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Data Driven Practice with e-MDs

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Data Driven Practice in e-MDs. This covers custom crystal reports from scratch, slicing and dicing data in Excel, Visualizing Data, and understanding that change isn't really a technical problem.

Data Driven Practice in e-MDs. This covers custom crystal reports from scratch, slicing and dicing data in Excel, Visualizing Data, and understanding that change isn't really a technical problem.

Published in: Health & Medicine

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  • \n
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  • Geek vs Fuzzy Perspective.\nHacks vs Keywords\n\nLet’s get started\n
  • Healthcare = least analytical industry\nPathetically un-analytical\n
  • So, anyone here is probably an Early Adopter\n
  • With focus, early adoption advantage won’t last.\nWhy Health IT? Giga? Multipositive\n
  • Makes win-win possible. Better decisions & better insights.\nAnd only 4% even have the possibility of kicking up the heat.\nWho uses the mounds of data?\n\n
  • Most Rx’d. Order Tracking Efficiency. Scan’s fastest? 99213/4 Ratio.\nTaskman Bottleneck. Sign Off issues. Holdups on Refills. Overdue Coumadin.\nBest Continuity.\n
  • More than ‘Running Reports’. Not predictable like cows. Herding Cats.\nYou need to do it for your own needs.\n
  • Rare Opportunity. It’s coming.\nToo good for “I’m busy” or “Maybe Later”\n
  • So how do you do this?\nKeep steps separate.\n
  • Reading email, Oh-no, one of my favorite meds has a new warning.\nNone of the built-in reports get me pt’s taking the 80mg Dose.\n
  • Some problems you know you have the data, you just need to get it.\nLet’s Face It: not in 20 minutes. Takes time/persistence.\nSimple version, doable. \nThink simple list or flat file as output.\n
  • These are investments/hurdles.\nOvertime ROI improves\n
  • How to get my Simvastatin Data?\nConnecting to Database\n
  • Same details but in Crystal.\n
  • In general use Views where possible.\nFor Zocor: You need these 3.\n
  • \n
  • Joining is a key aspect of relational database.\n
  • \n
  • So obviously, it’s not this fast your first time!\nBut responding to an FDA announcement is actually doable even with a busy schedule.\n
  • If you can do SQL, maybe use the built-in reports.\nFor when you need just one more column\n
  • So we’ve got a list dumped out of the database.\nNow it’s time to do something with the data.\n
  • Continuity is a benchmark of quality care. Let’s say I can dump out a list of visits from a report. How do we dice that info into something?\n
  • Let Face it 2: Excel takes more than 20 minutes to master.\nI think of dicing the list as adding a bit more logic/interpretation to data.\n\n
  • Spreadsheets are more approachable than Crystal.\nSubset of functions can be combined in multiple ways.\n\n
  • Quick Look around.\n\n
  • Top ten ICDs or CPTs, etc.\n
  • Horizontal Analysis!\n
  • \n
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  • So Dump a flat file list of data\nAnalyze horizontally with logic and lookups\nAnalyze vertically with a pivot table\nYou’re not done! You have to present it for ‘humans’\n
  • Needs Color, Organization.\nNot too many numbers.\nNot too few either.\n
  • Although you won’t master it now:\nDoable as a ‘hobby’.\n
  • \n
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  • Allow lots of data \n
  • \n
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  • So what’s the problem with my 3 step process?\n
  • This is not a tech problem.\nEMR transition is like this.\n
  • Cognitive Biases: Mistakes you make at the beginning\nSystems Errors: Mistakes you make on follow through\n
  • Counterexample: Receptionist’s smiles\n
  • Counterexample: Lookups\n
  • Counterexample: Outliers\n
  • Patient Continuity, not provider continuity\n
  • This isn’t in your e-MDs Database\n
  • You can’t do it alone. Need a team.\n
  • You need space to think.\n
  • Measure what matters\nManage what you measure.\n
  • Here we are again:\nWe’re lucky to have mounds of data\n
  • This is a rare opportunity\nIt’s doable; it’s not a career change.\n
  • \n
  • Transcript

