Data Mining for Managers

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Data Mining for Managers

• Laura Kroupa, M.D.

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Questions

• Please write down questions on 3x5 cards, and
  hand them to the assistants in the room.
• Questions will be answered at the end of the
  presentation

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Introduction

• St. Louis VA Medical Center
• Two division
• Urban
• Tertiary Care Medical Center
• Dual Affiliation
• Saint Louis University
• Washington University

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Introduction

• My role
• Currently ACOS for Education
• Informally ACOS for Medical Informatics
• Formerly ACOS for Primary Care
• Previously Acting COS 2006

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Data Mining

• Data mining is the process of sorting through
  large amounts of data and picking out relevant
  information. It has been described as the
  nontrivial extraction of implicit, previously
  unknown, and potentially useful information from
  data and the science of extracting useful
  information from large data sets or databases.

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Objectives

• What data is readily available in VISTA?
• What data sources are most likely to give us the
  information we need?
• What are the right questions to ask?
• What are some of the pitfalls in the various
  reports?

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Reports

• Reminder Reports
• Proclarity Cubes
• Ambulatory Care Report Program
• Clinic Utilization Statistical Summary
• Care Management Query Tool

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Clinical Reminders

• Software integrated into VISTA and CPRS that
  reminds clinicians to do something
• Reminders are completed (resolved) by the
  clinicians
• Reminders are generally developed to assist with
  performance measures and guidelines-some are
  nationally developed and others are local

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Reminder reports

• Reminder reports can be used to determine
  reminder completion rates
• Reminders reports can also be used to track
  compliance with performance measures and clinical
  guidelines
• Reminder reports are run from VISTA and templates
  can be developed to make running the reports
  easier

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Anatomy of a Reminder

• Medications
• Education topic
• Exam
• Health factor
• Immunization
• Laboratory test
• Mental Health Instrument
• Orderable item

• Radiology procedure
• Reminder computed finding
• Reminder taxonomy
• Reminder term
• Skin test
• VA drug class
• VA generic
• Vital measurement

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Reminder Reports

• Individual Patient Reminder reports settings
• Individual Patients
• Reminder Patient List
• Location
• OE/RR Team
• PCMM Provider
• PCMM Team

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Reminder Reports

• Reminder Reports can be
• Look into the future
• Identify patients who need to have an
  intervention in the future
• Look at the past
• Give a summary of performance
• Identify patients who missed an intervention

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Reminder Reports

• Reminder reports are useful for
• Looking at process
• Looking at performance
• But are limited by what data is in the reminders
• Reports can be DETAILED (with patient names)-only
  one reminder at a time
• Reports can be SUMMARIES-multiple reminders with
  completion rates

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Reminder Reports

• Reminder reports will give you three sets of
  numbers
• Number of patients the reminder is applicable to
  (the cohort)
• Number of patients who still have the reminder
  due
• Number of patients the report looked at to find
  the cohort

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Primary Care Performance Report

• Primary Care Provider performance
• Set of 12 reminders related to performance pay
  for primary care physicians
• Completion rate must be gt90
• Monthly report on patients seen in clinic that
  month
• This is a RETROSPECTIVE SUMMARY report run on
  multiple reminders by LOCATION (the various
  primary care provider clinics)

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Physician Performance Report by Location
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Reminder Report Parameters

• Report parameters can make a huge difference in
  outcome
• Entire panel vs patients seen
• Pts with particular diagnosis vs all patients
• Inpatients vs outpatients

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Physician Performance Report by Panel
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Detailed Reminder Report

• Detailed Reminder Report
• Can be run on only one reminder at a time
• Will generate list of names of patients who have
  the reminder due
• Can also list the future clinic appointments for
  each patient

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Detailed Reminder Report

• Detailed Reminder Report
• Patients who have breast cancer screening due
• 1. CPRSPatient, One
• PC clinic 1 7/14/2008
• 2. CPRSPatient, Two
• PC clinic 4 8/1/2008
• CPRSPatient, Three
• PC clinic 10 9/12/2008

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Reporting Reminders

• Reporting Reminder
• Reminders written only for data mining
• Often are more useful for outcome measures
• Can put together data from several reminders
• Can use health factors, vital signs, diagnoses,
  other data from reminders
• Reminders do not appear in CPRS or on the
  coversheet
• CAC must put these reminders together

