Using Health Information Technology to Support Population-Based Clinical Practice (Utah)

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Summary:

Acute respiratory infections (ARI) represent a major burden to the health care delivery system and the public's health. The overuse of antibiotics for viral infections has contributed to the rapid emergence of antimicrobial resistance and a substantial number of adverse drug events. As a result, preventing the overuse of antibiotics is a national priority area for research.

This project’s aim was to improve providers' ability to distinguish viral infections from bacterial infections by providing physicians and patients with timely, accessible information about the local incidence of common respiratory viruses through the use of a population health repository and decision support tools. Specifically, the project: 1) assessed primary care clinician use of current population-based ARI health information resources and decision support tools using focus groups and structured observation, 2) refined decision support tools to improve clinical information system workflow integration and patient communication, 3) implemented these decision support tools in primary and urgent care settings, and 4) measured the effects of the tools on population-based clinical practice and patient/parent compliance. The goal of these interventions was to increase the effectiveness and appropriateness of antibiotic prescribing for ARI.

This study addressed important gaps in the knowledge of patient and provider population-based health information needs, and the data and information technology tools required to fill these gaps. The lessons learned during the course of developing, implementing, and evaluating the impact of population-health and decision support tools for acute respiratory infection led to contributions in this priority research area and improvements in integrating decision support tools into health care practices.

Using Health Information Technology to Support Population-Based Clinical Practice - 2012

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 018538
  • Project Period: 
    September 2009 – July 2014
  • AHRQ Funding Amount: 
    $795,960
  • PDF Version: 
    (PDF, 312.09 KB)

Summary: Acute respiratory infections (ARIs) are a burden to the health care delivery system and the public’s health. The overuse of antibiotics for viral infections has contributed to the emergence
of antimicrobial resistance and a substantial number of adverse drug events. As a result, research on preventing the overuse of antibiotics is a national priority. This project aims to improve providers’ and patients’ ability to distinguish viral infections from bacterial infections by providing timely, accessible information about the local incidence of common respiratory viruses via a population health repository and related decision-support tools.

Working closely with Intermountain Healthcare and their flagship pediatric hospital, Primary Children’s Medical Center, which is affiliated with the University of Utah Department of Pediatrics, Dr. Gesteland and his team developed GermWatch ( http://www.intermountainphysician.net/gw), a reporting system for pediatric and adult respiratory infections that captures routine microbiological testing data from all Intermountain Healthcare system hospitals and clinics. The system generates reports that display pathogen-specific data in graphs and maps that are distributed with a bulleted summary to more than 400 clinicians in the Intermountain West every week. The reports are also available on the GermWatch Web site, which provides a user interface that supports custom queries based on time-periods, age ranges, pathogens, and regions. The overall goals of the project are to develop new tools sets, refine information delivery mechanisms, and further integrate these tools into clinical workflow. This study will address important gaps in patients’ and providers’ population-based health knowledge and the information technology tools required to fill them.

Specific Aims:

  • Assess primary care clinician use of current population-based ARI health information resources and decision-support tools using focus groups and structured observation. (Achieved)
  • Refine population-based ARI health information resources and decision-support tools to improve clinical information system workflow integration and patient communication. (Ongoing)
  • Implement these population-based ARI health information resources and decision-support tools in primary and urgent care settings. (Upcoming)
  • Measure the effects of population-based ARI health information resources and decision-support tools on population-based clinical practice and patient and parent compliance to increase the effectiveness and appropriateness of antibiotic prescribing for ARI. (Upcoming)

In addition to the research project goals, Dr. Gesteland is working toward his long-term career goal of utilizing information technology and clinical information systems to optimize the management of common diseases that affect the health of adults and children. Funding from this Mentored Clinical Scientist Research Career Development Award is helping Dr. Gesteland advance his skills through mentorships with experts in advanced epidemiologic and statistical methods, health services research, cognitive psychology of medical decisionmaking, integrated medical systems, health care quality improvement, and biomedical informatics.

2012 Activities: Dr. Gesteland and his team made significant progress on the refinement of the dashboard using data collected from provider interviews during 2011. The interviews yielded insight on how current data visualizations could be improved and what additional content and tools (e.g., patient education, ARI guidelines, information about viral testing) providers need. The interviews also helped identify where in the clinical information system and clinic workflow providers would prefer to access these resources. The interviews also identified new issues, including providers’ comfort level with office staff access to GermWatch. Refinements were ongoing at the end of the year.

