The NYU Langone Health

Transcription

1 Using the HealthMeasures API: The NYU Langone Health Experience Heather T. Gold, PhD, and Raj Karia, MPH Alissa Link, Long Zhao, Meredith Blake, Rachel Lebwohl, Devin Mann, Ben Weinstein, Joseph Zuckerman, Thomas Errico, James Slover, Aaron Buckland, Michael Cantor NYU School of Medicine

2 PROMs already being used, wanted to enhance Legacy instruments in orthopedics via Qualtrics HOOS, KOOS, ODI, etc Goal to include PROMIS Computer Adaptive Testing (CAT) to reduce participant burden, improve accuracy, validity Bridge formal human-computer interaction (HCI) techniques into academic medical center IT operations Provide real-time PROMs integration into EHR Build in components for data pulls for research 2 NYU School of Medicine

3 Interdisciplinary project team NYU Langone Health MCIT Digital Solutions Team Implementation team technical and user experience design MCIT Digital Solutions Team Orthopedic Surgery PROMs implementation team Champions: Department of Orthopedic Surgery Wanted Computer Adaptive question bank to save patient time Wanted real-time access to scores in EHR Population Health Clinical Research Informatics Facilitate project across clinical departments, research, IT Clinical Research Informatics Department of Population Health Research focus 3 NYU School of Medicine

4 Champions: Department of Orthopedic Surgery Started with 1 spine surgeon convincing Division Chief and Dep t Chair of importance for monitoring QOL Medicare reimbursement requirement by 2019 NIH-funded clinical studies Dep t supported with funds through Year 1, in addition to IT funds Rollout to musculoskeletal care: Total Joint, Sports, Rheumatology, Pain Management & Rehabilitation (all in same building) 4 NYU School of Medicine

5 Designed for optimal user experience (UX) Interviews with Epic super users at NYU Langone Health Workshop with orthopedic surgery faculty to ascertain preferences for data visualization Used rapid-cycle design, full team meetings bi-weekly Incorporated user feedback throughout all stages of development (usability testing) and on prototypes Patients Staff (Front Desk staff, Medical Assistants) Providers Researchers NYU School of Medicine

6 REDCap for administering Staff rely on system PROMs & de-identified data logic to assign PROMs storage to patients and use Patients PROMIS complete assessments Epic-integrated can QR code assessment be assigned via to by: provision registration MyChart Provider, prior to tablet Visit Type, appointment Location or Already had paperless tablet in Age waiting registration and tablets for room Parent/caregiver legacy Proxy PROMs (-12) Pediatric (13-17) Language Patient views Researchers query scores in data: PROMs plus MyChart clinical data from in real Epic Caboodle time Providers view scores, PROM Q&As, interpretation in Hyperspace in real time 6

7 Daily reports assess compliance Staff training of utmost importance to get check-in process and assessments completed Staff can document reason for non-completion by patient, included in daily report Daily report of total patients, assessments completed, partially completed, completion time, and by mechanism (i.e., tablet, home) 7 NYU School of Medicine

8 8 Daily report in tableau dashboard

9 Physician data access Data visualization is large focus Fewest clicks as possible to view Context for PROMs scores given National norm, age norm, gender norm Patient over time 9 NYU School of Medicine

10 PRO Data Dashboard in Epic 10 NYU School of Medicine

11 PRO Data Display 11 NYU School of Medicine

12 PRO Data Display: Hover detail 12 NYU School of Medicine

13 MyChart integration for patients: echeckin 13 NYU School of Medicine

14 MyChart echeckin link to all questionnaires

15 MyChart echeckin Health Assessment link

16 MyChart echeckin Health Assessment welcome page Betsy Ross 16 NYU School of Medicine

17 Easy configuration and/or modification of assessments for other departments/divisions Easy operationalization of platform via web app Allows divisions/ departments to manage own PROMs on platform via web app Non-developer can use web app to configure new assessments, set rules for assigning them by provider, visit type, age and/or language. Includes step-by-step instructions for importing PROMIS assessments, building or importing legacy assessments in REDCap, and configuring Epic flowsheets 17 NYU School of Medicine

18 Advantages of PRO Assessment Platform over existing tools (e.g., MyChart questionnaires, legacy Qualtrics portal) Real-time Epic integration with improved features for staff and providers Improved UX Improved reporting Data for research (incl randomized order of assessments) Customizability NYU School of Medicine

19 Troubleshooting Epic technical limitation: INP (patient encounter) record Patient needed to be checked in for data to save correctly, but assessment was pre-check-in or at check-in Data integrity issues in Epic Ensuring data can file correctly into Epic Big effort to sync custom DevOps with Epic DevOps Want everything automated, but required real-time error monitoring of end-to-end system Updates to PROMIS API Instrument name must match exactly to API (changing version #s) Updated versions sometimes have different question language NYU School of Medicine

