BigMouth: A multi-institutional dental data repository · Odontogram 1,903,625 Periodontal Chart...
Transcript of BigMouth: A multi-institutional dental data repository · Odontogram 1,903,625 Periodontal Chart...
Outline
• DemonstrationofBigMouth• DataGovernance(howtocontributeandaccess)
• DataStandardizationinDentistry• ExamplesofResearchProjectsusingBigMouth• DentalQualityMeasurement
BigMouth• BigMouthcontainsdatafromsixdentalschools• BigMouthallowsnon-technicaluserstoquerytheaxiUm data• Dataavailable- Demographics,Diagnosis,Procedures,Forms,
Odontogram,Perio,Medication,Insurance,Practice
HarvardaxiUm
UCSFaxiUm
TuftsaxiUm
UPitt axiUm
UMichiganaxiUm
Extractscripts
Extractscripts
Extractscripts
Extractscripts
Extractscripts
SFTPserver
Loadscripts
UTNetwork
Extractedfiles
UTSDaxiUm Extractscripts
ElectronicHealthRecords(EHRs)
• Increasedadoptionindentistry
• Largeamountandvarietyofdata
• MajorityofUSDentalSchoolsusesameplatform
• Unstructureddata
• DatacollectedforTreatment,Payment,Operations
• LimitedstandardizationNodiagnosticterminologyuntilrecently
DatainaxiUm• PatientInformation– Demographics,vitals,height,weight,zipcodeetc.
• Dentalinformation– Treatments,Diagnoses,DentalHistoryetc.
• Medicalinformation– MedicalHistory• Medication– Currentmedication,Prescriptionetc.• Toothlevelinformation– Odontogram,DMFS/DMFT• PeriodontalChart• Educational– StudentsandResidents,Grades• Financial– Billing,Insurance
BenefitsofusingEHRdataforresearch
• Lowercostandquickerthantraditionalclinicalresearch1
• Patientsratherthanresearchsubjects1
• Datareadilyavailable• Potentialofusingtheseresource
to generate abstracts/proposals• Opportunitytodevelopscholarlyportfolio
1MeiSong,Kaihong Liu,RebeccaAbromitis,TitusL.Schleyer,Reusingelectronicpatientdatafordentalclinicalresearch:Areviewofcurrentstatus,JournalofDentistry,Volume41,Issue12,December2013,Pages1148-1163
ChallengesofusingEHRdataforresearch
• Clinicalnotes(freetext)arenotreadilyqueryable1
• Dataqualityissues1– Incomplete,Missing(e.g.Ethnicity)– Inaccurate(e.g.selfreporteddata)– Inconsistent(Codingissues)
• EthicalIssues(e.g.PatientPrivacy)• Datamaybeidiosyncraticandmaynotbegeneralizable1
1MeiSong,Kaihong Liu,RebeccaAbromitis,TitusL.Schleyer,Reusingelectronicpatientdatafordentalclinicalresearch:Areviewofcurrentstatus,JournalofDentistry,Volume41,Issue12,December2013,Pages1148-1163
DatainBigMouth#ofpatients
#ofpatientsDemographics 2,178,816Diagnosis 301,970Procedures 1,223,806Forms 462,001Odontogram 1,903,625PeriodontalChart 227,369PrescribedMedication 141,613Insurance 444,727
LinkingMedicalandDentalRecordsUsinganeMPI
TheEnterprise-wideMasterPatientIndex:
• Adatabaseofallpatientsacrossanorganization,eachassignedauniqueID.
• Matchespatientsacrosssystemsusing“essentialdata”:– Name,Gender,DateofBirth,RaceandEthnicity,SocialSecurityNumber,CurrentaddressandContactinformation
• Necessaryforthemaintenanceofaccuratedemographicandclinicaldata
Joffe,E.,Byrne,M.J.,Reeder,P.,Herskovic,J.R.,Johnson,C.W.,McCoy,A.B.,...&Bernstam,E.V.(2014).Abenchmarkcomparisonofdeterministicandprobabilisticmethodsfordefiningmanualreviewdatasetsinduplicaterecordsreconciliation. JournaloftheAmericanMedicalInformaticsAssociation, 21(1),97-104.McCoy,A.B.,Wright,A.,Kahn,M.G.,Shapiro,J.S.,Bernstam,E.V.,&Sittig,D.F.(2013).Matchingidentifiersinelectronichealthrecords:implicationsforduplicaterecordsandpatientsafety. BMJquality&safety,22(3),219-224.
