Like all the hospitals affiliated with Harvard Medical School, Beth Israel Deaconess Medical Center aims to be the best of the best. A closer look suggests the hospital is achieving that lofty goal partly by taking shrewdly calculated technology risks.
A centerpiece of BIDMC's IT-based innovation is a new medical informatics platform called Clinical Query. To appreciate its value, you need to understand the current healthcare environment.
With the push to reform medical care in the U.S., providers are expected to improve quality while reducing costs. And clinicians are under pressure to focus not only on the care of the individual patients sitting in front of them, but also the larger population with the same disease or condition--so-called population health management. That mandate will require much more sophisticated data analytics tools.
Enter Clinical Query. John Halamka, BIDMC's ball-of-fire CIO, refers to it as a clinical trials/clinical research business intelligence system. It's a search engine married to a huge database of patient records that lets hospital employees test hypotheses about what causes a disease, for instance, or test which drug, diet, or lifestyle variables may reduce the risk of developing one.
The repository contains 200 million data points on 2.2 million patients, including medications taken, diagnoses, and lab values. The query tool is capable of navigating 20,000 medical concepts through the use of Boolean expressions. All the data has been mapped to standard medical language codes. Diagnoses, for instance, have been mapped to ICD-9; medications to RxNorm codes; lab data to Logical Observation Identifiers Names and Codes (LOINC).
So with the help of Clinical Query, a clinician or researcher might search the records to find out how many patients with breast cancer also take ACE inhibitors, a class of drug used to treat high blood pressure. If the results reveal a strong correlation between the drug and the malignancy, the hospital could do a deeper analysis and set up a formal research project to investigate the link. The ultimate goal is to discover a new medical intervention that would improve the survival of the entire population of breast cancer patients.
Not only would Clinical Query do the legwork to detect a link between breast cancer and ACE inhibitors, but it would also take a research hypothesis to the next stage, what Halamka calls the "drink" stage after the initial "sip" of data.
"Suppose I actually want to take the data on the 66,000 patients I just identified in my search and enroll them in a clinical trial," Halamka explains. "Once the institutional review board gives approval for that, we can take this query and automatically write letters to the primary care physicians to enroll these patients in the trial." It's a huge time saver.
Access to Clinical Query, as well as to the other clinical apps in the BIDMC system, is simplicity itself. A single sign-on protocol gives physicians access to 146 clinical apps--including an order entry app, a performance manager governing safety and quality, an emergency department dashboard, PeopleSoft ERP, and thousands of professional journals--as well as the 2 million-plus patient records. Other employees and students get a set of sign-on rights depending on their role in the organization.
The internally developed software under the Clinical Query hood is based on an open source system known as Informatics for Integrating Biology & the Bedside. And because the platform pulls data from multiple clinical and administrative applications, the hospital's IT team had to normalize the data with the use of the aforementioned vocabularies, LOINC, ICD-9, and RxNorm.
"What's unique about Clinical Query is that it's completely self-service," Halamka says. "I didn't have to go out and hire an analyst. I didn't have to get special permission to get access or approval from our [institutional review board] to use it."
Clinical Query is only one part of BIDMC's BI anatomy. Expert analysts at the hospital also do more sophisticated mining, looking at raw patient data and, in some cases, evaluating the quality of data that feeds Clinical Query and other apps. The hospital's IT team has reached out beyond its 2 million patients to look at community-wide data sources to find ways to manage the health of larger patient populations.
BIDMC runs one of 32 Pioneer Accountable Care Organizations recently started nationwide, taking commercial electronic health records software in doctors' offices, such as eClinicalWorks, GE Centricity, and more specialized programs, and writing specifications "to download data elements to a common community repository to do population analytics," Halamka says. Once again, the goal is better, cheaper patient care--what policymakers now call accountable care.
Halamka is also a driving force behind creating a state-funded, privately managed, cloud-based health information exchange in Massachusetts. The HIE is contracting with 16 EHR vendors to service doctors across the state via a massive interconnected network, due to go live in October.