1/6/2017 Leveraging the EHR and Other Technologies for Research at Yale Tesheia Johnson, MBA, MHS Allen Hsiao, MD, FAAP Deputy Director, Chief Operating Officer, YCCI Chief Medical Information Officer Associate Director for Clinical Research, Yale School of Medicine Associate Professor of Pediatrics & of Emergency Medicine Outline Background EHR-CTMS Integration Research Tools Leveraging EHR Serious Adverse Event Alerts Research Decision Support/ MLMs in Epic Engaging Research Subjects with the Patient Portal Research Data from Epic EHR Other Technologies 1
1/6/2017 Yale New Haven Health System Yale University & School of Medicine 2
1/6/2017 YSM & YNHH Legacy Environment c. 2010 BH HSR Cerner Clinical Enterprise Medipac SDK Revenue Cycle Quadramed GH Sunquest Meditech Enterprise YMG Picis OR Paper GE Centricity Ambulatory YNHH Sunrise Ambulatory OP Eclipsys/Allscripts Sunrise IP and Oncology Oncology OP NEMG GE OR/Anesthesia Varied Links ED GE Centricity Ambulatory Yale Health Soft Lab AllScripts McKesson Pharmacy SDK Revenue Cycle Epic EHR Unifies System and School Identity (HIM) Epic Care Inpatient Epic Care Ambulatory Prelude (Registration) Willow (Pharmacy) Phoenix (Transplant) Radiant (Radiology) Beacon (Oncology) Cadence (Scheduling) Cardiant/Cupid (Cardiology) Kaleidoscope Resolute- Hospital Billing (Ophthalmology) Stork (Obstetrics) Resolute-Professional Billing Healthy Planet ASAP (Emergency Dept) Clarity (Reporting) OpTime/Anesthesia (Periop) 2016 Adds: My Chart (Patient Portal) Beaker (Lab) ICON (Infection Control) Bed Management, EVS, Transport CPM-RC Welcome (Kiosks) Capsule BMDI Helix (Star) Data Warehouse 3
1/6/2017 Clinical/ Epic EHR Footprint Critical Yale-New Northeast Bridgeport Greenwich TOTAL Indicators Haven Medical Total Licensed 1,541 383 206 N/A 2,130 Beds** Inpatient 78,529 18,208 12,538 N/A 109,275 Discharges* Outpatient 1,187,405 277,043 289,860 402,000* 2,156,308 Encounters* Net Patient Service $2.4B $439 M $349 M $123 M $ 3.3B Revenue* Medical Staff*** 4,080 1,150 601 660 6,491 Employees 12,428 2,619 1,636 1,050 20,292**** Going liv e a t La w rence + Mem oria l, licensed for 28 0 bed s a nd p rov id e p a tient ca re to m ed ica l, surgica l, p ed ia tric, reha b, p sy chia tric a nd obstetrica l p a tients. A Little About Us Research Footprint Yale School of Medicine: 6 th in total NIH funding among medical schools 4 th in total NIH funding per full-time faculty member Research funding FY16: $593.1 M, with more than $333M coming from NIH Total faculty:1,565 teaching (ladder) faculty 713 research faculty 1,578 postgraduate fellows 28 basic science and clinical departments, 7 centers, and School of Public Health ~5,000 Active human subjects protocols 3,411 active patients on 1,491 active therapeutic studies, as of January 5 th 8 4
1/6/2017 Research Flow – Prior to February 2014 Now: Integrated Standards Based EHR-CTMS Environment 5
1/6/2017 Yale Clinical Research Dashboard Epic-OnCore Integration: Banner From: Epic Sent: Friday, August 03, 2016 9:31 AM To: Study PI; Study Coordinator Subject: ER or In-Pt status notification for research pt.'s Subject: ADVERSE EVENT INFORMATION Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: Hospital Service: Emergency Medicine Type of Event: ED Arrival STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701 6
1/6/2017 Epic Serious Adverse Event (SAE) Alerts From: Epic Sent: Friday, December 14, 2016 9:31 AM To: Study PI; Study Coordinator Subject: ER or In-Pt status notification for research pt.'s Subject: ADVERSE EVENT INFORMATION Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: Hospital Service: Emergency Medicine Type of Event: ED Arrival STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701 Epic Serious Adverse Event (SAE) Alerts 14,518 SAE Alerts to investigators since 2/ 2012 From: Epic Sent: Friday, August 03, 2016 9:31 AM To: Study PI; Study Coordinator 7,827 unique encounters Subject: ER or In-Pt status notification for research pt.'s 3,486 unique patients Subject: ADVERSE EVENT INFORMATION Investigators notified of: Patient: John Smith [MR151000] (DOB: 12/16/1950) Location: Yale New Haven Hospital Emergency Department Attending Physicians: 5,683 ED visits Hospital Service: Emergency Medicine Type of Event: ED Arrival 3,965 inpatient admissions 763 ICU transfers STUDY INFORMATION Name: PHASE II STUDY OF CAFFINE DEPENDANCY RELATED TO PLANNING 142 deaths EXTERNAL SCIENTIFIC ADVIOSRY BOARD MEETING ID: 12070XMS701 7
