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Michaels M, Jakhmola P, Lubin IM, Fochtmann LJ, Casey DE, Opelka FG, Skapik J, Larsen K, Tailor A, Matson-Koffman D. The Real-World Foundation of Adapting Clinical Guidelines for the Digital Age. Am J Med Qual 2024; 39:89-90. [PMID: 38424709 DOI: 10.1097/jmq.0000000000000167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Maria Michaels
- Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Priya Jakhmola
- Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Ira M Lubin
- Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | | | - Donald E Casey
- College of Population Health, Thomas Jefferson University, Philadelphia, PA
- Department of Internal Medicine, Rush Medical College, Chicago, IL
- Institute for Healthcare Informatics, University of Minnesota, Minneapolis, MN
| | | | - Julia Skapik
- National Association of Community Health Centers, Bethesda, MD
| | | | - Amrita Tailor
- Centers for Disease Control and Prevention (CDC), Atlanta, GA
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Iorga A, Velezis MJ, Marinac-Dabic D, Lario RF, Huff SM, Gore B, Mermel LA, Bailey LC, Skapik J, Willis D, Lee RE, Hurst FP, Gressler LE, Reed TL, Towbin R, Baskin KM. Venous Access: National Guideline and Registry Development (VANGUARD): Advancing Patient-Centered Venous Access Care Through the Development of a National Coordinated Registry Network. J Med Internet Res 2023; 25:e43658. [PMID: 37999957 PMCID: PMC10709786 DOI: 10.2196/43658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 03/07/2023] [Accepted: 04/14/2023] [Indexed: 11/25/2023] Open
Abstract
There are over 8 million central venous access devices inserted each year, many in patients with chronic conditions who rely on central access for life-preserving therapies. Central venous access device-related complications can be life-threatening and add tens of billions of dollars to health care costs, while their incidence is most likely grossly mis- or underreported by medical institutions. In this communication, we review the challenges that impair retention, exchange, and analysis of data necessary for a meaningful understanding of critical events and outcomes in this clinical domain. The difficulty is not only with data extraction and harmonization from electronic health records, national surveillance systems, or other health information repositories where data might be stored. The problem is that reliable and appropriate data are not recorded, or falsely recorded, at least in part because policy, payment, penalties, proprietary concerns, and workflow burdens discourage completeness and accuracy. We provide a roadmap for the development of health care information systems and infrastructure that address these challenges, framed within the context of research studies that build a framework of standardized terminology, decision support, data capture, and information exchange necessary for the task. This roadmap is embedded in a broader Coordinated Registry Network Learning Community, and facilitated by the Medical Device Epidemiology Network, a Public-Private Partnership sponsored by the US Food and Drug Administration, with the scope of advancing methods, national and international infrastructure, and partnerships needed for the evaluation of medical devices throughout their total life cycle.
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Affiliation(s)
- Andrea Iorga
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
- Computer Science and Electrical Engineering, University of Maryland, Baltimore County, Baltimore, MD, United States
| | - Marti J Velezis
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Danica Marinac-Dabic
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Robert F Lario
- Biomedical Informatics Research, University of Utah, Salt Lake City, UT, United States
| | - Stanley M Huff
- Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Beth Gore
- The Oley Foundation, Albany Medical Center, Delmar, NY, United States
| | - Leonard A Mermel
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School at Brown University, Providence, RI, United States
| | - L Charles Bailey
- Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Julia Skapik
- Internal Medicine, Inova Medical Group, Alexandria, VA, United States
- National Association of Community Health Centers, Bethesda, MD, United States
| | - Debi Willis
- PatientLink Enterprises, Oklahoma City, OK, United States
| | - Robert E Lee
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Frank P Hurst
- Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD, United States
| | - Laura E Gressler
- Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, Little Rock, AR, United States
| | - Terrie L Reed
- Symmetric Health Solutions, Pittsburgh, PA, United States
| | - Richard Towbin
- Emeritus, Department of Radiology, Phoenix Children's Hospital, Phoenix, AZ, United States
- VANGUARD Coordinated Registry Network, LLC, Phoenix, AZ, United States
| | - Kevin M Baskin
- VANGUARD Coordinated Registry Network, LLC, Phoenix, AZ, United States
- Division of Interventional Radiology, Department of Radiology, Conemaugh Memorial Medical Center, Johnstown, PA, United States
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Michaels M, Hangsleben M, Sherwood A, Skapik J, Larsen K. Adapted Kaizen: Multi-Organizational Complex Process Redesign for Adapting Clinical Guidelines for the Digital Age. Am J Med Qual 2023; 38:S46-S59. [PMID: 37668273 PMCID: PMC10476597 DOI: 10.1097/jmq.0000000000000133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
The need for a method to examine complex, multidisciplinary processes involving many diverse organizations initially led multiple US federal agencies to adopt the traditional Kaizen, a Lean process improvement method typically used within a single organization, to encompass multiple organizations each with its own leadership and priorities. First, the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health Information Technology adapted Kaizen to federal agency processes for the development of electronic clinical quality measures. Later, the Centers for Disease Control and Prevention (CDC) further modified this adapted Kaizen during its Adapting Clinical Guidelines for the Digital Age (ACG) initiative, which aimed to improve the broader scope of guideline development and implementation. This is a methods article to document the adapted Kaizen method for future use in similar complex processes, illustrating how to apply the adapted Kaizen through CDC's ACG initiative and showing the reach achieved by using the adapted Kaizen method. The adapted Kaizen includes pre-Kaizen planning, a Kaizen event, and post-Kaizen implementation that accommodate multidisciplinary and multi-organizational participation. ACG included 5 workgroups that each developed products to support their respective scope: Guideline Creation, Informatics Framework, Translation and Implementation, Communication and Dissemination, and Evaluation. Despite challenges gathering diverse perspectives and balancing the competing priorities of multiple organizations, the ACG participants produced interrelated standards, processes, and tools-further described in separate publications-that programs and partners have leveraged. Use of a siloed approach may not have supported the development and dissemination of these products.
