Analytics could drive the future of VistA

The next generation of VA's electronic health record should see benefits from agency advances in predictive analytics.

Shutterstock image: digital, global health.

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.

 

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.