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Duke-Durham Partnership Uses Informatics to Redesign Health System

Cynthia Johnson, May 5, 2010

Project team members have garnered a new understanding of their community and have come away from the project feeling energized and ready to set their changes in motion.

"We've made a point of saying that health is everyone's business and it's going to take all of us," says Harris. "With that ongoing message, people will see that they have a part to play."

Targeting obesity—one child at a time
The obesity committee decided to tackle obesity in the Durham school system. The team believes that this will also allow them to affect change in parents, teachers, and other members of the community. They selected a target school as part of their first-year effort, and it has been cooperating with their efforts.

"The school system was the lowest-hanging fruit in terms of the obesity project," says David Reese, MBA, chief operating officer of the Inter-Faith Food Shuttle and vice chair of the Partnership for a Healthy Durham, where he co-chairs its obesity and chronic illness committee.

"It was a demographic in which we had the ability to affect the greatest change." Duke's EMR system did not store data on weight checks, and some of the children were not in the Duke system. As a result, the team needed to visit the school to gather the vital data that were missing. They collected the heights and weights of all the students at the target school to identify overweight children.

They are currently in the process of implementing a nutrition-based cooking class called Operation Frontline. The school is also applying for a USDA grant that could provide healthy fruit and vegetables to the school.

Reese says the team will move cautiously and at a sustainable pace during the first year. He is optimistic about the project and believes it will yield "tremendous results." Without the project, he says efforts to tackle this obesity in the community would continue to be fragmented.

Creating a community health system
One unexpected outcome from the project was the community's support of having their healthcare data shared across providers. "They were actually comfortable with data being shared and aggregated so we could look at how problems affected their neighborhoods," says Michener.

In one example of data sharing, project team members discussed the benefits of creating a common, patient-centered medication list so they didn't have to reiterate their list of medications to every healthcare worker they saw.

Although members of the community support data sharing, they don't want a specific EMR to tie them down, especially one owned by Duke. Likewise, Duke doesn't want the responsibility that comes with owning large amounts of patient data.

Duke has already determined that it currently stores too much information and is trying to limit it to 20 to 50 data points. As a result of project team discussions, DHI team members no longer believe they need a single electronic medical record system for Durham county. Instead, they are now discussing how to create a common health record that allows them to share and aggregate data in their community.

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