1/6/2017 Clinical & Research Decision Support with Epic Clinical & Research Decision Support with Epic … Clinical & Research Decision Support with Epic 8
1/6/2017 Clinical & Research Decision Support with Epic Smoking Cessation MLM Example: 12,365 patients (Sep 2016): 6119 Intervention & 6246 Control patients: 2020 (33%) Int vs. 1752 (28%) Control had nicotine orders placed 2457 (40%) Int vs. 130 (2%) Control had T obacco use disorder on problem list 1717 (28%) Int vs. 0* (0%) Control successful referral to QuitLine 6102 (99%) Int vs. 0* (0%) Control message sent to PCP Approaches to Recruitment: “ Help us discover” clinical research awareness campaign Database of volunteers Cultural Ambassadors Advertising and media New clinical research recruitment call center 9
1/6/2017 Leveraging all resources: Utilizing Epic Data in a new way - Opt Out Text Yale is an Opt-out System: Information from your medical record and leftover blood and/ or tissue may be used for research and teaching purposes unless you opt out. To opt out, you may choose to do so in one of four ways: Email: optout@yale.edu 1) 2) Call 1-877-978-8348, option #3 2) 3) mychart.ynhhs.org 3) 4) Write: Office of Research Services Attn: Opt- 4) Out Recruitment Yale School of Medicine P.O. Box 208054 New Haven, CT 06520- 8054 Update to “Notice of Privacy” and “ Patient Acknowledgement and Financial A h i i ” Leveraging IT & MyChart for Recruitment & Foll0w-up MyChart tab for clinical research created March 2015 Yale is an Opt-out System: Information from your medical record and leftover blood and/ or tissue may be used for research and teaching purposes unless you opt out. To opt out, you may choose to do so in one of four ways: 1) Email: optout@yale.edu; 2) Call 1-877-978-8348; 3) mychart.ynhhs.org; or 4) Write: Office of Research Services Attn: Opt-Out Recruitment Yale School of Medicine P.O. Box 208054 New Haven, CT 06520- 8054 10
1/6/2017 MyChart for Research: Help Us Discover 1240 MyChart unique research volunteers since launch (3/15/15) All with no active advertisement 590 screened for studies from these volunteers 146 already participating in studies By comparison, 840 identified through “traditional” methods EHR Patient Portal: Direct Study Recruitment 11
1/6/2017 EHR Reporting Used for Subject Identification Report set up based on inclusion and exclusion criteria of study Patient Notification: Email & Login Message Patients receive email (based on preferences) noting new message in MyChart Upon login, message about study appears at top: 12
1/6/2017 Patient Notification: Study Information & Response Clicking on icon or message takes patient to study information From here, patients can easily log interest or decline Patient Education: Fully Integrated Study Information Patients can expand window for more information Can also embed hyperlinks to website for education and other info 13
1/6/2017 Messaging is Important Initial proposed language: “Based on your medical record, you have been identified as potentially eligible for these studies.” T o: “You are receiving this message because the Yale New Haven Epic medical record system has done a search based on medical conditions that you may have. No one has looked at your record and no information has been shared with any research doctor or research team member. This search was made by a computer.” Integrated Investigator Notification: Patient Decision Simple click on “I’m Interested” gets ball rolling “No, Thank You” will suppress future notification for this study 14
1/6/2017 Integrated Investigator Notification: Expressing Interest Investigators will only learn of patients who have expressed interest Integrated Investigator Notification: In Basket Message Notifications are easily managed via In Basket 15
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