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HEALTHCARE INFORMATION TECHNOLOGY & INFORMATICS FOCUS AREA

Neurosurgical Atlanta patient overlap project (NS-APOP)
Over a course of a lifetime, it is possible that a single patient may receive treatment at different hospitals within the same geographical area. Without appropriate sharing of information between these hospitals, there is a potential for errors to be made in diagnosis and treatment of the patient. As a result, when a patient is treated it is important that current medical records include relevant information (symptoms, diagnosis, treatments, etc.) compiled by other hospitals during previous visits. This will ensure that the patient receives the highest quality of care. In order to determine the potential value of facilitating a health information exchange between hospitals in the Atlanta metropolitan service area, we will perform an analysis of all neurosurgical admissions, outpatient visits, and emergency department consults in participating hospitals to determine the approximate number of neurosurgical patients being treated at multiple hospitals. The objective of this study is to identify the percentage of neurosurgical patients treated at more than one hospital in the Atlanta metropolitan area. Initially, we will focus our study on the following hospitals: Emory University Hospital, Emory University Hospital Midtown, and Grady Memorial Hospital. By identifying the percentage of neurosurgical patients shared among hospitals, we will be able to approximate the number of patients that would benefit from the sharing of patient-data between the institutions in the future. Hospitals that we hope to include in our analysis following the initial study include Piedmont Hospital, Saint Joseph’s Hospital, Northside Hospital, Dekalb Medical Hospital, Well Star Kennestone, Emory Johns Creek Hospital, Emory Eastside Hospital, among others.

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Transfer patient network and provider portal
One of the encouraging potential new technologies designed to decrease the cost, improve the safety, and increase the quality of inpatient care is health information exchange (HIE). HIE may play an important role in recognizing epidemics, early isolation of individuals infected with drug-resistant strains of bacteria, reducing costs due to a decreased need to repeat tests, and decreasing medication errors due to a better knowledge of patients' prior medication histories. This project involves developing a prototype portal that would provide an HIE between Emory University Hospital and outside hospital facilities desiring to transfer patients to Emory for further management of complex medical problems requiring specialists at Emory. The ultimate goal is to selectively establish HIE between the top outside hospital facilities sending transfer patients to Emory and Emory. The working hypothesis is that costs to the nation’s health care system could be decreased if HIEs were established for transfer patients (selectively and thoughtfully between centers where there are high volumes of transfer patients) broadly across the nation. An HIE could potentially reduce the frequency with which tests done at the sending facility are duplicated at the receiving facility and thereby lower costs. The amount by which costs could potentially be lowered would serve to estimate the potential value that could be created by establishing an HIE.

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Emory neurosurgery multi-hospital web-based administrative database
The Department of Neurosurgery at Emory University School of Medicine currently serves 6 hospitals across the Atlanta metropolitan area. At most of these facilities, neurosurgery uses a locally installed version of a Microsoft Access database for clinical administrative functions including generating patient lists for patient care and preparing monthly reports on case volume, among others. Unfortunately these locally installed Access databases are not networked or accessible remotely, which would be very helpful for the on-call neurosurgeon permitting them to better and more efficiently care for patients. In addition, because the databases are not networked, it is presently not possible to readily get an all inclusive snapshot of Neurosurgery operations across all hospitals without manually merging the each hospital’s database into one. This proposed project would involve creating a multi-hospital web-based database driven solution that would replace the current Access Database. This would not only streamline the current clinical administrative processes but it would also provide needed ‘on-the-fly’ data about Neurosurgery operations across all hospitals providing insight that presently is not readily available.

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Dynamic customizable web-based forms generator for clinical use at the point of care and for clinical trial / research data collection
This project involves creating a web-based database driven application that will assist medical professionals with following their patients and collecting meaningful clinically relevant information in an electronic and robustly organized format that is searchable / queryable. The application’s goal is to revolutionize patient care and accelerate research and discovery. Clinicians and clinical researchers have a need to collect and store specific disease related data on their patients or study enrollees in a format which can be accessed and searched at a later date to follow outcomes, do complex statistical analysis, or identify patients that may be candidates for particular research protocols, therapies or interventions. Current electronic medical records systems are ‘one-way’ systems that provide a means to report diagnostic test results and store / view dictated and typed clinical notes from patient visits and procedures. They solve the problem of inaccessible paper patient records by creating a means for accessing medical records from any location with a computer that can access the medical records system; but they fail to offer any functionality beyond this. Electronic medical records systems do not provide a means for physicians to search and identify patients they have cared for with particular diagnoses, patients that had a particular pathology finding, surgery or procedure, or patients taking a particular medication. They also fail to offer physicians a means to store information that they have determined is clinically relevant in a format that is readily searchable. The only way for a clinician to enter data into electronic medical records solution is through a clinical note (either a dictated report, a type written note, or a scanned hand written note). This does allow for rich clinical data to be stored but it is stored in loosely organized and inconsistent language that is not robust so the information cannot be queried efficiently at a later time. Data storage in such formats (other than scanned) does permit free text key words searches; however, this is a query technique which is laborious and very inefficient. Though this would be a starting point, most electronic medical records systems do not even provide this functionality. There are infinite numbers of examples across just about any medical institution or practice where clinicians have created their own patient databases to address this un-met need. However there is no universal tool to help them do this and doing this requires specific ‘know-how’ with a database program of some sort, a skill possessed by only a minority of medical providers. One-off solutions developed by providers are by and large not networked, potentially insecure (but have sensitive protected health information) and are created by manual data entry (as opposed to data feeds) and chart abstraction (by manually entering data after reviewing a patient’s medical record). Data collection in this manner is, to say the least, inefficient, error prone, and creates lots of duplicate work. This application will assist clinicians with following their patients and collecting clinician determined clinically relevant information in an electronic format that is searchable / queryable.

