December 2018, Volume XXXII, No 9
Leveraging your information resources
Put your data to work
ver the past decade, the transition to electronic health records (EHRs) has increased the amount of health data at our fingertips. At the same time, the pressure to improve access to care and patient outcomes is steadily increasing. Fortunately, advances in technology now allow providers to more easily leverage the data in the EHR to make improvements in care, recognize trends in their patient population, improve clinical processes, and publish and disseminate research.
EHRs contain a wide range of information about patients and their visits: demographic characteristics, diagnoses, vital signs, lab values, medications, patient-reported outcomes, dates and departments of appointments, billing codes, and more. The more complete and accurate the data being entered into the EHR, the more this wealth of information can be used to enhance the following:
Reimbursement. As Medicare and private insurers move to value-based reimbursement, providers will need to submit not just the appropriate billing codes, but documentation of improvement in patient outcomes.
Individual patient outcomes. During each visit, the patient’s EHR is pulled up for documentation of the visit. Having the chart up provides access to the patient’s complete medical history, making it easier to see trends in vital signs and symptoms over time and helping to diagnose diseases. EHRs can also alert providers when a new medication might be contraindicated—preventing a possible adverse event—and when the patient is due for preventive screenings.
Clinic-wide patient outcomes. With consistent and complete information being captured in the EHR for individual patients, providers can look at outcomes and trends among all patients who meet certain criteria. For example, providers can find out which chronic conditions are most prevalent in their clinic; what percentage of their patients with diabetes are meeting blood sugar goals; and what percentage of patients with hypertension are prescribed anti-hypertensive medications. With this information, providers can update clinic processes, refine standards of care, and target their continuing education to better treat their patients.
Research studies and quality improvement projects. Data from the EHR can also be used to support scholarships for research studies, quality improvement projects, and other initiatives. For example, if you are conducting a study on a rare condition, it may be helpful to use EHR data to estimate how many patients with that condition attend your clinic. This could inform your project’s recruitment plan and feasibility. As described below, the EHR can also be the source of data for research projects.
Seeking outside help
If you’re interested in using EHR data, seek out assistance to obtain and analyze the data. In-house IT teams are a good place to start, but they may not have the statistical background needed to fully analyze and interpret the data. Contact your in-house research department, if you have one, to see what statistical resources are available. If in-house resources are not available, consider retaining an outside data analyst. When interviewing external analysts, make sure they are familiar with the unique strengths and challenges of health care and EHR data, as well as HIPAA requirements.
Data analysts and statisticians can advise you regarding the best study design to answer your research question, calculate sample sizes, decide which pieces of EHR data to collect and how to collect them, analyze statistics, interpret results, and prepare manuscripts for journal submission. In the cases of clinical trials, statisticians can help with randomizing patients to study arms and submissions for FDA approval. Statisticians and analysts can also help initiate quality improvement efforts, streamline clinic processes, consult on how to use EHR data for clinic improvements, identify best practices, analyze and interpret quality improvement data, and prepare presentations and posters for medical conferences and key stakeholders.
Beyond the EHR
collect more information to support all of the goals we have identified. There are many data collection methods, including EHR chart abstraction (“chart reviews”), surveys (via phone, paper, or web), key informant interviews, and focus groups. Select the best method based on your research questions and the data required to answer them. For example, chart reviews are well suited for understanding patient demographics, co-morbid conditions, health care utilization, health outcomes, and tracking trends in these metrics over time. However, chart reviews may not be able to explain why trends are occurring, provide patient satisfaction or patient-reported outcomes, or describe the patient or staff experience. To obtain these types of qualitative data, a survey or interviews would be more appropriate.
General data collection tips
Regardless of the data collection method you choose, it is important to gather accurate and appropriate data. Haphazard data collection methods could lead to inaccurate or indefensible findings, wasted resources, and potential harm to patients. Some general tips:
Patient data … can lead to meaningful improvements in patients’ experiences and health.
Haphazard data collection methods could lead to inaccurate or indefensible findings.
Sara Richter, MS, is a senior statistician at Professional Data Analysts, Inc. She has over 10 years of experience in health care research, including health services research, clinical trials, and quality improvement.