DataAvailability
UTP:AllScripts - 1,234,423
patients
SOD:axiUm-327,175
Patientoverlap44,188patients
Medical
Dental
Asof01/17/2017
DataGovernance
1. Adheretoprivacyandsecurityrequirements
2. Accessprovidedtothoseinstitutionsthatcontribute
3. Eachsourcesiteretainscontrol/ownershipofcontributeddata
4. Projectreviewcommitteeapprovalrequiredforuseofdataforspecificresearchprojects
5. Continuouslyassessandimprovethequalityofdata
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DataGovernance2.0
1. Adheretoprivacyandsecurityrequirements
2. Accessprovidedtoresearchersfromnon-profitinstitutions
3. Eachsourcesiteretainscontrol/ownershipofcontributeddata
4. Projectreviewcommitteeapprovalrequiredforuseofdataforspecificresearchprojects
5. Continuouslyassessandimprovethequalityofdata
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HowtoAccessBigMouth• ContributingInstitution
– Signupathttps://bigmouth.uth.edu/
• Level1Access– ExplorethedatausingtheBigMouthWorkbench
• Level2Access– SubmitproposaltoResearchReviewCommittee
• IRBApproval– Receivedatasettoconductanalysis
• Fillouttheresearchdatarequesttemplate
HowtobecomeaContributingInstitution
• COHRImemberinstitutionseligible
• Completeadatauseagreement
• IRBapproval
www.cohri.org
VISIONTobeleadingexpertsininformaticsfororalhealth
research,education,andpatientcare
MISSIONCOHRIwill:Ø Create,standardize,integrateandsharedatausingelectronic
healthrecords
Ø Improveinformaticsutilizationindentaleducation,healthcare,andresearch
Ø Workcollaborativelytodevelopresearchprojectstopromoteevidencebaseddentistry
Current Member Institutions (n = 40)AcademicCentreforDentistry(ACTA)BaylorUniversityColumbiaUniversityCreightonUniversityHarvardIndianaUniversityLECOM BradentonLomaLindaMedicalUniversityofSouthCarolinaMeharry MedicalCollegeMidwesternUniversityDownersGroveNewYorkUniversityNovaSoutheasternUniversityOregonHealth&ScienceUniversitySouthernIllinoisUniversityTempleUniversityTuftsUniversityUniversityofCalifornia,SanFranciscoUniversityofColoradoUniversityofFlorida
UniversityofIllinoisUniversityofKentuckyUniversityofLouisvilleUniversityofMichiganUniversityofMinnesotaUniversityofNewEnglandUniversityofNevadaLasVegasUniversityofOklahomaUniversityofPacificUniversityofPuertoRicoUniversityofPittsburghUniversityofSharjah,UAEUniversityofSouthernCaliforniaUniversityofTennesseeUniversityofTexas, HoustonUniversityofTexas, SanAntonioUniversityofWashingtonVirginiaCommonwealthUniversityWestVirginiaUniversityWillametteDentalGroup
COHRI Resources
1. Adult medical and dental histories
2. Pediatric medical and dental histories
3. Problem list
4. Dental Diagnostic System (DDS)
5. Caries risk assessment (long + short)
6. BigMouth Dental Data Repository
ExamplesofResearchProjects
TheValueofUsingaDentalDiagnosticTerminologyinanElectronicHealthRecord– Kalenderian etal.
• Goal:FindpatientsdiagnosedwithmoderatechronicperiodontitiswhoreceivedtreatmentaccordingtocurrentAmericanAcademyofPeriodontology(AAP)guidelines.
• Dataused:DiagnosisandProcedures
Kalenderian E,Tokede B,Ramoni R,KhanM,Kimmes N,WhiteJ,Vaderhobli R,YansaneA,Feilzer A,WaljiMF.Dentalclinicalresearch:anillustrationofthevalueofstandardizeddiagnosticterms.JournalofPublicHealthDentistry.2015.Oct30.doi:10.1111/jphd.12124.
Efficacyandaccuracyofpre-doctoralperiodontaleducationintheUS:Anevaluationofthegeneralistandspecialistteachingmodelsonperiodontaleducation– AliSajadi,DDS
• Goal:Tounderstandtheaccuracyofdiagnosisbyanalyzingclinicalchartingparametersanddiagnosticcodesbyfinalyearstudents
• Dataused:Diagnosis
Partial-mouthperiodontalexaminationprotocolforestimationofprevalence,severityandextentofperiodontitis– Tranetal.
• Goal:Thisprojectaimstoidentifyapartial-mouthperiodontal;examinationprotocolwhichcloselyapproximatesafull-mouthperiodontalexaminationprotocolinestimatingprevalence,severityandextentofperiodontitis inpopulation
• Dataused:Perio,Forms
Associationbetweenobesityandperiodontitis:Cross-sectionalstudyonpatientsvisitinguniversities'dentalclinics- Tranetal.
• Goal:Evaluateperio initialexamofobesepatients.• Dataused:axiUm (Perio,medicalanddentalhistoryand
Missingteeth)andAllScripts (Diagnosis,medicalhistoryetc.)