    • 1. Data-driven practice with e-MDs User Conference, 2010 Jonathan Ploudré, MD
    • 2. Jonathan Ploudré, MD
    • 3. Geek?
    • 4. 2008 Any EMRYes No
    • 5. 2008 “Full” EMR Yes No
    • 6. Health IT
    • 7. Analytics: Secret Sauce
    • 8. Brainstorm…
    • 9. Herding Cats
    • 10. Innovation
    • 11. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    • 12. FDA Warning
    • 13. Dump
    • 14. Where to Start? $500 $2720 minutes 4 hours
    • 15. Reporting Setup
    • 16. Reporting Setup
    • 17. More Reporting Setup
    • 18. More Reporting Setup
    • 19. Inside the Database
    • 20. Views are Legos
    • 21. Joining…
    • 22. From Blank slate to ‘Zocor Report’ in 2 minutes
    • 23. Zip Code CatchmentSELECT…addr.Address_ZipCode as Zip…FROM…JOIN VIEW_Address addr on(a.Entity_ID = addr.Entity_ID)…
    • 24. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    • 25. Do I see my patients?Pt DOB DOS ICD CPT Doc PCP… … … … … … …… … … … … … …… … … … … … …… … … … … … …
    • 26. Dice
    • 27. Autofilter
    • 28. Autofilter
    • 29. AutofilterFlat File becomes Sortable/Filterable
    • 30. AutofilterFlat File becomes Sortable/Filterable
    • 31. Logic for Formulas• AND, NOT, OR, IF• =, !=, >, <, >=, <=,• True, False Focus Horizontally Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    • 32. 1/0/Nothing=IF(OR(E2=99213,E2=99212,E2=99214),IF(E2=99214,1,0),"") Nesting Logic gets tricky. To simplify your life: •Consider $5 on fiverr.com •Consider a Excel geek
    • 33. Lookups• Allows Non-Math, Non-Logical Groups.• Say, do OB docs have worse continuity? Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    • 34. Pivot Tables• Summarize & Group• Ridiculously Powerful. Focus Vertical Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    • 35. 5 Access/Billing Reports in 90 Seconds
    • 36. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    • 37. Design
    • 38. 30DAYSto context connection Use this practical guide to engage with visualization and build great context connection skills over the next 30 days. est. minutes ACTION, Content, *web address completion 30 0 MonWEEK 1 READ Is Information Visualization the Next Frontier for Design? http://bit.ly/30Days-InfoViz WATCH Hans Rosling shows the best stats youve ever seen http://bit.ly/30Days-Rosling Tue READ Business Intelligence isnt a technical problem, it is a Social Problem http://bit.ly/30Days-Problem Wed READ Who is Edward Tufte? http://bit.ly/30Days-Tufte Thu READ The Economist: New Ways of Visualising Data http://bit.ly/30Days-Visualize Fri PLAY New York Times Visualization Lab http://bit.ly/30Days-NYTimes MonWEEK 2 WATCH Before trying to communicate information, first understand it. http://bit.ly/30Days-Information READ Part 1 Foundation: Guide to Creating Dashboards People Love http://bit.ly/30Days-DashboardLove1 Tue READ The Best of Business Intellgience: Innovation at the Fringe http://bit.ly/30Days-BI Wed READ Think Like a Designer http://bit.ly/30Days-Think Thu DO 30 Resources to Find the Data you Need http://bit.ly/30Days-GetData Fri PLAY Indexed. Fun with communication of Data http://bit.ly/30Days-Indexed DO Create your own visualization http://bit.ly/30Days-ManyEyes
    • 39. 224
    • 40. Sparklines“Intense, Word-like” —Tufte
    • 41. Conditional Formatting Highlight results, direct attention.
    • 42. NormalizeMake results comparable, eliminate quibbles
    • 43. Analytics ≠ Tech Tech PolitcsExpectation Reality
    • 44. Pitfalls Biases SystemsMeasuring CowboyCounting Breathing Room Average ActiontasticHealthcare
    • 45. Measurability BiasWhat’s important but hard to measure?
    • 46. Counting BiasNot everything you can count should count
    • 47. Average BiasOutliers might be your best source for improvement
    • 48. Healthcare BiasSee things through the patient’s eyes
    • 49. Healthgrades.comNot much of this is in the e-MDs database.
    • 50. CowboyDon’t do it alone, it takes a team.
    • 51. Breathing RoomPeople need space to think and decide.
    • 52. Actiontastic?Measure what matters, manage what you measure.
    • 53. Go Forth
    • 54. Data-driven practice with e-MDs User Conference, 2010 Jonathan Ploudré, MD