Using the HealthMeasures API: The NYU Langone Health Experience · Using the HealthMeasures API: The NYU Langone Health Experience Heather T. Gold, PhD, and Raj Karia, MPH ... MCIT

NYU School of Medicine

Using the HealthMeasures API: The NYU Langone Health Experience

Heather T. Gold, PhD, and Raj Karia, MPH

Alissa Link, Long Zhao, Meredith Blake, Rachel Lebwohl, Devin Mann, Ben

Weinstein, Joseph Zuckerman, Thomas Errico, James Slover, Aaron

Buckland, Michael Cantor

PROMs already being used, wanted to enhance

• Legacy instruments in orthopedics via Qualtrics

• HOOS, KOOS, ODI, etc

• Goal to include PROMIS Computer Adaptive Testing

(CAT) to reduce participant burden, improve accuracy,

validity

• Bridge formal human-computer interaction (HCI)

techniques into academic medical center IT operations

• Provide real-time PROMs integration into EHR

• Build in components for data pulls for research

2 NYU School of Medicine

Interdisciplinary project team

PROMs implementation

team

Orthopedic Surgery

Population Health

Clinical Research

Informatics

MCIT Digital Solutions

Team

3

Champions: Department of

Orthopedic Surgery

• Wanted Computer Adaptive

question bank to save

patient time

• Wanted real-time access to

scores in EHR

NYU Langone Health MCIT

Digital Solutions Team

• Implementation team –

technical and user

experience design

Department of Population

Health

• Research focusClinical Research

Informatics

• Facilitate project across

clinical departments,

research, IT


Champions:Department of Orthopedic Surgery

• Started with 1 spine surgeon convincing Division Chief

and Dep’t Chair of importance for monitoring QOL

• Medicare reimbursement requirement by 2019

• NIH-funded clinical studies

• Dep’t supported with funds through Year 1, in addition

to IT funds

• Rollout to musculoskeletal care: Total Joint, Sports,

Rheumatology, Pain Management & Rehabilitation (all

in same building)


Designed for optimal user experience (UX)

• Interviews with Epic “super users” at NYU Langone

Health

• Workshop with orthopedic surgery faculty to ascertain

preferences for data visualization

• Used rapid-cycle design, full team meetings bi-weekly

• Incorporated user feedback throughout all stages of

development (usability testing) and on prototypes

• Patients

• Staff (Front Desk staff, Medical Assistants)

• Providers

• Researchers


6

Staff rely on system

logic to assign PROMs

to patients and use

Epic-integrated QR code

to provision registration

tablet

Already had paperless

registration and tablets for

legacy PROMs

Patients complete

assessment via

MyChart prior to

appointment or

tablet in waiting

room

Providers view

scores, PROM Q&As,

interpretation in

Hyperspace in real

time

Patient

views

scores in

MyChart

in real

time

Researchers query

data: PROMs plus

clinical data from Epic

Caboodle

REDCap for administering

PROMs & de-identified data

storage

PROMIS assessments can

be assigned by:

• Provider, Visit Type,

Location

• Age• Parent/caregiver Proxy (5-12)

• Pediatric (13-17)

• Language

Daily reports assess compliance

• Staff training of utmost importance to get check-in

process and assessments completed

• Staff can document reason for non-completion by

patient, included in daily report

• Daily email report of total patients, assessments

completed, partially completed, completion time, and

by mechanism (i.e., tablet, home)


Daily report in tableau dashboard

8

Physician data access

• Data visualization is large focus

• Fewest “clicks” as possible to view

• Context for PROMs scores given

• National norm, age norm, gender norm

• Patient over time


NYU School of Medicine10

PRO Data Dashboard in Epic


PRO Data Display


PRO Data Display: Hover detail


MyChart integration for patients: eCheckIn

MyChart eCheckIn – link to all questionnaires

MyChart eCheckIn Health Assessment link


MyChart eCheckIn Health Assessment welcome page

Betsy Ross

Easy configuration and/or modification of assessments for other departments/divisions

• Easy operationalization of platform via web app

• Allows divisions/ departments to manage own

PROMs on platform via web app

• Non-developer can use web app to configure

new assessments, set rules for assigning them

by provider, visit type, age and/or language.

• Includes step-by-step instructions for importing

PROMIS assessments, building or importing

legacy assessments in REDCap, and configuring

Epic flowsheets


Advantages of PRO Assessment Platform over existing tools (e.g., MyChart questionnaires, legacy Qualtrics portal)

• Real-time Epic integration with improved features for

staff and providers

• Improved UX

• Improved reporting

• Data for research (incl randomized order of

assessments)

• Customizability


Troubleshooting

• Epic technical limitation: INP (patient encounter) record

• Patient needed to be checked in for data to save correctly, but

assessment was pre-check-in or at check-in

• Data integrity issues in Epic

• Ensuring data can file correctly into Epic

• Big effort to sync custom DevOps with Epic DevOps

• Want everything automated, but required real-time error monitoring

of end-to-end system

• Updates to PROMIS API

• Instrument name must match exactly to API (changing version #s)

• Updated versions sometimes have different question language


Future Plans

• Rollout to other divisions and clinical departments

• Include surgical history context in provider dashboard

• Assign assessments in MyChart as planned series

e.g., 3 month follow-up, 6 month, etc.