A major accomplishment during the year was the development and launch of the public-facing version of the GermWatch system (http://www.GermWatch.org). This public site was informed by parent focus groups conducted in 2011 and contains content designed to meet the information needs of patients and parents relevant to common respiratory pathogens and the related ARI they cause. Dr. Gesteland and his team developed the general design, layout, and storyboard as well as the individual page content. The Web site was beta tested with Intermountain employees in summer 2012 and launched in November 2012. This site serves as a companion tool that clinics can give patients who want to learn more about conditions and specific pathogens. Dr. Gesteland is working with a new and cutting edge data visualization platform that will serve as the primary information visualization development and delivery tool for both the public- and provider-facing sides of the GermWatch system. They are also currently developing a mobile application that will provide convenient ways for clinicians to access up-to-date surveillance data and a mechanism for delivering push alerts with the latest disease outbreak updates.

In addition, Dr. Gesteland and his team developed and deployed a mobile antibiogram application that provides the last full year’s data on antibiogram testing data. They are currently testing the application and devising an evaluation plan.

Dr. Gesteland was invited to give a plenary talk in December 2012 at the International Society for Disease Surveillance in San Diego, at which he described the EpiCanvas infectious disease weather map, an interactive visual exploration of temporal and spatial correlations that depicts regional infectious disease activity at-a-glance.

Preliminary Impact and Findings: This project has no findings to date.

Target Population: Acute Respiratory Infections, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ’s priority populations.

Using Health Information Technology to Support Population-Based Clinical Practice - 2011

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 018538
  • Project Period: 
    September 2009 - July 2014
  • AHRQ Funding Amount: 
    $795,960
  • PDF Version: 
    (PDF, 222.62 KB)

Summary: Acute respiratory infections (ARIs) are a burden to the health care delivery system and the public's health. The overuse of antibiotics for viral infections has contributed to the emergence of antimicrobial resistance and a substantial number of adverse drug events. As a result, research on preventing the overuse of antibiotics is a national priority. This project aims to improve providers' and patients' ability to distinguish viral infections from bacterial infections by providing timely, accessible information about the local incidence of common respiratory viruses via a population health repository and related decision support tools.

Intermountain Healthcare's Primary Children's Medical Center, which is affiliated with the University of Utah Department of Pediatrics, developed GermWatch (http://www.intermountainphysician.net/gw), a reporting system for pediatric and adult respiratory infections that captures routine microbiological testing data from all Intermountain Healthcare system practices. The system generates reports that display pathogen-specific data in graphs and maps that are distributed with a bulleted summary to more than 400 clinicians in the Intermountain west every week. The reports are also available on the GermWatch Web site, which provides a user interface that supports custom queries based on time-periods, age ranges, pathogens, and regions. The overall goal of the project is to refine this dashboard and further integrate it into clinical workflow. This study will address important gaps in patients' and providers' population-based health knowledge and the information technology tools required to fill them.

Specific Aims:

  • Assess primary care clinician use of current population-based ARI health information resources and decision support tools using focus groups and structured observation. (Ongoing)
  • Refine population-based ARI health information resources and decision support tools to improve clinical information system workflow integration and patient communication. (Ongoing)
  • Implement these population-based ARI health information resources and decision support tools in primary and urgent care settings. (Upcoming)
  • Measure the effects of population-based ARI health information resources and decision support tools on population-based clinical practice and patient and parent compliance to increase the effectiveness and appropriateness of antibiotic prescribing for ARI. (Upcoming)

In addition to the research project goals, Dr. Gesteland aims to further his long-term career goal of utilizing information technology and clinical information systems to optimize the management of common diseases that affect the health of adults and children. Funding from this Mentored Clinical Scientist Research Career Development Award will allow Dr. Gesteland to advance his skills through mentorship by experts in advanced epidemiologic and statistical methods, health services research, cognitive psychology of medical decisionmaking, integrated medical systems, health care quality improvement, and biomedical informatics.

2011 Activities: Dr. Gesteland made significant progress on the first two aims during 2011. He sought to determine how providers use population-based ARI health information resources and decision support tools and understand the level of interest parents of patients have in accessing viral epidemic data. The research team conducted interviews with providers to inform the development of the dashboard style reports and to elucidate design objectives for the Web site redesign. Specifically, the team sought to understand how current data visualizations could be improved and what additional content and tools (e.g., patient education, ARI guidelines, information about viral testing) providers need and where in the clinical information system and clinic workflow would providers prefer to access these resources. The interviews also identified new issues, including providers' comfort level with office staff access to GermWatch and with tailoring information appropriately for parent access. These refinements are ongoing.

