Arizona Society of Pathologists
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1 Arizona Society of Pathologists Using in laboratory medicine to improve operations and outcomes April 2, 2016 Ron B. Schifman, MD Southern Arizona VA Healthcare System Department of Veterans Affairs 1
2 Big Data A buzz word that describes massive amounts of structured and unstructured data, or data that expands or changes rapidly. Technology (tools and processes) that organization uses to handle and analyze large amounts of data. Department of Veterans Affairs 2
3 Big Data advertisers - monitoring social media to learn about customer behavior, preferences, or responses to campaigns financial services - predict risk hospitals predict readmission Department of Veterans Affairs 3
4 Big Data Healthcare Analytics Startups Department of Veterans Affairs 4
5 Department of Veterans Affairs 5
6 Big Data Healthcare Analytics Department of Veterans Affairs 6
7 Big Data Healthcare Analytics Department of Veterans Affairs 7
8 Big Data Healthcare Analytics Department of Veterans Affairs 8
9 Big Data Performance and Value Metrics Department of Veterans Affairs 9
10 Big Data Population Health Department of Veterans Affairs 10
11 Big Data Laboratory Medicine Department of Veterans Affairs 11
12 Big Data Laboratory Medicine Pat Hanrahan CANON Professor of Computer Science and Electrical Engineering at Stanford University. Department of Veterans Affairs 12
13 Tableau Healthcare Analytics Department of Veterans Affairs 13
14 Extract, Transform, Load VHA Corporate Data Warehouse VistA HDR NPCD DSS ADR VA DoD CMS Source Systems VHA c VHA a Other Metadata Repository Research Data Marts Conformed Dimensions Data Warehouse Region Warehouses Diabetes OEF/OIF Prog Office Data Marts Outpatient Encounters Pharmacy Benefits Management Value Added Data Common Query, Reporting, Analysis, and Data Mining Tools Acquire Populate Create Access Data Warehouse Marts Information VHA c VHA clinical systems VHA a VHA administrative and financial systems Closed Loop Information System Program Offices Pharmacy Benefits Prosthetics Dental HDR Health Data Repository NPCD National Patient Care Database DSS Decision Support System ADR Administrative Data Repository DoD Dept. of Defense CMS - Centers for Medicare & Medicaid Services Department of Veterans Affairs 14
15 Big Data Test performance Hemolysis (preanalytical) Germline and phenotype testing (analytical) Evidence-based laboratory practices Myoglobinuria Protein C Poplulation health High and low risk (birth cohort) HCV screening Utilization Germline mutation and phenotype testing Department of Veterans Affairs 15
16 Benchmarking Test performance (preanalytical) Hemolysis Department of Veterans Affairs 16
17 Benchmarking Test performance (preanalytical) Hemolysis 16 facilities (November 2014) 220,596 serum potassium results of which 22,442 (10.2%) from ED. Median hemolysis rate: 3.5% ED 0.7% Other Department of Veterans Affairs 17
18 Effect of vitamin K deficiency (INR) on protein C activity and antigen values Protein C and INR 102 VA laboratories and 25,461 cases Protein C testing with elevated INR results The incidence of abnormal protein C results with normal (<1.1) INR levels was 2.9% and accounted for 48.9% of all protein C tests. Protein C was frequently tested when INR results were elevated; 17.2% and 10.9% of cases with INRs of >1.5 and >2.0 were tested for protein C respectively. Department of Veterans Affairs 18
19 Protein C Method Selection Protein C Functional vs Antigenic Testing 73.6% of protein C results are performed by functional methods. However, the relative percent varied by facility; 18 laboratories reported only antigenic protein C results while 30 reported only functional protein C results Distribution among 102 VA laboratories of all protein C tests as % measured by functional assay Department of Veterans Affairs 19
20 Evidence Based Best Practices Myoglobinuria Performance of urine dipstick blood test for detecting myoglobinuria 81 facilities 7,579 cases Department of Veterans Affairs 20
