The first day of the 8th annual Health Datapalooza in Washington, D.C., brought a reminder of the conference’s unofficial catchphrase: “Nothing about me without me.”
Tom Delbanco, M.D., and Jan Walker, R.N., M.B.A., and their colleagues at Open Notes were named the winners of this year’s Health Data Liberator award. The award recognizes the initiative that encourages healthcare providers to share their visit notes with patients. Their goal is to make open notes the standard of care for all patients nationally. Since their inception in 2010, the movement has grown to include more than 13 million people in 37 states having access to their notes.
“I view it as a new medicine,” said Delbanco, professor of general medicine and primary care at Harvard Medical School. “It is hard. We are facing pushback to the cultural change we represent. Doctors aren’t used to sharing notes with other people.” Some have embraced it, while others have found ways to avoid it, he said. “I want you to leave here determined to do something about it. We think this should be the standard of care. Clinicians will be saved and helped by their patients. They need to get together in a transparent interchange of information.”
Walker, assistant professor of medicine at Harvard Medical School and a member of the research faculty of the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center in Boston, said the movement could have major impacts on patient safety. She said that beyond primary care doctors, some organizations have expanded to specialty providers and inpatient notes. One health system uses Open Notes to share all notes — nurses, pharmacists, inpatient, and labs. Another has opened up mental health notes. “This award means a lot to us. A real hope is that this will nudge more providers this approach to openness.”
The Health Data Liberator Award recognizes extraordinary contributions to the liberation of health data that fosters improvement in the health care system. Prior recipients include Fred Trotter, CEO, DocGraph (2016); Niall Brennan, former director and chief data officer, Centers for Medicare & Medicaid Services (2015); Charles Ornstein, senior reporter, ProPublica (2014); and Nirav Shah, senior Vice President and Chief Operating Officer, Kaiser Permanente (2013).
Here are a few bullet point highlights from other presentations I saw on Day 1. I will write some of these up on more in-depth articles soon.
• Stacy Elmer, director of medical device integration and special programs for Kaiser Permanente, gave a talk about her work with clinicians and administrators at the Panorama City Medical Center's Emergency Department (ED) in Southern California to cut down on overuse of the ED. Her team used a design thinking approach alongside data to help the ED department narrow down who they want to target as high utilizers among KP members in order to develop a pilot project to address their needs. The goal is to intervene with emergency medical professionals who can provide care to low-acuity patients in a pre-hospital setting, such as their home, in order to reduce unnecessary utilization of emergency departments and provide the most appropriate care in the most appropriate setting.
• Shereef Elnahal, M.D., M.B.A., the Assistant Deputy Under Secretary for Health for Quality, Safety & Value at the Veterans Health Administration, spoke about how he founded the Diffusion of Excellence Initiative to drive consistency in clinical and administrative best practices. Innovative VA employees go through a “Shark Tank”-like event in front of 45 medical center directors looking for new solutions. Ones that are chosen are implemented at four or five centers and when the data shows they are proving effective, they are then spread throughout the VA system. “There are three enablers,” he said. “Technology, governance and process.” So far, there have been 400 replications of best practices at 70 facilities in less than year and a half.
• On a panel about predictive analytics, Craig Monsen, medical director for analytics and reporting at Atrius Health in Massachusetts, spoke about their predictive model Clinical RISk Prediction Initiative (CRISPI), which is an internally developed, multivariable logistic regression model that pulls data from the Atrius Health data warehouse, including clinical data from the Epic EHR, ADT feeds, and payer claims. If a patient is identified as at high risk of readmission, his or her EHR record has a header that turns purple.
Making the patients’ risk levels clearly visible at the point of care has helped care teams respond to patient needs more quickly and make sure they get seen by a provider sooner.
There are many more exciting presentations on the agenda for Day 2 of Datapalooza, including a talk by Patrick Conway, M.D., director of the Center for Medicare and Medicaid Innovation.