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Reporting Reminder Reports

• Health Numbers Contest
• Set of three reminders to track performance on
  three performance measures
• Lipid control in DM and CAD
• BP control
• Hba1c gt 9
• Reports can summarize performance for each team
• Reports can also identify patients needing
  attention on these issues

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Reporting reminders-Health Numbers
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Summary Reminder Reports

• Can be used to track reminder completion and to
  give feedback on performance
• Data from reminder reports is useful if reminder
  completion is high and report is run on the
  correct cohort
• Works very well in primary care to track provider
  performance
• Not as useful in some specialties where multiple
  providers involved in same clinic

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Proclarity Cubes

• Proclarity cubes are large data sets built from
  Austin database and available for mining
• Cubes have built-in reports and the data can be
  drilled down to the VISN, medical center and
  clinic level
• Data can be sorted and filtered and easily
  presented in graphical or table form

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Proclarity Cubes

• Advantages
• Extremely large amounts of data
• Does not require calculations or formatting
• Disadvantages
• Some proficiency at using the software needed
• Data is not real time-cubes are updated with the
  Austin data base
• Data is limited to what is in the cubes

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Proclarity Cubes

• Cubes to remember
• Pharmacy data cube
• Workload data cube
• Diabetes reports
• Advanced Clinic Access data cube

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Proclarity Data Cubes
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Workload Cube CP Processing
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Proclarity Cube CP
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Proclarity Cubes CP
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Diabetes Cube
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Ambulatory Care Report Program

• Has wealth of information-essentially everything
  that is available on an encounter
• Can be run in real time
• Can get some information that a reporting
  reminder could be used for, but does not require
  a CAC

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ACRP Reports

• Parameters
• Clinic
• Stop Code
• Provider
• Diagnosis
• Ambulatory Procedure
• V File Element
• Patient Demographics
• Patient Eligibility
• Primary Care
• Enrollment (historical)
• Enrollment (current)
• Outpatient Encounter

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ACRP Report

• V File Element
• Examination
• Health Factor
• Immunization
• Patient Education
• Treatments
• Skin Test

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ACRP Report

• Physician Productivity report
• Encounter data by provider
• Attach an wRVU to each code
• Sum the wRVUs and potential reimbursement for
  that provider
• Determine productivity index

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Physician Productivity
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Physician Productivity
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Physician Productivity
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Clinic Utilization Statistical Summary

• CUSS Report
• VISTA report
• Similar data in Proclarity cubes, but CUSS can be
  run in real time
• Clinic set up can affect how the report functions

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Clinic 1 CUSS
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Clinic 2 CUSS
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CUSS with patient detail

• Wed 02/27 0815 Status N
  CPRSPatient 1 slots (1)
• Wed 02/27 0830 Status
  CPRSPatient 2 slots 1
• Wed 02/27 0830 Status OB
  CPRSPatient 3 slots 1
• Wed 02/27 0915 Status
  CPRSPatient 4 slots 1
• Wed 02/27 0945 Status
  CPRSPatient 5 slots 1
• Wed 02/27 1015 Status
  CPRSPatient 6 slots 1
• Wed 02/27 1045 Status
  CPRSPatient 7 slots 1
• Wed 02/27 1115 Status N
  CPRSPatient 8 slots (1)
• CUSS report shows
• No-show rate25 (2 of 8 scheduled patients)
• Overbook 100 (1 of 1 Overbook slot used)
• Utilization 86 (6 of 7 slots used)

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Care Management

• Graphical interface with VISTA
• Built to look at groups of patients
• Two menus
• Dashboard (nurse and provider)
• Query
• Can directly link into CPRS

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Care Management

• Query Function
• Pre-loaded reports
• Custom reports
• Sort by clinic, ward, patient list, provider
• Sort by Any orderable item (lab, imaging test,
  medication, etc.)