20 Future Plans Rollout to other divisions and clinical departments Include surgical history context in provider dashboard Assign assessments in MyChart as planned series e.g., 3 month follow-up, 6 month, etc. Enhance branching logic to assign assessment based on answer to a previous question Provide multi-language support Governance rules across enterprise NYU School of Medicine

21 NYU Langone Health Project Team NYU Langone Health MCIT: Alissa Link, Rachel Lebwohl, Long Zhao, Meredith Blake, Ben Weinstein, Huming Tang, Bebeto Jefry, Sony Sebastian, Anokh Vijayakumaran, Tom Thliveris Dept of Population Health +/- Clinical Informatics: Heather T. Gold, Devin Mann, Michael Cantor Dept of Orthopedic Surgery: Raj Karia, Joseph Zuckerman, Thomas Errico, James Slover, Aaron Buckland

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23 Detail slides

24 Health assessment images 24

25 Health Assessment Instruments I Spine EQ-D ODI - back pain NDI - neck pain SRS22 - scoliosis PROMIS Physical Function (CAT) Total Joint EQ-D HOOS Jr -hip KOOS Jr -knee ASES -Shoulder Mayo Elbow -elbow Quick Dash -hand/wrist PROMIS PF Upper Extremity (CAT) PROMIS PF Mobility (CAT) 2 All PROMIS Pain Intensity (SF) PROMIS Pain Interference (CAT) Sports EQ-D HOOS Jr -hip KOOS Jr -knee IKDC -knee Marx Acitivy Scale - knee ASES -Shoulder Mayo Elbow -elbow Quick Dash -hand/wrist PROMIS PF Upper Extremity (CAT) PROMIS PF Mobility (CAT)

26 Health Assessment Instruments II Rheumatology EQ-D MDHAQ HOOS - hip KOOS - knee ASES -Shoulder/elbow Mayo Elbow -elbow Quick Dash -hand/wrist BASDAI - (Ankylosing Spondylitis, Psoriatic Arthritis) LupusQoL PSAID12 -(Psoriatic Arthritis) PROMIS Physical Function (CAT) 26

27 Spine Assessment Flow EQ-D + VAS 4 Pain Questions + Chief Complaint 13% 13% LEGEND All patients complete 1 0 Back Pain 1 0 Neck Pain Scoliosis or Kyphosis 2 4 ODI NDI SRS 22r Pitching Forward (hunched over) I don t know 39% Other 3 PROMIS Physical Function (CAT) PROMIS Pain Intensity (SF) 13% 8% PROMIS Pain Interference (CAT) 13% End Lowest total number of questions = 33 Average number of questions = 38 Highest total number of questions = 47

28 Total Joint Assessment Flow EQ-D + VAS Chief Complaint 13.1% LEGEND All patients complete 1 These counts assume one side only Hip Knee Shoulder HOOS Jr KOOS Jr ASES 1 2 Elbow Mayo Elbow 2 Hand/ Wrist Quick DASH Foot/ Ankle Other 39.% 3 PROMIS Physical Function Upper Extremity (CAT) PROMIS Physical Function Mobility (CAT) PROMIS Pain Intensity (SF) PROMIS Pain Interference (CAT) End 13.1% Total = % 7.9% 13.1%

29 Sports Assessment Flow EQ-D + VAS Chief Complaint 11.6% LEGEND All patients complete 2 0 These counts assume one side only Hip HOOS Jr Knee KOOS Jr IKDC Marx Activity Shoulder 1 9 ASES 1 2 Elbow Mayo Elbow 2 Hand/ Wrist Quick DASH Foot/ Ankle Other 46.6% 3 PROMIS Physical Function Upper Extremity (CAT) PROMIS Physical Function Mobility (CAT) PROMIS Pain Intensity (SF) PROMIS Pain Interference (CAT) End 11.6% Total = % 7% 11.6%

30 CMC Rheumatology Patient Reported Outcomes (PRO) Workflow Hx Diagnosis (2q) Completed on first time by all with the exception of patients that choose other and I don t know for reason for visit 2 MDHAQ (9q) EQ-D (6q) Reason for Visit This appears last LEGEND All patients complete Depends on Visit Reason Completed Annually 3 0 I don t know Hx Diagnosis (2q) Rheumatoi d Arthritis 3 Hx Diagnosis (2q) OA 3 Other Ankylosing Spondylitis 9 Hx Diagnosis (2q) BASD AI Scleroderm a 3 Hx Diagnosis (2q) Gout 3 Psoriatic Arthritis 30 Hx Diagnosis (2q) Vasculit is 3 Hx Diagno sis (2q) Lupus 37 Hx Diagnosis (2q) 4 Knee KO OS (16q) 4 7 Hand/ Hip Shoulder Elbow Foot/Ankle Other Spine Wrist HO OS (16q) 2 QuickDAS H (11q) 1 9 ASE S (6q) 1 9 ASE S (6q) MayoElbow (10q) 1 2 Work/ Employment (7q) PSAID12 (12q) BASDAI (6q) Completed on first time and then only if pt has neck/back pain (SEE NEXT SLIDE) LupusQoL (4q)