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Emory neurosurgery outside hospital imaging database
Patients with imaging studies done at facilities other than Emory are often seen in consultation as outpatients or as admissions to Emory’s inpatient hospital facilities. However at many facilities, including Emory, there is no central repository where outside hospital imaging studies can be uploaded and stored for review at a later date. Only imaging studies done at Emory are accessible via the web based imaging viewing portals employed by the institution. However, access to not only reports of the imaging studies previously done, but also the actual images themselves is key to providing quality care and preventing the need to repeat studies unnecessarily. Typically in this day and age, patients are able to obtain their images in CD Rom format. However, all too often, even if the patient remembers to bring in their imaging studies and provides them to their healthcare providers, keeping track of the CD Rom discs is a challenging logistical problem in and of itself. Many times, multiple providers caring for the patient need to review the films and ‘borrow’ the CD Rom. Inevitably the studies are left in someone’s office or on in some computer where it was last viewed in the hospital when the next provider that needs access to them goes to look for the imaging studies. Many outpatient offices, including various departments the Emory Clinic, have devised their own manual filing systems to store the outside hospital imaging CD Rom discs of their patients; unfortunately, these well intentioned filing systems are the source of hours of wasted time spent trying to find films that for some reason are not where they should be. Maybe they were left on someone’s desk or the last user did not re-file them, or the last user filed them in the wrong location out of order. When this happens, a patient has to go for repeat imaging, has to obtain their prior imaging again from the facility where it was done, or worse yet, the patient’s care is carried out without the benefit of this imaging data. As neurosurgeons, having access to a patient’s imaging studies not only at the time the patient is evaluated to determine if they need surgery, but also at the time of surgery is critical. If a patient’s films are lost or unavailable at the time of surgery, this is non-ideal and hurts patient care. Unfortunately this situation is faced more often than desired when a patient’s imaging was done at an outside facility and is not available on Emory Radiology’s image viewing portal (as studies done at Emory are). Sometimes the patient forgets to bring in their imaging on the day of surgery, the imaging media was lost somewhere in the hospital, or the imaging was left by the provider in their outpatient office. This proposed project would provide a solution to this problem, by creating a prototype for a central web-based repository of outside hospital imaging studies to which providers could upload studies from CD Roms for future access and viewing from anywhere there is a web browser provided the providers have appropriate credentials and password access.

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Discharge filter development project for improved patient safety upon discharge
The advent, adaptation and roll out of a newer technology called computerized physician order entry has created a new opportunity to notify medical providers about patients that may be unsafe to leave the hospital at the time the provider electronically signs a discharge order. We have developed an algorithm to identify patients that may be unsafe for discharge from the hospital based on a number of criteria. We have taken care to limit the patients flagged to only those that are at serious risk to avoid a phenomenon called 'alert fatigue.' We have retrospectively studied this algorithm on historical data, an analysis which we are presently writing up for scholarly publication. Our next step is a prospective analysis of the algorithm. We are working with the Emory University Hospital Chief Quality Officer and plan to pilot the prototype once built as part of this prospective effort in the patient care setting. Our goal is to be able to implement this product as an add-on to Electronic Medical Records Systems and our multi-hospital web-based administrative patient database solution to enhance patient safety at discharge.

