Data-driven practice    with e-MDs     User Conference, 2010         Jonathan Ploudré, MD
Jonathan Ploudré, MD
Geek?
2008 Any EMRYes   No
2008 “Full” EMR Yes   No
Health IT
Analytics: Secret Sauce
Brainstorm…
Herding Cats
Innovation
3 Steps•   Dump (Crystal Reports)•   Dice (Excel)•   Design (Excel)
FDA Warning
Dump
Where to Start?   $500        $2720 minutes   4 hours
Reporting Setup
Reporting Setup
More Reporting Setup
More Reporting Setup
Inside the Database
Views are Legos
Joining…
From Blank slate to ‘Zocor Report’ in 2 minutes
Zip Code CatchmentSELECT…addr.Address_ZipCode as Zip…FROM…JOIN VIEW_Address addr on(a.Entity_ID = addr.Entity_ID)…
3 Steps•   Dump (Crystal Reports)•   Dice (Excel)•   Design (Excel)
Do I see my patients?Pt DOB DOS ICD CPT Doc PCP…   …   …   …   …  …    ……   …   …   …   …  …    ……   …   …   …   …  …    …...
Dice
Autofilter
Autofilter
AutofilterFlat File becomes Sortable/Filterable
AutofilterFlat File becomes Sortable/Filterable
Logic for Formulas• AND, NOT, OR, IF• =, !=, >, <, >=, <=,• True, False                     Focus Horizontally  Pt DOB DOS...
1/0/Nothing=IF(OR(E2=99213,E2=99212,E2=99214),IF(E2=99214,1,0),"")     Nesting Logic gets tricky. To simplify your life:  ...
Lookups• Allows Non-Math, Non-Logical Groups.• Say, do OB docs have worse continuity?  Pt DOB DOS ICD CPT Doc PCP  …   …  ...
Pivot Tables• Summarize & Group• Ridiculously Powerful.                               Focus Vertical  Pt DOB DOS ICD CPT D...
5 Access/Billing Reports in 90 Seconds
3 Steps•   Dump (Crystal Reports)•   Dice (Excel)•   Design (Excel)
Design
30DAYSto context connection                                 Use this practical guide to engage with visualization and buil...
224
Sparklines“Intense, Word-like”            —Tufte
Conditional Formatting   Highlight results, direct attention.
NormalizeMake results comparable, eliminate quibbles
Analytics ≠ Tech                           Tech   PolitcsExpectation    Reality
Pitfalls  Biases                 SystemsMeasuring                CowboyCounting            Breathing Room Average         ...
Measurability BiasWhat’s important but hard to measure?
Counting BiasNot everything you can count should count
Average BiasOutliers might be your best source for improvement
Healthcare BiasSee things through the patient’s eyes
Healthgrades.comNot much of this is in the e-MDs database.
CowboyDon’t do it alone, it takes a team.
Breathing RoomPeople need space to think and decide.
Actiontastic?Measure what matters, manage what you measure.
Go Forth
Data-driven practice    with e-MDs     User Conference, 2010         Jonathan Ploudré, MD
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
Data Driven Practice with e-MDs
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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.

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  • \n
  • \n
  • Geek vs Fuzzy Perspective.\nHacks vs Keywords\n\nLet&amp;#x2019;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&amp;#x2019;t last.\nWhy Health IT? Giga? Multipositive\n
  • Makes win-win possible. Better decisions &amp; better insights.\nAnd only 4% even have the possibility of kicking up the heat.\nWho uses the mounds of data?\n\n
  • Most Rx&amp;#x2019;d. Order Tracking Efficiency. Scan&amp;#x2019;s fastest? 99213/4 Ratio.\nTaskman Bottleneck. Sign Off issues. Holdups on Refills. Overdue Coumadin.\nBest Continuity.\n
  • More than &amp;#x2018;Running Reports&amp;#x2019;. Not predictable like cows. Herding Cats.\nYou need to do it for your own needs.\n
  • Rare Opportunity. It&amp;#x2019;s coming.\nToo good for &amp;#x201C;I&amp;#x2019;m busy&amp;#x201D; or &amp;#x201C;Maybe Later&amp;#x201D;\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&amp;#x2019;s taking the 80mg Dose.\n
  • Some problems you know you have the data, you just need to get it.\nLet&amp;#x2019;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&amp;#x2019;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&amp;#x2019;ve got a list dumped out of the database.\nNow it&amp;#x2019;s time to do something with the data.\n
  • Continuity is a benchmark of quality care. Let&amp;#x2019;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
  • \n
  • \n
  • \n
  • \n
  • So Dump a flat file list of data\nAnalyze horizontally with logic and lookups\nAnalyze vertically with a pivot table\nYou&amp;#x2019;re not done! You have to present it for &amp;#x2018;humans&amp;#x2019;\n
  • Needs Color, Organization.\nNot too many numbers.\nNot too few either.\n
  • Although you won&amp;#x2019;t master it now:\nDoable as a &amp;#x2018;hobby&amp;#x2019;.\n
  • \n
  • \n
  • Allow lots of data \n
  • \n
  • \n
  • \n
  • \n
  • \n
  • So what&amp;#x2019;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&amp;#x2019;s smiles\n
  • Counterexample: Lookups\n
  • Counterexample: Outliers\n
  • Patient Continuity, not provider continuity\n
  • This isn&amp;#x2019;t in your e-MDs Database\n
  • You can&amp;#x2019;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&amp;#x2019;re lucky to have mounds of data\n
  • This is a rare opportunity\nIt&amp;#x2019;s doable; it&amp;#x2019;s not a career change.\n
  • \n
  • Data Driven Practice with e-MDs

