By Sarianne Gruber
I think why analytics is “hot” is because there is so much Big Data and you are running numbers. It seems “cool” and “sexy”, but there is more to it. I do want to reiterate the point that it’s not just about giving someone the data—you need to tell them what it means and help the providers. That is what will ultimately help to move the needle to get to value-based care and to give them more meaningful information so that they can take action. –Raven David, MPH, Project Manager, Department of Biomedical Informatics at Columbia University Medical Center
Raven David, MPH, is a Project Manager for the Department of Biomedical Informatics at Columbia University Medical Center. Her career as an Informaticist is one that she says “she stumbled on.” As an undergraduate at the University of Pennsylvania, she studied Public Health and Urban Studies. It wasn’t until she was working at a local health department in Quality Improvement and Health Services Research, where she was managing the data from sub-grantees and other collaborating organizations. She realized how much she liked it because it complemented what she saw on a day-to-day basis interacting with these organizations. That was in 2008, and since then she finished both a Certificate in Health Informatics and a Master of Public Health in Healthcare Management at Columbia University. Raven’s current role is as the Project Manager for Columbia’s HI-FIVE program and formerly for a clinical decision support study on breast cancer prevention with Columbia University’s Department of Medicine. In a conversation with Ms. Raven David, MPH, she elaborated on the innovation occurring within informatics and the role of an Informatician in patient-centric care studies, as well as the success of the HI-FIVE online course for health professionals.
Have you seen the EHRs and health-related technology increase the demand for informatics and informaticians?
Ms. David: Absolutely! I am seeing that a lot especially due to Meaningful Use and HITECH. There is pretty much an EHR everywhere. Because of that, clinicians are more and more engaged with technology whether they like it or not. Seeing that there is a deluge of data. We have data coming from everywhere with so many sources. There is a need for people to not only get a grip on the data, wrangle it, and analyze it, but give the data meaningful action – that is key. Not only do you need people who have more of a technical background to manage all the data. What I am finding is that is really important, regardless of what role you are in, you should be able to understand and interpret the data and give actionable information. There is a “Data Smog.” And being able to step through that and make it easier for providers is a really key skill set for people who are wanting to become informaticians. You may know all the data, all the statistics, and all the programming, but if you can take it the extra step and give it context – that is really key.
Can you discuss a study where informaticists are making a significant contribution to patient care?
Ms. David: Coming from of our department is a Precision Medicine study, which I used to manage. The study is a unique example of collaboration led by a Department of Biomedical Informatics faculty member and a Breast Oncologist from the Department of Medicine. The study is called KYRAS: Know Your Risk Assessment at Screening for Breast Cancer. We collect data from patients based on an NCI algorithm from which we calculate the risk for breast cancer. We developed a patient decision tool to help them understand if they are low risk or high risk. In addition, we give them the appropriate information to help them make decisions and for them to then talk about with their provider. On the flipside, we have also created a clinical support tool for the providers. It is important to give information to both. The output from the clinical decision support tool is integrated into the EHR. We are working on getting the information on patient preferences from the patient decision aid into the EHR.
Patient preferences are very important. As part of a treatment plan, there are many shared decisions and the provider needs to understand what the patient wants and needs. There are different situations. Even if a patient is a high risk, the patient may not prefer to get chemoprevention. Another example is a patient who may want to get more information about the three different pills she has to take. She may not want to take one every day. It means in a daily sense – what is preferred by the patient’s perspective. So even just knowing the subjective contextual information from the patient, collecting that upfront could be helpful in making the encounter more effective and efficient from both the patient and provider perspective.
What does the work of an informaticist encompass? Many think of informaticists as using only clinical data, but the job is more than just clinical. Does the data come from the entire care spectrum, not just an ICD code or the number of times a patient comes to the office or hospital?
Ms. David: Yes. An Informaticist provides a comprehensive view of the patient. It is not just lab results or billing codes or claims data either. They are giving a more comprehensive picture than that. We have been using Natural Language Processing (NLP). Right now, we are working on parsing out provider notes using NLP notes. Using over a million notes and providing it in real time on the EHR. And there are algorithms behind that. We are trying to get more data that is comprehensive so you have the notes, the text, and patient information in both structured and unstructured data. It is not just numbers. I think that is probably a common misconception – that informatics and informaticians just work with numbers. They need to know statistics, programming, and algorithms. Yes, that is a huge part of it. Yet, information comes in a lot of forms and so does data.
How has technology and innovation been growing in the Department of Biomedical Informatics?
Ms. David: Our department is very unique. Columbia has been doing a lot of in-house development very, very early on. Our department has been working on EHRs since 1987, and they continue to build innovative features into the EHRs today. The data that we have available today is on 5 million patients to 600 million patients. We use it to discover drug interactions, important clinical states like glucose in diabetes patients, and kidney function. The OHDSI (Observational Health Data Sciences and Informatics) Group uses a method of data assimilation, which is used in weather prediction. They pair it with empirical data to do a better job of predicting glucose levels based on what you eat and how active you are. We contribute to the technology by creating algorithms to make it smarter. We have a history of development and products, but we do try to use other technologies and other software. We do a lot of in-house development because we have the history and the resources. We have our own clinical data warehouse. There is a collaboration between the academic and the real world application of the hospital affiliated with Columbia University Medical Center, just by the sheer nature of our department, which employees staff from both the academic department and the hospital We do both. I think that is why it is also helpful that technology contributes to innovation. We need more collaboration to become more innovative. And we need more innovation because healthcare is a unique beast.
What are the advantages of the HI-FIVE program for a healthcare professional?
The online HI-FIVE professional development/training program is geared for all healthcare professionals. One can learn about informatics tools and technology. Informatics leverages data into all data-driven care goals such as population health management, care coordination, value-based care, analytics, and patient-centered care. The ultimate goal of informatics is to deliver high-quality, cost-efficient care that is at the right time, and the care for the right person. HI-FIVE stands for Health Informatics For Innovation, Value, & Enrichment. The one-month online course uses a case study for real-world experience and accommodates self-paced learning. Find out more about HI-FIVE.