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Emory neurosurgery regulatory and accreditation compliance report builder
Any laws placed on the books regulating industries inevitably create additional, and sometimes costly, burdens on organizations and frequently require data reporting to demonstrate or fulfill compliance. Healthcare is no stranger to this phenomenon. U.S. residency programs (post graduate medical training programs) are subject to a bevy of administrative reporting requirements in order to demonstrate compliance with the regulatory and accreditation entities that govern residency training program accreditation and funding. One such mandatory reporting requirement is that of case logs for surgical programs. Residents and surgical training programs as a whole are required to maintain logs of surgical case volumes by type. Residents need to keep logs of individual cases in which they participate as this is required to demonstrate competence for residency training completion and subsequently for board certification. Programs need to maintain logs of overall case volumes by type which are mandated to be reported in order to demonstrate that all residents in a given program are provided an experience with the necessary breadth and depth of cases in that specialty in line with other programs in that specialty across the nation. Paper based, hand written case logs often utilizing stickers with patient names and medical record numbers are an informal practice that has been carried out by surgeons and residents for years; however, this exercise is really one that creates duplicate work as the data recorded is abstracted from disparate information already available elsewhere and documented by the same providers in patient records. Moreover, compliance, accuracy and thoroughness of these case logs can be highly variable between individuals and between training programs at different institutions. One driver of the inaccuracy and variability of case logs maintained by individuals is the fact that self-reporting is labor intensive and therefore difficult to sustain. Studies have estimated that manual entry reflects only 60% of the true numbers of encounters or procedures. Today, with the advent and more widespread use of electronic medical records (EMR) systems, electronic data residing in various databases is now more readily available / accessible and can be linked with other data to create an automated case log that is less prone to difficulties with entry compliance and error. Thus, it is believed that the development of case log registries can be aided through the use of new information technologies that can access and query clinical, financial, and administrative patient care databases for the purpose of resident and surgeon case log generation as well as overall individual program case log report generation. This solution seeks to leverage this recent phenomenon of structured data availability in EMR databases. For every surgery done at Emory University Hospital, Emory University Hospital Midtown, and Children’s Healthcare of Atlanta (CHOA), an intraoperative record is maintained by the operating room circulating nurse which logs a wide variety of data for the surgical cases done. The completed solution would access this data and generate the reports mandated by the accreditation and regulatory bodies in a turnkey fashion eliminating duplicate work, improving accuracy and ultimately ensuring compliance. The solution will be accessible via a secure password protected web portal with reports viewable online and downloadable in pdf format. The reports will detail and summarize the operative case experience, volume and trends over time for the Emory Neurosurgery Department overall and by individual providers including both attending and resident neurosurgeons.

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Profit and loss statement automation and operational statistics dashboard development project
A Profit and Loss (P & L) statement measures a company's sales and expenses during a specified period of time. The function of a P & L statement is to total all sources of revenue and subtract all expenses related to the revenue. It shows a company's financial progress during the time period being examined. A P & L statement answers the question, "Are we making or losing money?" It is a extremely valuable tool to monitor and manage operations. At regular intervals the Department of Neurosurgery at Emory, like any other business, generates a P & L statement to assess its financial health and to gauge any changes needed in the department’s operations. Today these statements are generated as follows: i) a manual database query that was written by the departments accountant is run (this query was previously written and saved); ii) the file generated is saved and then manually pulled into excel; and iii) the formulas and reports in the excel P & L template are then manually adjusted so that reports containing data for the desired time period are generated. As mentioned, the raw data for this reporting functionality sits in a queryable database and the queries are already written. In addition an excel file into which this data is imported and subsequently processed to generate the desired output (reports) is already constructed and used regularly. This project entails the following aims: i) automating the queries so that they run at a regular specified interval independent of any human interaction (timed macros); ii) creating a MySQL backend with database tables into which this data will be written; iii) automating the writing of the data returned from the queries to the MySQL database; iv) creating a web-based (Java or PHP) front end with canned P & L reports mirroring those previously created in excel that can be generated with the push of a button after specific criteria are established (i.e. time period of interest); and v) creating a dashboard home view with operational statistics generated from data in the MySQL database used for the P&L statement’s generation that will raise visibility into the operations and facilitate the business manager’s daily management of the department’s financial operations. This is not an accounting project. All of the accounting expertise will come from a CPA member of the Client team. Familiarity with accounting is not a prerequisite for members of the team that may join this effort. That being said, the project will provide exposure to the financial management and reporting of a business operation.

