One area of focus for Phoenix Children’s over the past two years has been the application of health informatics to enhance intelligence filtered clinical decision support in ensuring adherence to standardized quality metrics, best practices and patient recovery. Clinical decision support is a sophisticated health IT component, requiring computable biomedical knowledge, person-specific data and a reasoning or inferencing mechanism that combines knowledge and data to generate and present helpful information to clinicians (healthit.gov/topic/safety/clinical-decision-support).
At the Barrow Neurological Institute at Phoenix Children’s, we are utilizing healthcare dashboards to collect and analyze complex data from multiple sources into a unified, organized, comprehensive visual display to facilitate clinical care and empower our providers. Our initial focus has been on epilepsy and headache, two of the most common chronic diseases encountered in the neurosciences.
The epilepsy dashboard has focused on ensuring adherence and compliance to several epilepsy quality metrics as defined by the American Academy of Neurology (AAN) and Child Neurology Society. Patients eligible for a specific metric are identified, and if the patient is found not to be in compliance with the metric, a reminder email, noting this, is sent to the appropriate provider prior to the scheduled visit.
Metrics include benzodiazepine prescription for emergency treatment of seizures/seizure rescue and folic acid prescription for young female patients and adolescents of childbearing age on anti-epileptic medication. Additionally, the dashboard identifies patients who have failed two anti-epileptic medications, thereby meeting criteria for epilepsy intractability and being managed by a general child neurologist.
These cases are reviewed by an epileptologist to see if a referral to an epileptologist is appropriate, thereby meeting the AAN quality metric of referral of intractable epilepsy patients to a “comprehensive epilepsy care center and specialist.” If the metric is appropriate but the patient is not in compliance, the dashboard allows a designated epilepsy reviewer to send an automated email to the identified neurology provider on the day of the clinic visit to see if such a referral may be appropriate.
This system has already resulted in patients being identified for epilepsy surgery and/or other surgical interventions (responsive neurostimulation, vagal nerve stimulator) or ketogenic diet. The electronic medical record now allows providers to capture seizure freedom or change in seizure frequency from the last visit in an electronic format that allows for automation and analysis of data. The use of the dashboard has also facilitated quality improvement from an operational perspective in identifying patients on treatment who have not been followed up by a provider in >6 months.
Schedulers utilize a list generated by the dashboard for service recovery to ensure patients/families are contacted, with a view to re-establish care or remove them from the list if they no longer plan on following up at our institution or have moved out of state. Other benefits of the dashboard utilization include business, demographic and health equity data around the program. Finally, the epilepsy dashboard also allows for capturing outcomes data such as Engel score related to specific epilepsy surgical interventions, which allows us to benchmark ourselves against other groups. Our current focus is addressing health equity and health literacy.
New digital platforms and health information technology are increasingly changing the way medicine is being practiced, impacting patient management, personalizing patient care and improving health outcomes. Interactive dashboards are an increasingly common tool, allowing for a high degree of customization, data-driven decisions, actionable alerts and benchmarking of outcomes. While health information technology is an important foundation of the future, it requires a cultural shift for medical providers and a willingness to adapt to changes in professional practice. Adoption of new technology needs to be seamlessly integrated into workflow, offering medical providers relevant and timely information required to determine daily decisions, patient care and quality outcomes. The system design and ease-of-use technology are paramount for the successful implementation of innovative technology such as dashboards. Identification and involvement of clinical “champions” are crucial to the success of these endeavors.
REFERENCES
- Masys DR, et al. J Am Med Inform Assoc. 2000;7:304–312.
