pitfalls and realities of working with big data
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Plenary II
Pitfalls and Realities of Working with Big Data
Karim Keshavjee MD, MBA, CCFP, CPHIMS
NAPCRG PBRN Jun 30, 2014Bethesda, Maryland
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Disclosure
I am a provider of commercial services that may be alluded to in this CME activity
I do not intend to discuss an unapproved or investigative use of a commercial product or device in my presentation
I will not be discussing any use of products used on patients
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German Proverb
“You have to take life as it happens, but you should try to make it happen the way you
want to take it”
Outline
The Problem Experience with Solutions/Lessons
Learned Stakeholder Engagement Solution Design Brief Data Collection Architecture Key Barriers and resolution Advantages Conclusion
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The Problem
>Physician use of EMR|EHR in North America has increased substantially in the last 4 years
Current EMRs are not able to Capture standardized data across
EMRs Transmit data to a central
repository Present guideline
recommendations at point of care
1National Physician Survey 2013
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Big Data Assumptions
Requires structured data
Ability to conduct many small experiments rapidly (Amazon phenomenon)
Greatest benefit lies in speeding up feedback cycle between research findings and bedside application
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Methods
Review of previous projects, experiences, lessons learned
Stakeholder Analysis Identified 8 distinct groups
Stakeholder interviews N = 90, 8-12 per stakeholder group
Iterative process of asking about problems and designing solutions
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N=90
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Experience to Date
• Data collection projects are costly
• EMR vendors not able to focus on data projects
• Not scalable to multiple diseases
• Difficult updating to new evidence
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Highly SuccessfulHigh Blood Pressure
Management Initiative
Now used in 40 Clinics across Ontario
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RA Form
Used by 60
RheumatologistsIn Ontario
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Design Challenge
Design clinical forms
Usability tested (once)(with researchers, policy makers, patients and
providers)
Evidence-based
incorporated into EMRs|EHRs instantly or almost instantly?
Independent of the vendor
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A Browser Window in Every EMR|EHR
• Vendors include browser window in EMR
• Provider selects template the usual way
• EMR gets the form from a website
• Form data provided to EMR using XML
Structured Data Collection Architecture
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Standard Data
Forms Authoring System
EMR 1 EMR 2 EMR 3
Forms Server
Research Database
Ability to Intervene at Point of Care
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Standard
Data
Forms Authoring System
EMR 1 EMR 2 EMR 3
Forms and Knowledge Server
Research Database
Clinical Knowledge Server
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Issues Identified and Solved
Privacy –Privacy Architecture
Governance –Governance infrastructure
Balancing needs of various stakeholders Usability for clinicians vs. structured/coded for
research
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Advantages of Solution
Faster updates to forms and evidence
Faster time to data collection and research
Less onus on vendor
A/B testing of forms
Ability to deliver decision support into form
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Longer Term Goals
Make research easier, faster and cheaper
BUILD IN
REB approvals and Privacy Patient involvement Usability testing A/B testing and forms feedback eHealth and mHealth Testing
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Conclusion – The Zen of Design Big data pitfalls can only be solved by new
designs, not by accepting the limitations of current EHRs
New designs need to balance the needs of multiple stakeholders to be successful
New designs need easy data capture at the point of care, guideline recommendations in real-time, analyze provider and patients behaviors quickly, reject hypotheses daily
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Acknowledgements
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