Clinical Studies Fueled by EMR Data

Gienna Shaw, June 29, 2010

At Montefiore Medical Center in Bronx, NY, researchers are harnessing the power of more than a decade's worth of electronic medical record data using a software program called Clinical Looking Glass (CLG). Developed by the academic medical center, the program interprets de-indentified data for entire patient populations and can be used to gauge the effectiveness of patient safety measures, identify and track public health threats, and provide data for professional articles and published studies.

Researchers, physicians, and other clinicians run as many as 2,800 queries every month using the software. Three examples: They used the program to measure the impact of Medicare regulations on rehabilitation patients, quantify the reduction in radiation exposure for emergency department patients, and track the care and progress of diabetes patients over time.

Measuring Medicare Policy
The Centers for Medicare and Medicaid (CMS) announced in 2005 a new rule that said a large percentage of rehabilitation hospitals' patients must have one of 13 specific diagnoses or the organizations could lose reimbursement. Concerned about the rule's potential impact on patients, a group of physicians at Montefiore, using CLG, performed a retrospective study of discharges from the hospital the year before the rules were implemented and discharges the year after the rules. They found that, in general, "restricting access to inpatient rehabilitation on the basis of diagnosis alone" resulted in patients being readmitted sooner and dying sooner. Their study called for broader, evidence-based guidelines to allocate rehabilitation services.

Reducing Radiation
To reduce unnecessary radiation exposure to patients admitted to the ED with a suspected pulmonary embolism, a group of radiology and nuclear medicine physicians conducted educational seminars for ED physicians. They showed the ED physicians that for certain embolism patients, a high-radiation CT pulmonary angiography (CTPA) was not necessary and that the lower-radiation ventilation-perfusion scan was just as effective. Using CLG, they showed that the number of CTPA scans performed decreased from 1,473 before the educational seminars to 920 after the seminars for an average reduction in radiation exposure of 23% percent per patient.

Improving Care for Diabetes Patients
Using CLG, physicians at Montefiore's 25 ambulatory care centers have identified 14,000 diabetes patients and tracked their care and progress over time, including improvements in blood glucose and cholesterol levels. Then they compared the results of patients in different centers and the results of those being treated by different doctors. Some Montefiore physicians practice outcome-based medicine linked to pay-for-performance incentives. The study showed that those patients being treated by those physicians had lower blood glucose and cholesterol levels.

Fostering Intellectual Growth
The organization says not every query run through CLG is as successful as the three examples above. Sometimes inquiries hit a dead end. But that doesn't mean Montefiore's investigators stop learning. They can attend bimonthly lunches to exchange ideas and share their CLG experiences. Out of those meetings, new avenues of exploration often emerge.

"CLG allows all clinicians and hospital administration to test hypotheses that just a few years ago would have been impossible to do," says Eran Bellin, MD, vice president for clinical IT research and development at Montefiore, who was instrumental in designing CLG. "It democratizes the research process. To be able to identify, within minutes, a cohort of patients, qualify them by a specific disease, medication, clinical event, race, time period or neighborhood provides a new paradigm for population-based medicine and a new level of importance for health care informatics."

(To read more about how hospitals and health systems are using EMR data to conduct research—and some of the legal pitfalls to avoid—see A Data Gold Mine in this month's issue of HealthLeaders magazine.)

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