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Care Management

• Useful for looking at clinical data for
  relatively small units (ward, clinic, individual
  provider)
• Report can be printed or downloaded, but only set
  outputs on reports
• Minimum training or experience needed to run the
  reports-the software guides you

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Care Management
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Care Management

• Resident Clinic report
• Internal Medicine continuity clinic
• Each resident in clinic ½ day every two weeks
• How to ensure important labs ordered by the
  residents dont fall through the cracks?
• How to get residents to take responsibility for
  their patients?

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Care Management

• Report is run on patients who are seen in
  resident clinic
• Report looks at patients seen in resident clinic
  who had lab or imaging ordered
• Only tests ordered by resident shown
• Avoids tests ordered by other clinics or while
  inpatient
• Report indicates whether result is normal or
  abnormal

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Care Management
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Care Management

• Rosiglitazone concerns about safety
• Report run on all patients in panel on
  rosiglitazone
• Real time data to respond to media
  reports/patient calls

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Scenario

• Scenario 1
• Your medical center is looking to improve
  performance
• ACS High/moderate risk patients have Cardiology
  involvement within 24 hours
• How could Cardiology track these patients?
• How could you track their progress?

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Scenario 1

• What data sources could the cardiologists use to
  track patients needing to be seen?
• Care Management
• Reporting reminder
• Both of these data sources can bring together
  patients and lab values and can be run in real
  time

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Troponin Report- Care Management
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Scenario 1

• How can you track the cardiologists performance?
• EPRP reports (the one that counts)
• Chart review
• Care management
• All of these bring together data about patients
  and notes-can tell if the cardiologist wrote a
  note ( if they used the note title defined).

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Cardiology Report- Care Management
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Scenario 2

• You would like to add another physician to your
  service
• You need to convince the Chief of Staff that
  there is a need for more manpower and that your
  current service is productive and efficient
• What data sources would you use to help make your
  case?

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• Data sets that would show your services
  productivity
• CUSS report
• Proclarity cube-workload, advanced access cubes
• VSSC reports-next available appt

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Scenario 2-Proclarity
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Scenario 2-CUSS Report
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Scenario 2

• As COS
• Look critically at the overbook percentage
• Look at the utilization rate

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Scenario 3

• Mental Health would like to follow up on
  Emergency Department patients who need follow-up.
• How can they get a list of patients who are
  treated for mental health problems?

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Scenario 3

• Options
• Have the ED keep a manual log of Mental Health
  patients
• Insist that the ED send consults on all MH
  patients
• Use the ACRP report to find possible cases

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Scenario 3

• ACRP report
• Can be run in real time
• Can obtain data by clinic or clinic stop
• List of diagnoses for each patient seen
• List can be associated with patient demographics

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ACRP Report-Mental Health Patients

• CPRSPatient 1 JC-EMERGENCY DEPT
• - PATIENT AGE 45
• 
  
• 296.7 BIPOLOR I CURRENT NOS
• 
  
• 296.40 BIPOL I CURRNT MANIC NOS
• 
  
• E958.9 SUICIDE/SELF-INJURY NOS
• CPRSPatient 2 JC-EMERGENCY DEPT
• - PATIENT AGE 40
• 
  
• 295.90 SCHIZOPHRENIA NOS-UNSPEC
• CPRSPatient 3 JC-EMERGENCY DEPT
• - PATIENT AGE 53
• 
  
• 493.90 ASTHMA NOS

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Scenario 4

• Your OIF/OEF Coordinator wants to keep track of
  appointments for female OIF/OEF veterans so he
  check on them during their visits to the Medical
  Center.
• How could the coordinator keep track of these
  appointments?

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Scenario 4

• Options
• Have the OIF/OEF Coordinator keep an Excel
  Speadsheet with the names of these veterans and
  manually enter their appointments
• Reporting reminder that reports on female
  veterans from the current conflicts and their
  future appointments
• Data from reminder report can be downloaded into
  a spreadsheet and sorted by name, date, etc.

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Reporting Reminder-Scenario 4

• STL IRAQ/AFGHAN FEMALE VETERANS 
• CPRSPatient 1
• 100 pm JC-PC WOMEN'S
• CPRSPatient 2
• 230 pm JC-PC WOMEN'S
• CPRSPatient 3
• 900 am JC-PC WOMEN'S
• CPRSPatient 4
• 100 pm JC-PC WOMENS

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