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Web-based database driven activity based costing managerial accounting for healthcare provider overhead allocation
The Department of Neurosurgery at Emory has recently initiated an effort to examine how each provider’s (surgeon’s) practices drive certain expenses generally thought of as ‘overhead.’ By better understanding this phenomenon, each provider’s cost or profitability to the department can be determined by matching these allocated expenses against the productivity or revenue generated by each provider. The methodology used for this cost allocation is something called activity-based costing (ABC). A critical advantage of ABC is that it can help identify providers that are generating deficits for the department which have to be made up by their peers. ABC allows for i) inter-provider differences to be examined; ii) high overhead generating outliers to be reined in; and iii) dissemination of the best practices of the most efficient providers. By having this information available, incentive structures can be devised to encourage more efficient use of department resources and to discourage practices that generate losses for the department. Moreover, this data can empower individual surgeons with insights into the economic impact of their actions so that they can identify activities that generate potentially unnecessary overhead expenses that have no incremental benefit to patient outcomes. Traditional accounting practice arbitrarily allocated a percentage of overhead expenses or indirect costs to each surgeon equally (i.e. splitting overhead evenly across all surgeons) without examining which surgeons generate the majority of the overhead expenses. While in reality, inter-provider variability in resource consumption driven by practice habits invariably results in variation in the overhead expenses each surgeon generates. Thus, the ABC method enables the department to determine which providers may be unknowingly generating losses or practicing inefficiently. In addition, by using the information made available through ABC, the department business manager can i) create a better, more accurate budget; ii) eliminate expenses that have no incremental benefit to patients which are adversely impacting the department financially; and iii) better manage the expenses that are required to keep the department running smoothly. The ABC analysis has currently been implemented as follows: i) a manual database query that was written by the department’s accountant is run (this query was previously written and saved); ii) the file generated is saved and then manually pulled into excel; iii) the formulas and reports in the excel ABC template are then manually adjusted so that reports containing data for the desired time period are generated. The raw data for this reporting functionality sits in a queryable database and the queries are already written. In addition an excel file into which this data is imported and subsequently processed to generate the desired output (reports) is already constructed and used regularly. This project entails the following aims: i) automating the queries so that they run at a regular specified interval independent of any human interaction (timed macros); ii) creating a MySQL backend with database tables into which this data will be written; iii) automating the writing of the data returned from the queries to the MySQL database; iv) creating a web-based (Java or PHP) front end with canned ABC reports mirroring those previously created in excel that can be generated with the push of a button after specific criteria are established (i.e. time period of interest, provider of interest, etc.); and v) creating a provider portal that each provider can log into individually to examine their resource consumption against their revenue generation as compared to their peers. The portal would show each provider the raw data (buckets of overhead and their consumption of each versus their peers) and summary data including rank by revenue generation, resource consumption and profitability as well as benchmarks or goals and their variance from goal. This is not an accounting project. All of the accounting expertise will come from a CPA member of the Client team. Familiarity with accounting is not a prerequisite for members of the team that may join this effort. That being said, the project will provide exposure to the financial management and reporting of a business operation.

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Physician professional billing revenue cycle optimization solution
One of the challenges in academic medial centers critical to maintaining the ability to provide care and 'keep-the-lights-on' is capturing charges and billing for services rendered in a timely fashion. This is actually quite challenging in academic medical centers. General surgery at Emory has developed best in class tools for this process that leverages a 'home-grown' access database. This project involves moving this technology to a web based portal that can then be deployed across Emory.

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Neurosurgery question bank testing solution
Create a web-based database driven question bank (q-bank) application for Neurosurgeons in training preparing for the National Board Examination administered by the American Board of Neurological Surgeons. The application will offer sophisticated analytics that help test candidates identify content areas of weakness and allow the user to create custom tests based on specific criteria including number of questions, difficulty and content. The Neurosurgery Question Bank testing solution will bring exam preparation in Neurosurgery into the information technology age, a change long overdue. A prototype of this solution has already been developed and a subsequent release is under development. This solution is content agnostic and can be deployed in any test preparation arena with the right content partners.

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Resident hours compliance manager and centralized reporting solution
Work hour regulations have become the norm in medical and surgical training and are continually gaining more media attention. Medical and surgical post graduate training programs have struggled to figure out how to best monitor hours and regulatory bodies are putting increasing pressure on programs to demonstrate they are compliant. We have partnered with a group that has developed an i-phone application for tracking resident work hours. This project would involve designing a web portal mirroring the i-phone application, but most importantly the team that would take on this project would help us build reporting machinery to which i-phone data can be submitted over the internet. Submitted data can then be grouped by individual post graduate residency training programs and complete hours reporting for all residents in a given program can be provided; similarly, these reports can then be rolled up across all residency programs at a given university for the local graduate medical education (GME) office that is charged by the university to ensure their programs are in compliance with work hour rules and subsequently to the regulatory entities. With this solution, the burden of hours compliance reporting to the regulatory bodies / entities that govern medical and surgical program accreditation can be made turnkey. This product offering will be a web-based, database driven solution.

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Healthcare provider sign-out report manager for improved hand-offs that will drive improved quality and better patient care
With increasing pressure on resident work hours and a move to a 'shift work' model for medical care, patient hand-offs have become key to ensuring quality of care and patient safety. This project involves building a web based database driven solution for managing care hand-offs that would facilitate passing off the key information and ‘to-dos’ for each patient in a report available online and printable that would complement oral reports given at sign-out.

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