Our Team… a multidisciplinary approach

1. Cerebrovascular Clinical Research Office (CCRO) Our Team… a multidisciplinary approach Dr. J Mocco Neurosurgery Dr. Michael Froehler Neurology Stephanie Smith, MA, CCRP FEAT Project Lead Emily Gilchrist, MPH Cerebrovascular Clinical Improvement and Research Coordinator Bree Burks RN, MSN, CCRP Manager-CCRO 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

2. 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

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

4. Challenges • DATA • StarForms/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

5. Challenges Objective, comprehensive perspective is required Need for uniformity • Multidisciplinary Issues

6. Challenges How could we repurpose that time in stroke alone to improve patient care? • 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

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

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

9. Solution • Created in house/flexible • User-friendly • Robust analysis and reporting properties • Experience with Automation • Research Derivative • DDP Automated Cerebrovascular Data Collection

10. 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

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

12. 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

13. Solution • Manual Abstraction Obsolete

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

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

16. End Product

17. 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

18. 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

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