Yale has built a strong integrated informatics infrastructure to support safe, effective patient care and innovative research. Epic, Yale’s enterprise-wide electronic health record (EHR) and the cornerstone of this work, contains more than four million unique patient records that enable clinical scientists to harness the power of ever-increasing amounts of digital health data.
In September, Yale-New Haven Hospital (YNHH) was awarded the Healthcare Information and Management Systems Society (HIMSS) Stage 7 award, the highest stage in the HIMSS Analytics EMR Adoption Model, which evaluates the progress and impact of electronic health record systems in hospitals. Less than four percent of U.S. hospitals have achieved this prestigious designation. HIMSS noted that YNHH is leveraging its EHR technology in innovative ways that include saving time and improving the patient experience; implementing such functionality as the tele-ICU module, which allows intensivists to monitor ICU patients 24/7; integrating the recruitment of research subjects into the MyChart patient portal; and proving the value of clinical decision support. “We’re thrilled that we received recognition for our efforts to collaborate with our colleagues at the School of Medicine to leverage technology to improve patient care and promote research,” said Lisa Stump, MS, senior vice president and chief information officer (interim) at Yale School of Medicine and Yale New Haven Health System.
YCCI has worked closely with the Yale Epic team to ensure that the EHR strategy integrates research with Yale’s Help Us Discover clinical research recruitment and awareness campaign. This integration has led to novel research recruitment tools, including implementation of a Help Us Discover tab in MyChart. The tab includes a categorized listing of all clinical trials at Yale that are open to new accruals, as well as enabling patients to build and submit their personalized clinical trial profiles, including the kinds of trials they’re interested in and how they wish to be contacted. The portal operates in conjunction with yalestudies.org, Yale’s clinical trial website for patients, where they can learn about clinical research and search for available clinical trials.
MyChart is a powerful tool for connecting potential subjects to clinical trials that incurs no additional cost, as it leverages technologies and licenses already purchased for clinical use. So far, almost 700 patients have built profiles through MyChart, even though this feature has not yet been promoted; approximately 100 of these patients have been referred to a clinical trial for possible enrollment. The Yale MyChart team, led by Timothy Cooney, is also creating MyHealth, a patient education section that will contain information and links to relevant clinical trials specifically targeted to the patient’s health issues.
Yale also provides enterprise-wide access to patient data that enables cutting-edge research across the T1 through T4 spectrum. Yale’s Joint Data Analytics (JDAT) and OnCore teams help assess study feasibility and identify cohorts, while the recently adopted opt-out policy allows EHR data from the entire health system to be used for research unless the patient opts out. This policy gives researchers unprecedented access to the wealth of data available within the system. In addition, best practice alerts (BPAs) can be generated in the EHR to inform physicians of clinical research opportunities for patients at the point of care. These messages, which are triggered when predefined criteria are met, alert the health care provider that an individual patient may be eligible for a clinical study. The provider then has the option of sending an alert to the study team, providing contact information directly to the patient, or both. BPAs can also be set to fire behind the scene so they don’t interrupt physician-patient interactions.
Our ability to provide the highest-quality clinical care is intertwined with our ability to conduct research.
Paul Taheri, MD, MBA, CEO of Yale Medical Group and Deputy Dean for Clinical Affairs
“Our ability to provide the highest-quality clinical care is intertwined with our ability to conduct research,” said Paul Taheri, MD, MBA, CEO of Yale Medical Group and Deputy Dean for Clinical Affairs. “Our EHR plays an important role in both, and we are continually seeking ways to harness what it has to offer.”
Led by Allen Hsiao, MD, chief medical information officer for the School of Medicine and Yale New Haven Health System, and associate professor of pediatrics (emergency medicine) and of emergency medicine, the Yale IT team has worked closely with Epic to refine its tele-ICU module; it was the first to deploy it nationally. The module is used to provide overnight intensivist coverage of several ICUs across Yale’s hospital campuses. One innovation includesan early warning system that continually monitors and scores ICU patients, and is refined over time as patient data are acquired. At Yale’s urging, Epic is working with the FDA ondeveloping the ability to stream live cardiopulmonary data to increase the module’s effectiveness—an improvement that will benefit the many patients cared for in hospitals using Epic.
Yale has also used the EHR to improve blood product ordering across the health system. A multidisciplinary group of hospitalists, hematologists, and informaticians studied the use of blood products and identified opportunities to improve ordering. The recommendations were incorporated into the provider workflow, with indications and guidelines built into the design.
“Our EHR has had a positive impact on how we practice medicine, and has opened up new avenues for research,” said Hsiao. “As we continue to leverage this technology, patients will reap the benefits in unforeseen ways.”