StatinUseisInverselyCorrelatedwithSymptomaticEndodonticDiagnoses– Kanwal etal.
• Goal:Thepurposeofthisretrospectivestudywastoverifyifcorrelationsexistbetweenendodonticdiagnosesandstatinuse.
• Dataused:Forms,Procedure
AssessmentofDiagnosedTemporomandibularDisordersandOrofacial PainConditionsbyPre-doctoralDentalStudents– Adibi etal.
• Goal:Thepurposeofthisstudywastoassessthedegreetowhich1)patientsreportsignsandsymptomsofTMD/OFP,2)ifpre-doctoraldentalstudentdiagnoseTMD/OFP,and3)ifpatientsreceiveanytreatmentforTMD/OFP.
• Data:Forms,Procedures,Diagnosis,Provider
Adibi SS,Kookal KK,Fishbeck NM,ThompsonCR,WaljiMF.AssessmentofDiagnosedTemporomandibularDisordersandOrofacialPainConditionsbyPredoctoral DentalStudents:APilotStudy.JDentEduc 201680:1450-1456.
ImplementingDentalQualityMeasuresinPractice
Ø R01,5-YearNIH/NIDCRGrantØ UTHouston,HSDM,UCSF,WDGØMarch012015– February282020
1. Assessdentalqualitymeasureimplementationfeasibilityandvalidityacross4coresites.
2. Implementvaliddentalqualitymeasuresacrossall11sitesandassessinter-sitevariation.
3. DevelopusefulandusableDentalQualityMeasuredashboardviewsandfunctionalitytosupporttheinterpretationofdentalqualitymeasures
WhatisQuality?
“Thedegreetowhichhealthservicesforindividualsandpopulationsincreasethelikelihoodofdesiredhealthoutcomesandareconsistentwithcurrentprofessionalknowledge.”
IOM
https://www.nationalacademies.org/hmd/Global/News%20Announcements/Crossing-the-Quality-Chasm-The-IOM-Health-Care-Quality-Initiative.aspx
WhatareClinicalQualityMeasures?
• Clinicalqualitymeasures,aretoolsthathelpmeasureandtrackthequalityofhealthcareservicesprovided
• CQMMeasure:– healthoutcomes– clinicalprocesses– patientsafety– efficientuseofhealthcareresources– carecoordination– patientengagements– populationandpublichealth– adherencetoclinicalguidelines
MeasuredomainsClinicalqualitymeasures:
ProcessPercentageofelevatedcariesriskpatientswhowereprescribedahighconcentrationfluoridetoothpaste
Access Percentageofelevatedcariesriskpatientswhovisitedadentalclinic
OutcomesPercentageofelevatedcariesriskpatientswhoremaineddiseasefreeinthepastyear
StructureDoesthehealthcarefacilityusesEHRs?
PatientSatisfactionPatientreportsthedentistcommunicatedwellwithhim/her
https://www.qualitymeasures.ahrq.gov/about/domain-definitions.aspx
TenDentalQualityMeasures1. DiabetesandAnnualOralEvaluation2. Sealants3. TobaccoScreeningandCessationCounseling
Intervention4. CariesRisk5. CariesTreatment6. CariesOutcomes7. PeriodontalRisk8. PeriodontalTreatment9. PeriodontalOutcomes10. PregnancyandOralEvaluation
Whatpercentageofdiabeticsreceiveanannualoralexamination?
NUM: Numberofdiabeticswhoreceivedthefollowingdentalexaminationprocedures:D0150,D0120&D0180inthemeasurementperiod
DEN: Dentalpatients,whoreportedhavingdiabetes,ofrecordinthedentalclinicinthereportingyear
MeasureScore
%
Claimsdataà EHR
ApproachforEvaluatingDQM1. DevelopmentofEHRquery
2. Calculatesamplesizesneededtoreview
3. 2Reviewersindependentlyreviewed50charts
4. Inter-raterreliability
5. Singlereviewofremainingcharts
6. Calculationofsensitivity,specificity,NPV,PPVandKappa
7. Identificationofwhypatientsdidnotreceiveoralevaluation
8. Developandevaluateimprovedmeasure
InitialEHR-Measureresults:
NUM: Howmanyreceivedthefollowingprocedures:D0150,D0120&D0180inthemeasurementperiod
DEN: Dentalpatientsofrecord,whoreportedhavingdiabetes,inthedentalclinicinthereportingyear
MeasureScore
60.3%*MeasureScore
71.7%**
*ManualReview**Automatedquery
Initial EHR measure
Overall Score
ManualReview(n= 1,242)
Measure rate:60.3%(95% CI; 58-63%)
P<0.0011
AutomatedQuery(n=12,960)
Measure rate:71.7%(95% CI; 71-72%)
Sensitivity 93% (95% CI; 90.7-94.5) of the time thatmanualreviewrevealedOralEvaluation,thequery
identifiedOralEvaluationSpecificity 100% (95% CI; 100-100) of the time that the
manual review did not reveal Oral Evaluation, the query did not identify Oral Evaluation
Positive Predictive Value
100% (95% CI; 100-100) of the time that the query identified Oral Evaluation, the manual
review revealed Oral EvaluationNegative Predictive Value
100% (95% CI; 100-100) of the time that the query did not identify oral evaluation, the manual
review did not reveal oral evaluation
WhydidDiabeticsNotReceiveanOralEvaluation?
