Duke-Durham Partnership Uses Informatics to Redesign Health System

Cynthia Johnson, May 5, 2010

When Durham-based Duke University and the Durham, NC, community launched Durham Health Innovations (DHI) in April 2009, they knew they were embarking on a groundbreaking project that would use medical informatics to identify chronic disease interventions and improve the health of patients. But at some point during the recently completed planning stages of the project, team members realized that they had stopped talking about patients—and started talking about communities.

"We realized that we were doing a whole lot of work on individuals," says Lloyd Michener, MD, chair of the Department of Community and Family Medicine at Duke. "Until this project, we hadn't clearly seen how individuals were part of the same networks, the same communities, and the same neighborhoods. In many cases, it makes sense to do things at the community and neighborhood level rather than one at a time at an expensive doctor's office."

The project uses data from Duke's electronic medical records (EMR) system. The university runs customized software that assigns geographic locations to the data, also known as geocoding. This HIPAA-compliant process lets team members look at areas of disease clustering.

The technology allows DHI to track progress and create interventions to prevent health problems from worsening in real time, says Gayle Harris, public health director in Durham County and member of the DHI oversight committee. The disease clustering maps are "amazing," says Harris, adding that they helped DHI identify disease hot spots at the neighborhood level.

"We shared the data with community members so they could see the patterns of illnesses that were affecting the community and the burden that imposed and talk about the interventions they would like to implement," says Michener. "It helped the communities galvanize and come together to find solutions."

Ten disease-based project teams, composed of diverse members from the Duke health system and the Durham community, used the data to develop plans to reduce death or disability from specific diseases and improve overall health outcomes.

"This is actually fairly exciting," says Michener. "With all the talk about unhappy doctors and patients and healthcare not working, this feels like people starting to take control of their own destiny and saying we can do better."

DHI project teams are now in the process of implementing their plans to evoke long-term change in the community. This month, Medicine on the 'Net® took the opportunity to follow up with them on the progress that they've made this past year.

It takes a village to improve health outcomes Michener was impressed by the deep level of interest that the project created in the tight-knit Durham community.

The project involved nearly 1,000 participants from Duke, the community, and 90 agencies who volunteered to work together to develop a better way of providing healthcare.

"This really brought the community together," Michener says. Team members involved in the project discovered that there were groups in the community that were working on similar issues, but that they weren't aware of one another's existence. "I couldn't count how many groups were working on obesity in the Durham community," he says. "The project let people connect and coalesce."

One of the teams has started working with a free clinic in the community to provide mammograms and cancer screenings using grant funding, says Harris. This opportunity came about because the project united people who wouldn't normally work with one another, she says. It helped them tap into current resources to put something in place that had been missing.

There was initial friction within the project teams from time to time as team members would attempt to determine who should be leading a particular effort, says Michener. Ultimately, however, everyone realized that the project was for the Durham community and not for one particular research or community group, he says.

"When the teams started working together, they realized they were more similar than they were different," Michener says. Finding and identifying the "enormous strengths" in the community allowed Duke project team members to support the community rather than impose their academic views upon it, he explains.

"Duke faculty members have learned just how talented and strong community members can be and what good partners they can make," Michener says.

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