Home Forums Discussions General Discussion Data mining

I am still considering AC. I love this user board. I am a solo FP and one of my concerns (other than being paralyzed with fear over switching from paper to computers since I am NOT particularly computer literate) is the lack of ability to mine the data. One of the major reasons I want ehr is to improve the quality of care I provide. I need the data in order to do that. Am I wrong or do I need to look at other softwares to be able to manipulate patient data.

Thanks

I am less experienced at using AC than some others on the UserBoard, however I am very computer literate and I've looked into this.

At first look, there is no ready built means of data mining. I presume you are talking about finding A1C's, BP's, cholesterol's, which patients are on ACE-I's, etc. I further presume this is for P4P, since you are probably confident that the care you provide is excellent.

There is a means to monitor this data for selected individual patients, however there is no statistical analysis built in to search across multiple patients.

One could construct Excel flowsheets, but I'm quite certain this would not get you what you are looking for.

Other users please correct me if I am mistaken, but I believe the type of data collection Bill is seeking does not exist within AC. Part of the low cost associated w/ AC is that it's not a perfect all-in-one system. It's best as an electronic SOAP note and it's ok as an electronic filer. It's less perfect as an office management system/billing system.

I'm not sure if this will help, but if you click on the "Search" box on the upper left side of the schedule screen (where the pt list is), you can search by insurance, dx, meds, etc. There's also an advanced search menu that I haven't used, but looks interesting. This is pretty basic stuff, so I'm not sure if this is what you're looking for.

I have been playing with the advanced search function. I am looking for two things.
A. Areas of concern for improving the quality of care we render.
B. Tools for "cleaning and pruning" the database.

The advanced function is very easy to use, simply click the button, a box opens and you add criteria to the box over and over until you are done, then start search.
For example: to find all of your diabetic patients, you must search for 250.00 and 250.02 and 250.42 and etc. You get the idea.

To work on the quality of the database I am trying to find easy tools, but the system is a little primitive. In our office one physician was asking the MA's to enter the medications. This resulted in the database being corrupted as 'lasix' and 'furosemide' are both entered. To identify those patients, (to be forwarded back to the guilty party) we can search for Lasix, then for furosemide, then compare the lists manually and pull the chart numbers that appear twice. Not ideal.

Guys,
Let's not forget the "Tracked Items" section where any practice can set up some of the favorite things, like A1C's, various lab levels or other things to track. At some point I gather Jon may expand on this section so we can have more it we care to. But it works for our small purposes.

The problem is the P4P and CCHIT kind of imply that any carrier or the gov't should be suddenly able to ask us to produce data on anything they darn well want to track. The Level of granuality for such a thing is just insane and it is this stupid level of sub-dividing up any and all things entered that is going to kill (is killing) EMR's for the average small office.

And as someone who studied lots of experimental model and stats none of this data collected is really very valid anyway. Is is polluted with subject and experimentor bias from the very nature of it's collection and use. No less is any thing from either side (Patient or Provider) double blind.

Yes tracking things to see how you or your practice is doing is all well and good, being able to bring up DM patients that need some follow-up is a great reason to use any EMR, but much beyond that is BULLCCHIT, especially in the solo, small and even mid-sized office. We should not all be obligated (it's kind if illegal and unethical actually) to turn each and every patient and encounter into a study. Where is both the provider's and the patient's rights of informed consent? No less the actual protection of the quality of the data collected?

We in this business need to stop falling for and giving in to each and every new trick these SOB's come up with in their attempt to tie us up in knots and take away the money for your services that we have all worked so hard for. Stand up for yourselves for goodness sake and get a clue.

Sorry for going off so, but this data mining and tracking thing really gets me going. We are here to guide and heal, not to mine data to create false studies based on corupt data that lead to incorrect inferences for the great corporate and gov't gods of the oh mighty dollar.

Good Night and Good Luck,
Paul

I am trying to understand the problem. Are you saying that there are patients whose medication list contains both Lasix and furosemide, as if they were two separate medications?