• Group1:Reasonsthatjustifiedthepatientbeingexcludedfromthedenominator
• Theselectionofeligiblepatientsintheinitialmeasuredidnotfollowanexclusioncriteria
Group Category– Reasons forExclusion
1 Patientswerediscontinued2 Edentulous
3 Patientreportedforlimited/emergency/urgent./specialistcareonly
4 Lessthanayearofvisit5 Miscoded
WhydidDiabeticsNotReceiveanOralEvaluation?
• Group2:Reasonsthatjustifiedthepatientbeingincludedinthenumerator
• ToincludeonlycomprehensiveperiodontalevaluationORcomprehensiveoralevaluationORperiodicoralevaluationmayunderestimatethecarepatientsreceived
Category– ReasonsforInclusionOtheracceptablePeriodontalcare:Adult Prophylaxis(D1110)Periodontalmaintenance(D4910)Fullmouthdebridement(D4355)Scalingandrootplaningofonetothreeteeth(D4342)Scalingandrootplaningoffourormoreteeth(D4910)Periodontal ChartCompleted orInProgressDentalProceduresunderPlanned andinconjunctionwiththeDDSterminology
RevisedEHR-qualityMeasurescores:
NUM
DEN
MeasureScore
82.3%*MeasureScore
83.9%**
*Manualreview**Automatedquery
Initial EHR measure Revised EHR measure
Overall Score
ManualReview(n= 1,242)
Measure rate:60.3%(95% CI; 58-63%)
P<0.0011 ManualReview(n= 710)
Measure rate:82.3% (95% CI; 79-85%)
P =0.2601
AutomatedQuery(n=12,960)
Measure rate:71.7%(95% CI; 71-72%)
AutomatedQuery(n= 13,221)
Measure rate:83.9% (95% CI; 83-85%)
Sensitivity 93% (95% CI; 90.7-94.5) 99% (95% CI; 98.7-100) P <0.001
Specificity 100 (95% CI; 100-100) 90% (95% CI; 85.0-95.2) P <0.001
Positive Predictive Value
100 (95% CI; 100-100) 98% (95% CI; 96.5-99.0) P <0.001
Negative Predictive Value
100 (95% CI; 100-100) 98% (95% CI; 94.8-100) P <0.001
Measure rates for the Initial and Revised EHR-Measures across four sitesfor both automated query and manual reviews.
1 – Relationshipbetweenmanualandautomatedqueriescalculatedwithtwosampletestofproportions2- Relationshipbetweenofthevalidationanalysisbetweentheadaptedandrevisedmeasurescalculatedwithtwosampletestofproportions
NextSteps
• Scalability
• Standardization
• Sustainability
• LinkingtoMedicalData
• LinkingtoGenomicData
BigMouthTeamUT-Houston• MuhammadWaljiPhD• KrishnaKookal M.S• JosephApplegate• SusanGuerrero
Tufts• BrittaMagnuson,DMD• MattJohnston
UCSF
Harvard
• Elsbeth Kalenderian DDS,MPHPhD• JoelWhiteDDSMS• BingEspiritu
• GermanGallucci DMD,PhD• ScottJason
Univ of Pittsburg• PatrickHetherington
Univ of Michigan• WillyWangsa
DQMTeamUT-HoustonMWalji(PI)ANeumannKKookalSKumarSBangarCVanStrienJModha
UCSFEKalenderian(PI)JWhiteEni ObadanAYansaneRVaderhobliBMertz
Harvard
BTokede
J Etolue
WillametteDentalGroup
KSimmonsJEvensJMullinsEBlagaTGuy
AcknowledgementsG08LM010075 (NLM):DevelopmentofanInter UniversityOralHealthResearchDatabase
R01DE021051(NIDCR):ACognitiveApproachToRefineAndEnhanceUseOfADentalDiagnosticTerminology
R01DE023061 (NIDCR):AWholeSystemsApproachToImplementingStandardizedDentalDiagnosticTerms
R01DE022628 (NIDCR):DevelopingaPatientSafetySystemforDentistry
R01DE024166 (NIDCR):ImplementingDentalQualityMeasuresinPractice
• Thankyoutoourresearchteammembers!