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Precision monitoring to transform health care: Right data, right person, right time

IU School of Medicine • 10/19/15

INDIANAPOLIS — Precision medicine – prevention and treatment strategies taking individual patient variability (genes, environment, lifestyle) into account – is emerging as a way to revolutionize the practice and outcomes of medical care. In a similar way, with the advent of electronic health record systems in hospitals and doctors’ offices, precision monitoring of care – using available information on an individual to ensure that the right person receives the right data at the right time – also is emerging as a way to promote high quality, efficient care and improve patient outcomes. 

With the support of a new $5 million award from the U.S. Department of Veterans Affairs, researcher-clinicians with the Richard L. Roudebush VA Medical Center, the Regenstrief Institute and Indiana University School of Medicine are at the forefront of this change.

The new VA award funds the unique five-year, multi-site Precision Monitoring (PRIS-M) program. PRIS-M will use existing VA electronic health data to implement actionable, personalized, timely monitoring to generate data to transform care quality and outcomes.

Projects will take place in various health care environments including the Emergency Department, inpatient units and outpatient units, and will focus on diverse medical conditions. In addition to studying the technical solutions to precision monitoring, investigators also will study how providing actionable data can be used to activate healthcare providers and teams to engage in improvement activities without drowning in information overload.

“The VA is the single largest provider of health care in the United States with a wealth of patient information and a single unified electronic health record. It is ideally poised to apply precision monitoring to transform care and outcomes for veterans and to exert national leadership in this important area,” said co-principal investigator of the new program, Linda S. Williams, M.D.

“The potential impact of our study is vast,” said Dr. Williams. “I believe what we are dealing with in the VA is similar to what other healthcare systems will encounter as they move forward to meet new government regulations and envision and manage care as an accountable care organization rather than as a single hospital or clinic.” Dr. Williams is an investigator with the Roudebush VA Medical Center in Indianapolis and the Regenstrief Institute, and a professor of neurology at the IU School of Medicine.

“The VA’s expertise and experience with patient-specific electronic medical data may help identify strategies to ensure that patients receive the best care and, importantly, are not lost to follow-up,” said study co-principal investigator Dawn Bravata, M.D. “Precision monitoring is critical to that care; there are facility, cultural and medical-specialty variations in how data are used which we must overcome.” Dr. Bravata is an investigator with the Roudebush VA Medical Center and the Regenstrief Institute, and a professor of medicine at the IU School of Medicine.

The new grant supports four precision monitoring related projects. All focus on delivering the right information to the right person at the right time.

  1. Nationwide implementation of electronic quality indicators for inpatient stroke care (led by Dr. Williams)
  2. Use of patient-specific data and telehealth technology to facilitate improvement in care for veterans with transient ischemic attack (led by Dr. Bravata)
  3. Remote monitoring of continuous positive airway pressure for patients with sleep apnea (led by Dr. Bravata and funded with an additional $100,000 grant from the Roudebush VA Medical Center)
  4. Reduction of inappropriate carotid artery imaging orders (led by Salomeh Keyhani, M.D., MPH of the San Francisco VA and UCSF)

“We have learned from past studies led by Drs. Williams and Bravata that there are lots of variations in how stroke is treated throughout the VA. We want to make data on the best care available to clinicians and to managers and help them use it in real-time. That’s the goal of PRIS-M,” said co-principal investigator Teresa Damush, Ph.D., who leads the implementation and data core which supports all four projects. She is an investigator with the Roudebush VA Medical Center and the Regenstrief Institute, and an associate research professor of medicine at the IU School of Medicine.

Recurring themes throughout PRIS-M’s five-year program will include assessment and evaluation of how the context of care influences use of data, as well as the identification of how clinical champions help facilitate data sharing and promote ongoing quality improvement. This work will be directed by Dr. Damush and Edward Miech, Ed.D., an investigator with the Roudebush VA Medical Center and the Regenstrief Institute, and an IU School of Medicine assistant professor of emergency medicine.

“There are a lot of data in the VA electronic health record, but it’s hard to access and to work with without adequately prepared staff, who understand the clinical and technical aspects of our data,” said Dr. Miech. “Many VAs and other hospitals don’t have this capability, so with PRIS-M we hope to develop and test tools and implementation strategies that make data accessible and beneficial when and where needed in ways that will help patients in the VA and eventually those in other facilities.”  

Regenstrief Institute health services researchers drive high-impact lines of patient-centered research in university-based, community-based and veterans healthcare systems.