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UW MED – PHINEX U niversity of W isconsin Med ical Record– P ublic H ealth In formation Ex change. Wisconsin ’ s Clinical EMR – Public Health Data Exchange Pilot Theresa Guilbert, MD, MS Project PI University of Wisconsin-Madison Department of Pediatrics [email protected]. - PowerPoint PPT Presentation
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UW MED – PHINEXUniversity of Wisconsin Medical Record–
Public Health Information Exchange
Wisconsin’s Clinical EMR – Public Health Data Exchange Pilot
Theresa Guilbert, MD, MSProject PI
University of Wisconsin-MadisonDepartment of Pediatrics
Why study chronic disease risk factors present in the environment &
community?
Multi-Level Approach
• A multilevel approach that includes an ecological viewpoint may help to explain heterogeneities in chronic disease expression across socioeconomic behavioral, and geographic boundaries that remain largely unexplained
• Improved knowledge regarding disease disparity is important in order to develop intervention strategies
Overall Hypothesis
• Data exchange between UW Dept Family Medicine (DFM) clinics and the Wisconsin State Division of Public Health (DPH) and subsequent linking of these data to public databases on geographical, environmental, socioeconomic, and demographic profiles will highlight areas of disparity and discover novel chronic and communicable disease risk factors
Rationale
• By having such a large clinical data set and using sophisticated spatial and multivariate modeling and data mining tools, areas of healthcare disparities will be highlighted
• New information about risk factors will be discovered to guide:– Clinical care– Inform clinical quality improvement– Design public health interventions– Facilitate further research
Specific Aims• Establish a health information exchange between
DFM clinics the DPH using a HIPAA privacy rule compliant limited data set– All Personal Health Identifiers are removed except for
gender, ethnicity/race, birth year/month, dates of service, zip code, and census block group
– This approach has been proved by the UW IRB
• Determine areas and populations of chronic and communicable disparity through collaboration with the UW Applied Population Laboratory (APL)
Specific Aims• GIS and spatial analyses of population trends to
chart areas of disparity and geographic characteristics of those communities that can lead to hypotheses regarding etiology
• Assess novel environmental and community risk factors by matching CBG coded EHR to its community level demographic and socioeconomic characteristics using data bases available through the APL and DPH.
Specific Aims• Use multivariate (logistic and Poisson regression,
fixed and random effects regression modeling) and data mining techniques at DPH to create predication models that specify risk factors associated with asthma among many environmental and community based factors from the census and commercial databases
• Using statistical clustering techniques analyze and determine prominent within patient disease co-morbidity groupings and determine the individual and community risk predictors of these clusters
Specific Aims• DPH operates the Public Health Information Network
(PHIN), a secure, web based system: – Advanced statistical and GIS modeling services– SAS Business Intelligence Server/Enterprise Miner– ESRI ArcGIS server
• Available community level databases include:– Census Demographic– Tapestry Segmentation– Consumer Spending– Business Summary and Location– Retail Market Place
Multi-Level Modeling and Data Mining of Disease Risk, Disparity, and Health Outcome Quality
Outcomes = Patient Clinician Clinic Community
Factors + Factors + Factors + Factors
Asthma Age Age Location Census Block Group:
Diabetes Gender Gender Capabilities Poverty
CVD / CHF Race/ethnicity Certifications Processes Education level
Immunizations Co-morbidities Graduation Built environment:
Obesity Medications date Traffic
Hypertension Education Years of practice Recreation / parks
Smoking Literacy Safety / crime
Alcohol Language Psycho-demographics
A1c level Insurance Restaurant mix
LDL Urban / Rural Fast food sales
HDL Census Block Group Fresh fruit & vegetable sales / consumption
BP
Hospitalizations Public Health Program Information
Health Care -Process factors
(e.g, time to repeat follow-up)
Electronic Health Record & Hospitalization Data Census / ESRI BA Data
Data Sets
• Public Health – Behavioral Risk Factor Surveillance System 2004-2009
• Clinical – UW Family Medicine & UW Hospitals and Clinics (demographics, diagnoses, problem lists, laboratory test results, vital signs, procedures, medication lists)
• Community Data – ESRI geo-coded data (CBG)
ESRI Data Bases Fresh Fruit & Vegetable Consumption Index
Milwaukee & Suburbs – Census Tracts
Color Ramp
Grey –Lowest
White-Low
Cream-Medium
Yellow-High
Red-Very High
Source:
ESRI / BLS Consumer Expenditure Survey
Fresh Fruit & Vegetable Consumption IndexWith Individual Store Location / Sales Volume
Milwaukee & Suburbs – Census Tracts
Color Ramp Grey –LowestWhite-LowCream-Medium Yellow-HighRed-Very High
Circle size = store sales volume
Source:ESRI / BLS Consumer Expenditure Survey
Disparity in Dane County?• ~50% of K-12 students in Madison schools are
economically disadvantaged (> 70% in some)• 50% of the kids in the Madison Metropolitan School
District are of racial/ethnic minority groups (poor access to care)
• Disparity does not always correlate with poverty– Falk Elementary School (West Madison) has 9% children
with asthma and a 65% poverty rate with 70% minorities – Mendota Elementary School (North Madison) has 22%
children with asthma and a 70% poverty rate with 74% minorities
Collaborative Effort
• Brian Arndt-UW DFM• Bill Buckingham-UW APL• Tim Chang-UW Biostats• Dan Davenport-UW Health• Kristin Gallager-UW Pop
Health• Theresa Guilbert (PI)-UW
Peds • Larry Hanrahan-DPH
• David Page-UW Biostats• Mary Beth Plane-UW DFM• David Simmons-UW DFM• Aman Tandias-DPH• Jon Temte-UW DFM• Kevin Thao-UW DFM• Carrie Tomasallo-DPH
What have we learned so far?
Presenters• Brian Arndt MD-UW Family Medicine
UW MED- PHINEX Diabetes & Obesity Use Case Clinician Lead
Estimating the Prevalence of Diabetes in Wisconsin
• Kevin Thao-UW Family MedicineThe Prevalence of Type 2 Diabetes Mellitus in a
Wisconsin Hmong Patient Population
Presenters• Carrie Tomasallo, PhD, MPH-Wisconsin
Division of Public Health Wisconsin Asthma Program
Estimating Wisconsin Asthma Prevalence Using Clinical Electronic Health Records and Public Health
Data