• Enhance branching logic to assign assessment based

on answer to a previous question

• Provide multi-language support

• Governance rules across enterprise


NYU Langone Health MCIT: Alissa Link, Rachel Lebwohl, Long Zhao, Meredith

Blake, Ben Weinstein, Huming Tang, Bebeto Jefry, Sony Sebastian, Anokh

Vijayakumaran, Tom Thliveris

Dept of Population Health +/- Clinical Informatics: Heather T. Gold, Devin

Mann, Michael Cantor

Dept of Orthopedic Surgery: Raj Karia, Joseph Zuckerman, Thomas Errico,

James Slover, Aaron Buckland

NYU Langone Health Project Team

22

Detail slides

24

Health assessment images

25

Health Assessment Instruments I

Spine

• EQ-5D

• ODI - back pain

• NDI - neck pain

• SRS22 - scoliosis

• PROMIS Physical Function (CAT)

Total Joint

• EQ-5D

• HOOS Jr -hip

• KOOS Jr -knee

• ASES -Shoulder

• Mayo Elbow -elbow

• Quick Dash -hand/wrist

• PROMIS PF Upper Extremity (CAT)

• PROMIS PF Mobility (CAT)

All

• PROMIS Pain Intensity (SF)

• PROMIS Pain Interference (CAT)

Sports

• EQ-5D

• HOOS Jr -hip

• KOOS Jr -knee

• IKDC -knee

• Marx Acitivy Scale - knee

• ASES -Shoulder



• PROMIS PF Upper Extremity (CAT)

• PROMIS PF Mobility (CAT)

26

Health Assessment Instruments II

Rheumatology

• EQ-5D

• MDHAQ

• HOOS - hip

• KOOS - knee

• ASES -Shoulder/elbow



• BASDAI - (Ankylosing Spondylitis,

Psoriatic Arthritis)

• LupusQoL

• PSAID12 -(Psoriatic Arthritis)

• PROMIS Physical Function (CAT)

EQ-5D + VAS

4 Pain Questions

+ Chief Complaint

Scoliosis or

KyphosisBack Pain OtherNeck Pain

Spine Assessment Flow

LEGEND

All patients complete

Pitching

Forward

(hunched

over)

I don’t

know

ODI NDI SRS 22r

End

PROMIS Physical Function

(CAT)

PROMIS Pain Intensity (SF)

PROMIS Pain Interference (CAT)

5

5

5

5

3

1

0

1

0

2

4

Lowest total number of questions = 33

Average number of questions = 38

Highest total number of questions = 47

13%

13%

8%

39%

13%

13%

EQ-5D + VAS

Chief Complaint

ShoulderHip Foot/ AnkleKnee

Total Joint Assessment Flow

LEGEND


ElbowHand/

Wrist

HOOS Jr KOOS Jr ASES

Other

Mayo

Elbow

Quick

DASH

End

PROMIS Physical Function –

Upper Extremity (CAT)



5

5

3

5

9 1

01

9

1

2

2

5These counts

assume one

side only

Total = 38

39.5%

13.15%

13.15%

7.9%


Mobility (CAT)5

1

5

13.15%

13.15%

EQ-5D + VAS

Chief Complaint

ShoulderHip Foot/ AnkleKnee

Sports Assessment Flow

LEGEND


ElbowHand/

Wrist

HOOS JrKOOS Jr

IKDC

Marx ActivityASES

Other

Mayo

Elbow

Quick

DASH

End


Upper Extremity (CAT)



5

5

3

5

9 3

31

9

1

2

2

5These counts

assume one

side only

Total = 43

46.6%

11.6%

11.6%

7%


Mobility (CAT)5

2

0

11.6%

11.6%

MDHAQ(9q)

EQ-5D(6q)

Reason for Visit

OA

35Lupus

37I don’t know

Psoriatic

Arthritis

30

Rheumatoi

d Arthritis

3Other

KneeHand/

WristHip Shoulder Elbow Other SpineFoot/Ankle

BASDAI(6q)

PSAID12 (12q)

Work/

Employment(7q)

LupusQoL(4q)

KO

OS(16q)

HO

OS(16q) QuickDAS

H(11q)

ASE

S (6q)

ASE

S (6q)

MayoElbow(10q)

CMC Rheumatology Patient Reported Outcomes (PRO) Workflow

LEGEND


Depends on Visit

ReasonCompleted Annually

Completed

on first time

and then

only if pt has

neck/back

pain (SEE

NEXT

SLIDE)

Scleroderm

a 3

Ankylosing

Spondylitis

9

Hx

Diagnosis

(2q)

Gout

3Vasculit

is 3

This

appears

last

Hx

Diagnosis

(2q)

BASD

AI

Hx

Diagnosis

(2q)

Hx

Diagnosis

(2q)

Hx

Diagnosis

(2q)

Hx

Diagnosis

(2q)

Hx

Diagnosis

(2q)

Completed

on first time

by all with

the

exception of

patients that

choose

“other and “I

don’t know”

for reason

for visit

Hx

Diagno

sis

(2q)

52

5

4

5

4

7

1

92

5

1

9

1

2

3

0

Documents

Using the HealthMeasures API: The NYU Langone Health Experience · Using the HealthMeasures API: The NYU Langone Health Experience Heather T. Gold, PhD, and Raj Karia, MPH ... MCIT