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Affiliation(s)
| | - Mindy Hangsleben
- Former HHS Entrepreneur-in-Residence (Lean Innovation Fellow), US Department of Health and Human Services – Office of the National Coordinator for Health IT (ONC), Washington, DC
- Former HHS Entrepreneur-in-Residence (Lean Innovation Fellow), US Department of Health and Human Services – Centers for Medicare & Medicaid Services (CMS): Quality Measurement and Health Assessment Group, Baltimore, MD
- Varyn Consulting LLC, Saint Louis Park, MN
| | - Amy Sherwood
- Former HHS Entrepreneur-in-Residence (Lean Innovation Fellow), US Department of Health and Human Services – Centers for Medicare & Medicaid Services (CMS): Quality Measurement and Health Assessment Group, Baltimore, MD
| | - Julia Skapik
- National Association of Community Health Centers, Bethesda, MD
| | - Kevin Larsen
- Optum, Eden Prairie, MN
- University of Minnesota, Minneapolis, MN
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Romero L, Carneiro PB, Riley C, Clark H, Uy R, Park M, Mawokomatanda T, Bombard JM, Hinckley A, Skapik J. Building capacity of community health centers to overcome data challenges with the development of an agile COVID-19 public health registry: a multistate quality improvement effort. J Am Med Inform Assoc 2021; 29:80-88. [PMID: 34648005 PMCID: PMC8524633 DOI: 10.1093/jamia/ocab233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 10/11/2021] [Indexed: 11/12/2022] Open
Abstract
Objective During the coronavirus disease 2019 (COVID-19) pandemic, federally qualified health centers rapidly mobilized to provide SARS-CoV-2 testing, COVID-19 care, and vaccination to populations at increased risk for COVID-19 morbidity and mortality. We describe the development of a reusable public health data analytics system for reuse of clinical data to evaluate the health burden, disparities, and impact of COVID-19 on populations served by health centers. Materials and Methods The Multistate Data Strategy engaged project partners to assess public health readiness and COVID-19 data challenges. An infrastructure for data capture and sharing procedures between health centers and public health agencies was developed to support existing capabilities and data capacities to respond to the pandemic. Results Between August 2020 and March 2021, project partners evaluated their data capture and sharing capabilities and reported challenges and preliminary data. Major interoperability challenges included poorly aligned federal, state, and local reporting requirements, lack of unique patient identifiers, lack of access to pharmacy, claims and laboratory data, missing data, and proprietary data standards and extraction methods. Discussion Efforts to access and align project partners’ existing health systems data infrastructure in the context of the pandemic highlighted complex interoperability challenges. These challenges remain significant barriers to real-time data analytics and efforts to improve health outcomes and mitigate inequities through data-driven responses. Conclusion The reusable public health data analytics system created in the Multistate Data Strategy can be adapted and scaled for other health center networks to facilitate data aggregation and dashboards for public health, organizational planning, and quality improvement and can inform local, state, and national COVID-19 response efforts.
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Affiliation(s)
- Lisa Romero
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Pedro B Carneiro
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
| | - Catharine Riley
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Hollie Clark
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Raymonde Uy
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
| | - Michael Park
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Tebitha Mawokomatanda
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Jennifer M Bombard
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Alison Hinckley
- Centers for Disease Control and Prevention COVID-19 Response, Health Systems and Worker Safety Task Force, Atlanta, Georgia, USA
| | - Julia Skapik
- National Association of Community Health Centers, Department of Clinical Affairs, Bethesda, Maryland, USA
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Pavel M, Jimison HB, Wactlar HD, Hayes TL, Barkis W, Skapik J, Kaye J. The role of technology and engineering models in transforming healthcare. IEEE Rev Biomed Eng 2013; 6:156-77. [PMID: 23549108 DOI: 10.1109/rbme.2012.2222636] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The healthcare system is in crisis due to challenges including escalating costs, the inconsistent provision of care, an aging population, and high burden of chronic disease related to health behaviors. Mitigating this crisis will require a major transformation of healthcare to be proactive, preventive, patient-centered, and evidence-based with a focus on improving quality-of-life. Information technology, networking, and biomedical engineering are likely to be essential in making this transformation possible with the help of advances, such as sensor technology, mobile computing, machine learning, etc. This paper has three themes: 1) motivation for a transformation of healthcare; 2) description of how information technology and engineering can support this transformation with the help of computational models; and 3) a technical overview of several research areas that illustrate the need for mathematical modeling approaches, ranging from sparse sampling to behavioral phenotyping and early detection. A key tenet of this paper concerns complementing prior work on patient-specific modeling and simulation by modeling neuropsychological, behavioral, and social phenomena. The resulting models, in combination with frequent or continuous measurements, are likely to be key components of health interventions to enhance health and wellbeing and the provision of healthcare.
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Affiliation(s)
- Misha Pavel
- Department of Biomedical Engineering, Oregon Health and Science University, Portland, OR 97239, USA.
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