>>> The advanced function is very easy to use, simply click the button, a box opens and you add criteria to the box over and over until you are done, then start search.
For example: to find all of your diabetic patients, you must search for 250.00 and 250.02 and 250.42 and etc. You get the idea.

You should all learn how to use MS Access' powerful native query language (which is not all that hard) to look up stuff directly on your AC tables. That is one topic which can and should be discussed in the AC get-together.

The SQL queries for lasix/furosemide is:

"SELECT ListMEDS.* FROM ListMEDS WHERE (((ListMEDS.MedName)=Left("Lasix",5) Or (ListMEDS.MedName)=Left("furos",5)));"

The SQL queries for the ICD diagnosis codes for diabetes would look something like this:

"SELECT superbill.* FROM superbill WHERE (((superbill.ICD1) Like "250*")) OR (((superbill.ICD2) Like "250*")) OR (((superbill.ICD3) Like "250*")) OR (((superbill.ICD4) Like "250*"));"

These look somewhat complicated, but there are MS Access wizards to help you put them together. Then again, there is always this community server board where those of us in the know and who like this stuff can help you out.

First of all, database is password protected... I'm sure it's done so that people don't go in and mess around and break something.

I've actually suggested this to John in person at a convention a while back. He didn't seem interested. I've even submitted the Access query string in the past but no response.

AC's Data mining is not remotely usable -- right now.

However, once the database is on SQL Express, and as long as we can query the database, then small utilities to query this kind of information can be done.

I understand that there will be a health maintenance component of Version 4. Maybe this will facilitate data mining.
I currently produce a quarterly report for our Ozarks Technical Community College Health and Wellness Clinic. The report is presented to the board of directors and to the president of the college. I actually asked that this be put into my contract to self discipline myself to complete the task. It is relatively easy to data mine basic data with my small family practice using AC. Since I store the current and past HgbA1C, cholesterol and components on the Summary sheet, I pull all of my diabetics with the Search button, click on the individual patients and check their HgbA1C's, click on Hyperlipidemia and check the lipids, click on hypertension and so on. It seems a bit laborious, but is sure a lot easier than attempting to do this with paper charts. It would be great to be able to pull it all up with a single action.
We can further encourage Jon at the ACUC to enhance the data mining capabilities of AC.
Jim

Another option would be for someone with some computing skills to create a small stand-alone application to help harvest the needed data, and output it to a text-delimited file which could be imported into Word, Excel, Access, what have you.

Brian, you mean something like this:



http://www.box.net/shared/static/ebziurpk40.dot ?

Currently the backend is a separate MS Access file hidden in the background with only the data imported into a MS Word template. This data can always be linked to the AC tables...

This is another graph, but done within MS Access itself:



Same, looking at diagnoses (as above, filter is applied):



Here I plot my hemeonc portion of my practice to my general medicine patients, and you can see the difference in the patient ages (hemeonc is skewed to the right):



This is a graph of the new to old patients seen daily at my office for the past 2 years:



I apologize for the overdone yellow background; when I did these MS Access graphs back some 12 years ago, I had something for yellow backgrounds. The MS Word graph template is about 8 months old, done a programming show-off with one of Nick's programmers at emrupdate. I hope you can appreciate how I've grown to use color in a better manner!

Anyhow, that's it for graphing fun with the MS Office graphing ActiveX module... a very powerful tool indeed!

Al

Awesome, Al.

What about it, Users? If you were designing a stand-alone program to perform your data-harvesting tasks, how would you want it to work? What would you want it to do?

Brian,

Ideally,

Data entry only once and user friendly

Retrievable Lab data entered via interface

Data retrievable by a search (e.g. all HgbA1C values above 7.0, all LDL's above 100 etc)

Data graph entries as demonstrated by AL

Tracked data viewable on the Summary Page for each visit.

Pre-set Alerts for immunizations, health maintenance.

Jim