Big Data in Healthcare & Medicine: The Implementation
My name is Monique Diaz M.D. and I am pleased to have returned to my roots at the University of Illinois at Chicago for a fellowship in clinical informatics. I attended medical school at UIC and went on to do residency in Physical Medicine and Rehabilitation (PM&R) at Loyola University Medical Center. My first job out of training was at a community hospital where I focused on general in-patient rehabilitation for a small private practice group. During that time I became involved in several quality improvement projects that were centered on health information technology workflow. Naturally when I learned about President Obama’s Precision Medicine Initiative and how one of its many facets is to engage more clinicians in health data management, I felt this was something for which I had been preparing myself without even knowing it. I decided to make a commitment to this burgeoning aspect of healthcare by returning to academia in the form of a clinical informatics (CI) fellowship. I was delighted to learn that UIC has the second oldest CI fellowship in the nation and that its fellows represent various specialties. I started my fellowship in CI this past July (2017) and was graciously taken under the wing of the Neurology Department in conjunction with our new collaborative efforts with the Schwab Rehabilitation Hospital (Sinai), as 25% of my time will be spent maintaining my clinical skills. The other 75% of my fellowship centers on CI projects.
The neurology department’s new partnership with Schwab Rehabilitation Hospital has created an opportunity for me to apply clinical informatics for patient transitions between acute and post-acute care. To do this, I am in discussions with hospital administrators regarding the process from admission to discharge and establishing a data governance plan so that each step along this path is accounted for. From there I can look for trends and report on outcome measures like length of stay for neuro patients in relationship to diagnosis, timing of case management intervention and PM&R consultation, and disposition. A key factor to overcome is the challenge of interoperability. UIH uses Cerner; Schwab is a Meditech system. When the EHRs cannot “talk to each other” this creates so-called data silos and it becomes difficult to transmit important updates between clinicians. There are low-tech means of circumventing this, but my hope is that we can make use of direct messaging in such a way that both security and data provenance are improved.
Another one of my projects has me acting as a project manager for the Advancing Clinical Information (ACI) segment of the Merit-based Incentive Payment System (MIPS). Trying to boost physician engagement in a federally mandated health information technology program is about as glamorous as that sounds, but despite its challenges I am buoyed by my belief in the end-goal of ACI. Patient portals are here to stay and are becoming the preferred method of communication for patients, and electronic health information exchange between consultants and the ordering physician is best practice. Incorporating these and other aspects of the EHR into clinical care is how we keep up and move health information technology forward, otherwise we are left in its shadow.
I feel extremely privileged to be at the forefront of big data integration in medicine, and grateful to the Neurology and Rehabilitation department for hosting me as a fellow!