    1. 1. Data-driven practice with e-MDs User Conference, 2010 Jonathan Ploudré, MD
    2. 2. Jonathan Ploudré, MD
    3. 3. Geek?
    4. 4. 2008 Any EMRYes No
    5. 5. 2008 “Full” EMR Yes No
    6. 6. Health IT
    7. 7. Analytics: Secret Sauce
    8. 8. Brainstorm…
    9. 9. Herding Cats
    10. 10. Innovation
    11. 11. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    12. 12. FDA Warning
    13. 13. Dump
    14. 14. Where to Start? $500 $2720 minutes 4 hours
    15. 15. Reporting Setup
    16. 16. Reporting Setup
    17. 17. More Reporting Setup
    18. 18. More Reporting Setup
    19. 19. Inside the Database
    20. 20. Views are Legos
    21. 21. Joining…
    22. 22. From Blank slate to ‘Zocor Report’ in 2 minutes
    23. 23. Zip Code CatchmentSELECT…addr.Address_ZipCode as Zip…FROM…JOIN VIEW_Address addr on(a.Entity_ID = addr.Entity_ID)…
    24. 24. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    25. 25. Do I see my patients?Pt DOB DOS ICD CPT Doc PCP… … … … … … …… … … … … … …… … … … … … …… … … … … … …
    26. 26. Dice
    27. 27. Autofilter
    28. 28. Autofilter
    29. 29. AutofilterFlat File becomes Sortable/Filterable
    30. 30. AutofilterFlat File becomes Sortable/Filterable
    31. 31. Logic for Formulas• AND, NOT, OR, IF• =, !=, >, <, >=, <=,• True, False Focus Horizontally Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    32. 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. 33. Lookups• Allows Non-Math, Non-Logical Groups.• Say, do OB docs have worse continuity? Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    34. 34. Pivot Tables• Summarize & Group• Ridiculously Powerful. Focus Vertical Pt DOB DOS ICD CPT Doc PCP … … … … … … … … … … … … … … … … … … … … … … … … … … … …
    35. 35. 5 Access/Billing Reports in 90 Seconds
    36. 36. 3 Steps• Dump (Crystal Reports)• Dice (Excel)• Design (Excel)
    37. 37. Design
    38. 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. 39. 224
    40. 40. Sparklines“Intense, Word-like” —Tufte
    41. 41. Conditional Formatting Highlight results, direct attention.
    42. 42. NormalizeMake results comparable, eliminate quibbles
    43. 43. Analytics ≠ Tech Tech PolitcsExpectation Reality
    44. 44. Pitfalls Biases SystemsMeasuring CowboyCounting Breathing Room Average ActiontasticHealthcare
    45. 45. Measurability BiasWhat’s important but hard to measure?
    46. 46. Counting BiasNot everything you can count should count
    47. 47. Average BiasOutliers might be your best source for improvement
    48. 48. Healthcare BiasSee things through the patient’s eyes
    49. 49. Healthgrades.comNot much of this is in the e-MDs database.
    50. 50. CowboyDon’t do it alone, it takes a team.
    51. 51. Breathing RoomPeople need space to think and decide.
    52. 52. Actiontastic?Measure what matters, manage what you measure.
    53. 53. Go Forth
    54. 54. Data-driven practice with e-MDs User Conference, 2010 Jonathan Ploudré, MD

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