Based on input from parent focus groups, the research team began developing a public-facing version of the GermWatch system, which will have content designed specifically to meet the information needs of patients and parents relevant to common respiratory pathogens and the related ARI they cause. General design, layout, and storyboard development are complete and individual page content has been drafted. The public-facing Web site will be beta tested with Intermountain employees in summer 2012. This site will serve as the companion tool that clinics can give patients who want to learn more about conditions and specific pathogens. The pediatric infectious disease (ID) team will conduct a critical review of the content to ensure that messages are well articulated for specific pathogens. Dr. Gesteland is also working on the process of message authoring with public relations, in collaboration with ID colleagues and media relations personnel from State and local health departments.

On the provider interface, new dashboard style reports have been developed and refinements to the GermWatch provider-facing site that incorporate the dashboard components are underway. Some mock-ups have been developed, and navigation improvements have been discussed. Refinements to the GermWatch infrastructure include improvements to the GermWatch database with new schemas that support analysis at the level of a viral 'episode of care,' new data types (ICD-9 coded visits), and a quality assurance check before data becomes public. Newly developed functionality includes the ability to monitor influenza-like illness, measles, and pertussis outbreaks automatically. In addition, the system now has the ability to look at antibiotic resistance information in many different ways, for example, by region, by condition (e.g., skin and soft tissue infections, febrile infant), or hospital versus ambulatory information.

A primary focus during the year was on project dissemination and manuscript development. The development of the dashboard was presented in May at the meeting of the Pediatric Academic Societies. Dr. Gesteland presented a paper, The EpiCanvas Infectious Disease Weather Map: An Interactive Visual Exploration of Temporal and Spatial Correlations, at the 2011 American Medical Informatics Association Symposium. This paper won the Homer R. Warner Award and is now available as an e-publication in the Journal of the American Medical Informatics Association. Dr. Gesteland is working on integrating this "infectious disease weather map," which depicts regional infectious disease activity at-a-glance into the GermWatch system.

Preliminary Impact and Findings: Parents participating in focus groups reported interest in having access to the type of information about common viral epidemics that the GermWatch system provides.

Target Population: Acute Respiratory Infections, Pediatric*

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Using Health Information Technology to Support Population-Based Clinical Practice - 2010

Summary Highlights

  • Principal Investigator: 
  • Organization: 
  • Funding Mechanism: 
    PAR: HS09-085: Mentored Clinical Scientist Research Career Development Award (K08)
  • Grant Number: 
    K08 HS 018538
  • Project Period: 
    September 2009 – July 2014
  • AHRQ Funding Amount: 
    $795,960
  • PDF Version: 
    (PDF, 642.81 KB)


Target Population: Acute Respiratory Infections, Pediatric*

Summary: Acute respiratory infections (ARIs) are a major burden to the heath care delivery system and the public’s health. The overuse of antibiotics for viral infections has contributed to the rapid emergence of antimicrobial resistance and a substantial number of adverse drug events. As a result, research on preventing the overuse of antibiotics is a national priority. This project aims to improve providers’ and patients’ ability to distinguish viral infections from bacterial infections by providing timely, accessible information about the local incidence of common respiratory viruses via a population health repository and decision support tools.

Intermountain Healthcare, affiliated with the University of Utah School of Medicine, developed Germ Watch (https://intermountain.net/portal/site/mdvsi/), a reporting system for pediatric respiratory infections that imports data from all Intermountain Healthcare system practices. The reports display pathogen-specific data presented in graphs on the Web site with a user interface to select for age ranges, pathogens, and regions. The overall goal of the project is to refine this dashboard and further integrate it into clinical workflow.

This study will address important gaps in patients’ and providers’ population-based health knowledge and the information technology tools required to fill these gaps. The lessons learned through developing, implementing, and evaluating the impact of population health and decision support tools for ARI treatment will lead to significant scientific contributions in this research area and will improve the integration of decision support tools at health care practices.

