Health IT

Analytics could drive the future of VistA

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The Veterans Administration collects a lot of patient data. The agency data mart has about 2.5 petabytes of structured information on patient interactions -- about 900 billion rows of data covering 1.6 billion encounters and 1.5 billion pharmacy orders.

The big question for VA's experts in informatics and analytics is how to make that information available to improve the quality of care, without drowning providers in data.

"We've created a created a system where the complexity of the task at hand almost always exceeds the cognitive capabilities of providers," said Dr. Stephan Fihn, director of the Office of Analytics and Business Intelligence at the Veterans Health Administration.

To manage the firehose of data, Fihn is leading an effort to develop analytics that interpret signals from the vast stores of VA data to alert physicians when patients are at risk. The early work, which has been in place for about three-and-a-half years, assesses risk factors for death and hospitalization. Research is underway to develop analytic models to measure individual risk of kidney failure, acquiring serious infections and suicide.

The mortality and hospitalization analytics are run on 6 million patients each week, using data that is updated from VistA about every four hours. Real time data is the ultimate goal -- as is the integration of data from mobile medical devices and apps, although the lack of industry-wide data standards makes this problematic at present.

According to Fihn, about one-quarter to one-third of providers are looking at the analytic data regularly -- it's available via a web app that links through the VistA health record, and can be accessed on its own. The next step is the integration of analytic information in VistA, which has already begun in the VistA Evolution project that is modernizing the VA's home grown health record.

The models are complex, Fihn says.

The hospitalization and mortality model draws on more than 120 variables from domains across the VistA health record, from diagnoses to rates of health care utilization to demographic information. There is a push to incorporate even more data from outside sources, including the Defense Department, Health and Human Services and elsewhere.

The models are quite accurate, in terms of predicting risk, but the overall goals for analytics at VA are more ambitious.

"It's really about the ability to capture not only what we typically allude to when we talk about datasets, but the narrative of the patient, their story," said Dr. Theresa Cullen, chief medical information officer at VHA.

In an ideal system, a provider would be able to access structured and unstructured data about patients, including  diagnostic tests and personal history, and be able to query and view the information in such a way that it doesn't disrupt the personal connection between provider and patient -- a critical factor in a medical system when interactions might last only 15 or 20 minutes.

"We're nowhere near there yet," Cullen cautioned, but said that she had recently come around to thinking that such a system wasn't just "pie in the sky."

In the near term, Fihn said, it’s about getting the right information in front of the provider at the right time.

"Increasingly, what physicians are doing is acting as information managers, collating information from tests, procedures, histories, and consultants," he said.

Right now, the health record does not do a good job of managing the display of relevant information.. The goal is to redesign the interface to highlight more relevant data.

"So that when a patient comes in and says, 'my knee hurts,' I see a very different view than when the patient comes in and says, 'my head hurts,'" Fihn said.


About the Author

Adam Mazmanian is executive editor of FCW.

Before joining the editing team, Mazmanian was an FCW staff writer covering Congress, government-wide technology policy, health IT and the Department of Veterans Affairs. Prior to joining FCW, Mr. Mazmanian was technology correspondent for National Journal and served in a variety of editorial roles at B2B news service SmartBrief. Mazmanian started his career as an arts reporter and critic, and has contributed reviews and articles to the Washington Post, the Washington City Paper, Newsday, Architect magazine, and other publications. He was an editorial assistant and staff writer at the now-defunct New York Press and arts editor at the online network in the 1990s, and was a weekly contributor of music and film reviews to the Washington Times from 2007 to 2014.

Click here for previous articles by Mazmanian. Connect with him on Twitter at @thisismaz.

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Reader comments

Mon, Aug 18, 2014 Dennis Murphey Virginia

In the mid to late 90s I was involved in a AHRQ SBIR called Smart Note, where we experimented with A. I. logic to drive query and response for Medical professional during exams. Later we bid a Phase II but funding was short. It seems with the techniques, technology and skills applied to financial analysis, predictive failure, aerospace and advertising we have all the tools needed to create much more robust informative medical record presentation with query support and hints to diagnosis etc. I applaud the look in analytics with VistA and want to see funded research to help us get there faster for the masses. It is not pure R&D but more of an Applied Science approach needed in Open Labs with standards in Open Arch with low cost basis such as Vista all the investment then goes to the solution. Great focus.

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