Cerebrovascular Clinical Research Office CCRO Our Team a

Cerebrovascular Clinical Research Office (CCRO) Our Team… a multidisciplinary approach Dr. J Mocco Neurosurgery Dr. Michael Froehler Neurology Bree Burks RN, MSN, CCRP Manager-CCRO Stephanie Smith, MA, CCRP FEAT Project Lead Emily Gilchrist, MPH Cerebrovascular Clinical Improvement and Research Coordinator Dr. Howard Kirshner Neurology Diane Brown, RN, BSN, CCRP Research Nurse Specialist III Jessica Marlin, CCRP Clinical Trials Specialist Andrea Wimsatt Reed, MS Data Collector

Vanderbilt CCRO Expertise Complex Data Capture and Analysis Currently lead coordinating center for 3 multicenter clinical trials Coordinating over 30 active clinical trials Adjudicating complex data sets Analyzing data to assess project milestones REDCap Work closely with creator (Dr. Paul Harris) to implement new functionality Create complex databases storing information for thousands of patients used by institutions across the country Streamlining Clinical Workflow Parallel clinical workflow for cerebrovascular patients in an effort to standardize care (at VUMC and across the country) Experienced in implementing clinical improvement/best practices driven by new evidence

Challenges with Our Current Data Retrieval Process Data Multiple Disciplines Involved System Issues

Challenges DATA Star. Forms/EMR data is not outcomes specific nor consistent across users Data in EMR is not easily retrievable Structured data in EDW is not user friendly Data is reviewed after patients are discharged using billing and coding criteria

Challenges Multidisciplinary Issues Informatics • Nursing • Radiology • Neurosurgery • Consulting Services • Star. Panel • EDW • REDCap Point of Care Need for uniformity • Measurement • Performance Improvement • Monitoring • Analysts • Abstractors • Consultants Back End Users • Clinical improvement at VUMC • Accreditation Requirements • Complex Reporting Requirements • Reimbursement • Research QSRP Objective, comprehensive perspective is required

Challenges System Issues Abstractors often enter same medical records multiple times while pulling reports Abstractors and Consultants cannot independently generate reports (even routine reports) Coding drives patient selection sometimes weeks after point of care EDW is complex and data is limited, therefore cerebrovascular data is abstracted manually 70 -100 patients a month/approximately 70 -90 minutes per patient Approximately 2 FTE’s a month for cerebrovascular data abstraction ONLY Approximately. 7 FTE’s a month for defining patient population How could we repurpose that time in stroke alone to improve patient care?

What’s Missing 1. Real-time/Reliable Data 2. Streamlined Clinical Workflow 3. Streamlined Reporting Properties 4. Automated Dataset (ie: no more manual abstraction)

Proposal • Create a new, automated data abstraction process from Star. Panel that is outcome specific • Pilot this process in one controlled clinical area • Cerebrovascular Disease/Stroke Once finalized implement across VUMC

Solution 1) Created in house/flexible 2) User-friendly 3) Robust analysis and reporting properties 4) Experience with Automation 1) Research Derivative 2) DDP Automated Cerebrovascular Data Collection

Solution Real-time Reliable Data Ability to impact care before discharge and decrease failures VTE Prophylaxis Written educational materials Daily snapshots of clinical workflow Recover time spent identifying patients’ true diagnoses from generic ICD-9 Codes

Solution Streamlined Clinical Workflow Medical record templates are consolidated New templates are outcomes specific, reflective of current best practice, and conducive with clinical workflow

Solution Streamlined Reporting Properties • Flags missing values • Determines “Failures” based on pre-determined criteria • Logic can be built to capture any existing value and used repeatedly or amended • Executes reports in seconds

Solution Manual Abstraction Obsolete Clinical Documentation Occurs Star. Server Data Parsing Enterprise Data Warehouse REDCap End Users

Project Goals Improving patient care at Vanderbilt Reduce the burden of manual data abstraction Increase efforts towards implementing new processes for quality, safety, and riskprevention

Implementation Define CV patient population Define data points Organize and prioritize new MR templates • • • Core measures GWTG Meaningful Use Clinical needs Research needs • • Per clinical users Collapse current options Reformat for automation • • • Update notes and forms • • • Review Current form Identify data currently captured and necessary additions Draft Template Approval Construction Pilot new forms/Delete alternatives • Build REDCap database Map data points Star. Panel → EDW → REDCap Begin using REDCap to generate reports • Mirror the MR with a calendar design Incorporate vitals, labs, and meds through the DDP

End Product

Benefits DATA Single form reporting will create consistency in the EMR Data in EMR will be easily retrieved due to standardization Generating reports within the EDW based on ICD-9 codes will be unnecessary Data is retrievable within 12 -24 hours of entry into the EMR

Benefits Multidisciplinary and System Issues Uniformity in data collection will create a system benefitting multiple disciplines and departments System redundancies will be significantly reduced Abstractors and Consultants will be able to independently generate reports Patient population will be predetermined eliminating the need to verify ICD-9 codes against the EMR

Recap Improving patient care at Vanderbilt Reduce the burden of manual data abstraction Increase efforts towards implementing new processes for quality, safety, and riskprevention