Our Team… a multidisciplinary approach

Dr. J MoccoNeurosurgery

Dr. Michael FroehlerNeurology

Bree Burks RN, MSN, CCRPManager-CCRO

Cerebrovascular Clinical Research Office (CCRO)

Stephanie Smith, MA, CCRPFEAT Project Lead

Jessica Marlin, CCRP Clinical Trials Specialist

Emily Gilchrist, MPHCerebrovascular Clinical Improvement and Research Coordinator

Diane Brown, RN, BSN, CCRPResearch Nurse Specialist III

Andrea Wimsatt Reed, MSData Collector

Dr. Howard KirshnerNeurology

Vanderbilt CCRO Expertise

Complex Data Capture and Analysis Currently lead coordinating center for 3 multicenter clinical trials Coordinating over 30 active clinical trials Adjudicating complex data sets Analyzing data to assess project milestones

REDCap Work closely with creator (Dr. Paul Harris) to implement new

functionality Create complex databases storing information for thousands of

patients used by institutions across the country

Streamlining Clinical Workflow Parallel clinical workflow for cerebrovascular patients in an effort

to standardize care (at VUMC and across the country) Experienced in implementing clinical improvement/best

practices driven by new evidence

Challenges with Our Current Data Retrieval Process

Data

Multiple Disciplines Involved

System Issues

DATA StarForms/EMR data is not outcomes specific

nor consistent across users

Data in EMR is not easily retrievable

Structured data in EDW is not user friendly

Data is reviewed after patients are discharged using billing and coding criteria

Challenges

Multidisciplinary Issues

Challenges

Need for uniformity

Objective, comprehensive perspective is

required

System Issues Abstractors often enter same medical records multiple times while

pulling reports Abstractors and Consultants cannot independently generate reports

(even routine reports) Coding drives patient selection sometimes weeks after point of care EDW is complex and data is limited, therefore cerebrovascular data

is abstracted manually 70-100 patients a month/approximately 70-90 minutes per patient Approximately 2 FTE’s a month for cerebrovascular data abstraction ONLY Approximately .7 FTE’s a month for defining patient population

Challenges

How could we repurpose that time in stroke alone to improve patient care?

What’s Missing

1. Real-time/Reliable Data

2. Streamlined Clinical Workflow

3. Streamlined Reporting Properties

4. Automated Dataset (ie: no more manual abstraction)

Proposal

• Create a new, automated data abstraction process from StarPanel that is outcome specific

• Pilot this process in one controlled clinical area• Cerebrovascular Disease/Stroke

Once finalized implement across

VUMC

Solution

1) Created in house/flexible

2) User-friendly

3) Robust analysis and reporting properties

4) Experience with Automation1) Research Derivative2) DDP

Automated Cerebrovascular Data Collection

Solution

Real-time Reliable Data Ability to impact care before discharge and

decrease failures VTE Prophylaxis Written educational materials

Daily snapshots of clinical workflow Recover time spent identifying patients’

true diagnoses from generic ICD-9 Codes

Solution

Streamlined Clinical Workflow Medical record templates are consolidated New templates are outcomes specific, reflective

of current best practice, and conducive with clinical workflow

Solution

Streamlined Reporting Properties• Flags missing values

• Determines “Failures” based on pre-determined criteria

• Logic can be built to capture any existing value and used repeatedly or amended

• Executes reports in seconds

Solution

Manual Abstraction Obsolete

Project Goals

Improving patient care at Vanderbilt

Reduce the burden of manual data abstraction

Increase efforts towards implementing new processes for quality, safety, and risk-prevention

Define CV patient population

Organize and prioritize new MR

templates

Update notes and forms

Pilot new forms/Delete alternatives

Map data pointsStarPanel → EDW → REDCap

Begin using REDCap to

generate reports

Build REDCap database

Define data

points

• Core measures• GWTG• Meaningful Use• Clinical needs• Research

needs• Per clinical

users• Collapse

current options

• Reformat for automation

• Mirror the MR with a calendar design

• Incorporate vitals, labs, and meds through the DDP

Implementation

• Review Current form• Identify data currently

captured and necessary additions

• Draft Template• Approval• Construction

End Product

DATA Single form reporting will create consistency in the EMR

Data in EMR will be easily retrieved due to standardization

Generating reports within the EDW based on ICD-9 codes will be unnecessary

Data is retrievable within 12-24 hours of entry into the EMR

Benefits

Multidisciplinary and System Issues Uniformity in data collection will create a system

benefitting multiple disciplines and departments System redundancies will be significantly reduced Abstractors and Consultants will be able to

independently generate reports Patient population will be predetermined eliminating

the need to verify ICD-9 codes against the EMR

Benefits

Recap

Improving patient care at Vanderbilt

Reduce the burden of manual data abstraction

Increase efforts towards implementing new processes for quality, safety, and risk-prevention