Specific Aims:
  • Assess primary care clinician use of current population-based ARI health information resources and decision support tools using focus groups and structured observation. (Ongoing)
  • Refine population-based ARI health information resources and decision support tools to improve clinical information system workflow integration and patient communication. (Ongoing)
  • Implement these population-based ARI health information resources and decision support tools in primary and urgent care settings. (Upcoming)
  • Measure the effects of population-based ARI health information resources and decision support tools on population-based clinical practice and patient and parent compliance. The goal of these interventions is to increase the effectiveness and appropriateness of antibiotic prescribing for ARI. (Upcoming)

In addition to the specific research project aims, Dr. Gesteland has, as part of this Mentored Clinical Scientist Research Career Development Award, the following career goals:

  • Expand existing skills in the extraction, analysis, and graphical display of health care data using electronic data warehouses, business intelligence platforms, and the Web 2.0.
  • Develop new expertise in the cognitive science of data and information visualization and display to support clinical decisionmaking and patient-centered care delivery.
  • Develop additional expertise in the integration and implementation of knowledge management and decision support tools in clinical information systems.
  • Develop additional skills in conducting health information technology intervention studies including workflow analysis, cluster-randomized control and quasi-randomized controlled trials, interrupted time series analysis, and controlled before-and-after studies suitable for testing proposed intervention.
  • Expand and refine existing skills in measuring the effect of information or communications systems on the quality and productivity of health care.

2010 Activities: Initial 2010 work has focused on: determining how providers use population-based ARI health information resources and decision support tools, understanding the level of interest that patients and parents have in having access to viral epidemic data, and evolving the system infrastructure to support improved and enhanced data visualization. The original plan to conduct focus groups with providers was changed to an approach involving one-on-one contextual interviews in which the principal investigator sits with providers and reviews how they use current tools and information resources, and solicits ideas for how the system could be improved. The switch to contextual interviews was based upon advice from the research organization’s Strategic Planning Group that has extensive expertise in conducting focus groups and soliciting input from physicians. During the interviews the project team showed providers dashboard prototypes, which they continue to refine in an iterative fashion. Dr. Gesteland has been incorporating methods of Cognitive Task Analysis that he initially learned about at the Health Information Technology Grantee and Contractor meeting in June 2010. By December 2010, Dr. Gesteland has completed three of the targeted 20 projected interviews. In addition to these formal interviews, Dr. Gesteland has had numerous impromptu discussions with physicians about their information needs and ideas for improving the current system. Overall, feedback has been very positive and numerous ideas have been provided on how to improve the functionality of the tool and better integrate it into clinical workflow as a dashboard.

Activities in 2010 also included two focus groups with parents of patients to help inform the development of patient-facing components of the decision support tools being developed. The intent of these focus groups was to assess parent information needs relevant to ARI, understand where parents receive ARI information, and determine parent preferences on ARI information and how it should be presented. Focus group participants included both first-time parents and parents with multiple children. An additional focus group for Spanish-speaking parents is planned.

The research team has made substantial progress with evolving the system infrastructure to support improved and enhanced data visualization. The team analyzed the content of current reports for common information communication objectives and interviewed system users (administrators, clinicians, infectious disease experts, and epidemiologists) to understand their goals and tasks when accessing current reports and tools. Using weekly counts of positive tests and percent positive, the team developed pathogen-specific activity thresholds by analyzing historical outbreaks. These thresholds were used to develop a set of dashboard elements that present pathogen-specific indicators of activity (None, Minimal, Moderate, Heavy, Intense), trend (5 weeks, 1 year, 5 years), severity (percent inpatient, critical, respiratory. failure), and regions affected.

Preliminary Impact and Findings: During the focus groups with parents, participating parents reported interest in having access to the type of information about common viral epidemics that the Germ Watch system provides. These findings were presented to Intermountain Healthcare’s Pediatric Guidance Council, which subsequently has generated discussion and early planning such as discussions with the public relations office about the development of a public-facing version of Germ Watch. The vision of this spin-off project is to provide the equivalent of a weather report for respiratory viruses that could be published in the local news media.

The development of the dashboard will be presented in May 2011 as a platform presentation at the meeting of the Pediatric Academic Societies.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Using Health Information Technology to Support Population-Based Clinical Practice - Final Report

Citation:
Gesteland P. Using Health Information Technology to Support Population-Based Clinical Practice - Final Report. (Prepared by the University of Utah under Grant No. K08 HS018538). Rockville, MD: Agency for Healthcare Research and Quality, 2014. (PDF, 5.4 MB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 
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