21 Evidence Based Best Practices Department of Veterans Affairs 21
22 Population Health Department of Veterans Affairs 22
23 Patient Results Letters Department of Veterans Affairs 23
24 Automated Patient Letters Test result notification TIU notes are entered automatically via a rules based system, and printing and mailing is automated. Department of Veterans Affairs 24
25 Viral Hepatitis C VHA HIV, Hepatitis & Public Health Pathogens Program Department of Veterans Affairs 25
26 Patient Result Letters Initiative Hepatitis C birth-cohort screening Department of Veterans Affairs 26
27 Hepatitis C Birth Cohort Screening Department of Veterans Affairs 27
28 Viral Hepatitis C High Risk Screening Use of automated algorithm and HCV registry to screen for occult HCV infection among high risk population at risk for HCV infection (ICD-9 code).no history of anti-hcv testing.not in HCV registry.blood specimen in lab Department of Veterans Affairs 28
29 Viral Hepatitis C High risk vs low risk screening Department of Veterans Affairs 29
30 Duplicate Germline Genetic & Phenotype Testing Reliability of Test Results Test Utilization Department of Veterans Affairs 30
31 HLA-B *5701 Phenotype (Abacavir Hypersensitivity) HLA B5701 HLA-B*5701 W/RFL HLA-B HIGH (HLA B*5701.HLA-B*5701 GENOTY ABACAVIR SENS ABACAVIR HYPERSENSITIVITY ABACAVIR HYPERSENSITIVITY (006926) B*5701-HLA B5701 HLA B 5701 HLA B*5701 HLA B*5701 LC HLA B*5701 TYPING HLA B5701 HLA B5701 (D/C 8/1/13) HLA B5701 (LABCORP) HLA B5701 (LC006926)QQQ HLA B5701 (OUTPUT) HLA B5701 (V2) HLA B5701 ANTIGEN HLA B5701(PRE 8/1/2013) HLA B5701* HLA B5701/SEND OUT HLA-B 5701 HLA-B 5701 ( ) HLA-B 5701 TYPING HLA-B 5701 TYPING RT HLA-B 5701 TYPING(STL) HLA-B*5701 HLA-B*5701 HLA-B* HLA-B*5701 (Dcd ) HLA-B*5701 (dc'd 5/6/14) HLA-B*5701 (PCR) HLA-B*5701 Buccal Swab HLA-B*5701 REPORT,blood HLA-B*5701 Test HLA-B*5701 TYPING HLA-B*5701 TYPING (Q) HLA-B*5701 TYPING (QU) HLA-B*5701 TYPING HLA-B*5701 TYPING SPL HLA-B*5701 TYPING(Q) HLA-B*5701 TYPING,blood HLA-B*5701(DC'D 10/24/14) HLA-B*5701. HLA-B5701 HLA-B5701 (19774) HLA-B5701 (REF LAB) HLA-B5701 TEST HLA-B5701 TEST (LC) HLA-B5701 TYPING HLA-B5701(Mayo91833) HLA-B5701(o) HLA-B5701, ABACAVIR HYPERSENSITIVITY ID***HLA-B5701 zzhla B*5701 TYPING ZZ-HLA-B*5701 ZZHLA-B5701 TYPING ZZZHLA-B*5701 Department of Veterans Affairs 31
32 Factor V Leiden testing 120 facilities Department of Veterans Affairs 32
33 Repeat factor V Leiden testing 120 facilities Department of Veterans Affairs 33
34 Repeat factor V Leiden testing 120 facilities 20% retested at different facility Department of Veterans Affairs 34
35 Effect of genotype/phenotype on repeat testing Department of Veterans Affairs 35
36 Genetic Test Patient Registry Reliability of Test Results Department of Veterans Affairs 36
37 Duplicate Germline Genetic Test Utilization Program Process for detection and notification of laboratories about new orders for duplicate germline and phenotype orders Factor V Leiden Prothrombin gene mutation Hemochromatosis IL28B genotype HLA B*5701 HLA B27 Department of Veterans Affairs 37
38 Improving utilization of genetic tests National automated notification system Department of Veterans Affairs 38
39 Duplicate Genetic Testing Program February 2015 January 2016 Intervention Control 22 facilities 101 facilities Previous testing performed at a different facility in 87 (37.5%) cases 232 duplicates 949 duplicates Previous testing performed at a different facility in 280 (29.5%) of cases 142 (61.2%) cancellations 32 (3.4%) cancellations Department of Veterans Affairs 39
40 Duplicate Germline Genetic Test Utilization Program Department of Veterans Affairs 40
41 Duplicate Germline Genetic Test Utilization Program Department of Veterans Affairs 41
42 Department of Veterans Affairs 42
43 Big Data Team Department of Veterans Affairs 43
44 Department of Veterans Affairs
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