Health Data Equals Better Medical Decisions
Serving more than 9.6 million beneficiaries in the Military Health System requires rapid and complex exchange of massive amounts of health data. With each patient and every encounter, information is fed into the Clinical Data Repository in AHLTA, the military’s electronic health record; but the data collection and exchange doesn’t stop there.
Using the Clinical Data Mart to improve care
The MHS Clinical Data Mart is a reporting tool that is used to measure and analyze the extensive clinical data collected in the military’s electronic health record. This data capture allows health care providers to proactively manage health promotion, disease prevention, care delivery and health care outcomes.
“For the providers, CDM supplies secure access to information and analytical functionality that impacts the care of patients by contributing real results to the practice of medicine,” said George “Dan” Magee, program manager for the Defense Health Services Systems, the CDM management office.
The uses for CDM continue to grow as rapidly as the data it collects. Since being fielded in February 2008, CDM has been used to support a vaccine recall, including patient notification, in a number of hours; allowed the Ophthalmology community to perform real-time tracking of corneal refractive surgery outcomes; and given Primary Care Managers a take home analysis for their diabetic patients, showing trends of lab results, Body Mass Index and status of other co-morbid conditions, just to name a few.
A New and Improved CDM 2.0
Every great tool can always be improved. A new version of the Clinical Data Mart, version 2.0, is set to deploy later this year. With this deployment comes many developments. Among these are a redesigned data model, enhanced access, addition of new data elements and a freshly harvested copy of historical CDR data.
To create an updated version to better meet provider and patient needs, the CDM team worked with renowned expert Dr. Rick Biehl, Data Warehouse Architect and a Healthcare Information Management Systems Society presentation award winner, to recreate the data model for CDM.
The team developed ways to link data fields together in a more logical method, making reporting, easier as well as more flexible and intuitive for providers. As a result, a number of preconfigured provider reports will also be fielded with the release of CDM 2.0. Reports can be selected on demand or scheduled to run overnight so the report results are pre-aggregated when clinical staff arrive in the morning. The reports not only describe the reason for and time of the appointment, but can also be used for proactive management of patients’ health care. For example, if a patient is overdue for a certain lab test, their record will be flagged so these orders can already be generated prior to the patient’s arrival to the appointment. This saves valuable time during the encounter and allows both providers and patients to discuss treatment and answer questions.
Another key update in CDM 2.0 is the enhanced user access component. Today, users must have both an active AHLTA session open on their desktop and CDM account access in order to use the reporting tool. Once CDM 2.0 is fielded, users will have the ability to access CDM through a Web link using a Common Access Card, in addition to the current AHLTA access mode. The account request process remains, as do the multiple levels of access (Personal Health Information and non-PHI levels at the enterprise and military treatment facility levels, as well as provider access), to maintain security.
The release of CDM 2.0 also brings quadruple the amount of data elements available for reporting. A data element is a single field within the Clinical Data Repository, the database from which CDM pulls information (e.g. patient name, MTF where encounter occurred, ICD9 code). Once deployed, the number of data elements available in CDM will increase from 300 to more than 1,200.
Finally, CDM 2.0 will improve data quality. In the past, system qualification tests and user feedback identified data gaps and anomalies in CDM. The team listened and made harvesting a new copy of production data from the Clinical Data Repository a central feature of CDM 2.0. Ongoing data quality review and improvement have also been addressed by the creation of a cross-program office workgroup that reviews and resolves user data issues.
Future of CDM
“The MHS will continue to find innovative ways to tap into CDM to improve the quality of care delivered to beneficiaries,” said Magee. The next big step is to support more rapid access to near real time data from the Clinical Data Repository. The technology has already been laid out in an initiative termed Change Data Capture to support refresh of the CDM data daily. Currently, CDM data is refreshed three times per week. With the release of this initiative, data will be refreshed every 24 hours.
Past CDM Notable Impact
The Clinical Data Mart has proven to be beneficial to the health of Service members in more ways than one. For example, in 2008 the Navy effectively recalled flu and hepatitis vaccines as a result of the information stored in the CDM. Specifically, the Navy used the system to determine which patients had potentially been affected by the recall of Haemophilus Influenza Type B and Hepatitis B vaccinations. A search of the data included in CDM identified 8,000 patients at risk and nearly 340 patients were identified to receive personal notification. The process, including drafting letters, took less than three hours. A previous manual review of individual medical records for another recall required six weeks and 3,840 labor hours to perform. Using the CDM, all patients affected by the recall were contacted swiftly, thus reducing potential adverse effects.
Additionally, diabetic patients have benefited from the CDM’s capability to allow physicians to access recent test results and visually display the lab trends. These results can be shared with beneficiaries, their families and providers through the Diabetes Provider Panel report, another function of CDM. The reports include summary pages as well as individual pages for different data types, including appointments, vitals, diagnoses, counseling, medication and immunizations. (Access the Defense Health Services Systems’ newsletter, The eXpresso, February 2009 issue Pages 2-3 for more information.)
The CDM also identifies patients who are at risk for disease. A clinical study conducted using CDM data found that 80 percent of the 56,000 patients identified to be at risk for chronic kidney disease had not been diagnosed. Paper records or other electronic systems do not have the same type of capability to gather, synthesize and analyze these data.
The real-time, positive impact on health care delivery and treatment of MHS beneficiaries is what makes the capture, sharing and availability of electronic health information so compelling. As the MHS continues to enhance not just the CDM, but all military health information technology tools, health care delivery will become more effective and efficient in the treatment of beneficiaries.
Krista Holyak, OCIO Communications, contributed to this article.
Editor’s Note: Dan Magee has a Ph.D. in Business Administration from Pennsylvania State University. He is a Level III Certified Acquisition Professional in Program Management and a certified Program Management Professional.