Every day, UPHS generates an enormous amount of statistics, clinical findings, lab results, demographic information, and medication histories. All are crucial for high quality patient care. And Penn researchers have come to rely on these mountains of information to conduct their pioneering investigations. But amidst this abundance of riches, tracking down and sorting out the right information can present real challenges.
Help has arrived, however, in the form of the Penn Data Store.
The PDS is a virtual warehouse containing years of highly detailed patient data from six major information systems throughout UPHS, including the outpatient electronic medical record and a number of inpatient databases. It currently contains over a billion rows of information, with about 400,000 more added every day.
“Our goal was to create a single storehouse with all patient data in one spot,” said Brian Wells, chief technology officer for Information Services at UPHS. “The PDS has become a one-stop shopping experience for researchers and physicians. Having critical information organized, accessible, and ready to use makes everyone’s life easier.”
“The PDS has become a one-stop shopping experience for researchers and physicians.” - Brian Wells
The PDS, which began operations this past November, is fully automated. Every night between midnight and 4 a.m. it receives and classifies preprogrammed data extracted from each of its six feeder information systems. Researchers can retrieve data quickly, either by directly accessing it themselves or submitting custom requests to PDS staff members.
Mark Weiner, MD, of Medicine, credits the Data Store with helping him and his colleagues carry out important research. “We were interested in comparing four major strategies for managing patients who came to the Emergency Department with chest pain. Through the PDS we indentified nearly 600 patients who met our research criteria. Going through each of their charts and looking for demographic information, lengths-of-stay, medication histories, lab results, EKG reports, readmissions, and many other variables would have been an enormously time-consuming exercise. But with the PDS, we were able to efficiently extract the information we needed as well as study a large sample size to give us a more comprehensive picture of the treatment approaches we were interested in.”
Dashboards: A Population-Based Treatment
In addition to streamlining research options, the PDS is also used for managing patient care. It does so by providing clinical dashboards, which, like their automobile namesakes, are visual displays for providing information. Clinical dashboards provide data for clinicians to make informed decisions about patient care. To simplify its interpretation, the information is supplied graphically. PDS dashboards are designed in-house at Penn with the input of physicians, nurses, and information services employees. “Dashboards are a huge step up from spreadsheets and graphs that simply contain data in fixed rows and columns,” said Maggie Massary, who oversees the PDS. “We can configure the dashboards in a variety of ways: graphs, tables, bar charts, and more. Color coding can help set off key measures. Dashboards really make the information come alive.”
Dashboards are now available for cardiovascular surgery, heart attacks, reconciling outpatient medications, breast cancer, anticoagulation efforts, and inpatient alerts. New ones are being developed for allergy management, infection control, and diabetes management. The potential for additional dashboards is essentially limitless.
Peter Gabriel, MD, medical director for Clinical Information Systems at UPHS, helped design a number of the dashboards. Gabriel, who has an undergraduate degree in computer science and is currently pursuing a master’s degree in technology management, said, “Dashboards open up a population-based way of treating patients. Customarily, and quite appropriately, physicians think about our patients as individuals when we are seeing them for an office visit. But dashboards allow us to think about their care at different times and in the context of larger groups. For example, by reviewing the Penn dashboard on diabetes management, Mrs. Smith's doctor may notice that she is lagging behind similar patients in achieving control of her blood sugars, or that she is among a group of patients who have not had their recommended eye exam yet this year. This may prompt the physician to follow up with her to address these issues outside of a regularly scheduled visit. In this way, dashboards enlarge the framework for treating patients and help to improve the quality of their care.”
HUP’s Anticoagulation Management Center is just one of the Health System units that rely on PDS dashboards. Patients who receive anticoagulation medication must be carefully monitored to ensure that the right dosage is being used. Too little medication leaves a patient vulnerable to potentially fatal blood clots. Too much medication increases the risk of internal bleeding. Calibrating and maintaining the right medication dosage requires frequent blood tests for patients. The anticoagulation dashboard maintains data on clinical visits and critical blood values on more than 1,000 patients. It alerts physicians and nurses when patients miss appointments for blood tests and ensures that they are contacted to re-schedule their visit. And by providing immediate access to blood test results for patients -- either individually or as a group or group subset -- the dashboard helps physicians deliver accurate, potentially lifesaving care.
With new dashboards on the horizon, as well as the prospect of adding more feeder information systems, the Penn Data Store will become an increasingly valuable part of the treatment and research missions at UPHS.
-- by Mark Gaige
