By Patrick Dickey, Developer
At FDI, we spend a lot of time working with legacy electronic health record (EHR) systems and thinking about ways to help our customers use legacy data to improve care and business operations. One way to do this is to serve historical patient data visually through graphs and charts. These visualization tools are now available in Flatirons Digital Hub for Healthcare.
Let’s look at some demonstration clinical data to visualize (see what I did there?) how healthcare providers can use historical clinical data to improve care.
Encounters Are Important
Clinicians tell us that their delivery of care is centered around encounters. Vitals, medications, assessments, orders, and order results frequently occur within the context of an encounter. To support that modality, Flatirons Digital Hub provides pages that show data for a single encounter:
Figure 1 – Vitals for an Encounter
Building Context with Historical Patient Data
That approach works well for clinicians or HIM staff who have a priori knowledge that allows them to research a particular timeframe or have reason to look at patient information for a particular encounter.
However, we realized that this view might be a bit too narrow. For our demo patient Bill Foley, let’s imagine he presents symptoms consistent with COPD and the provider considers prescribing an opiate to reduce the sense of shortness of breath.
The provider is wondering about prior opiate usage and is concerned about possible side effects. The patient mentions a hospital admission through the emergency department (ED) several years ago for severe shortness of breath. The current EHR does not contain data from that time frame and hospital, and his current demographics and medication list appears incomplete based on an in-office assessment.
Accessing Flatirons Digital Hub (the central repository for legacy EHR data), the provider looks across all encounters for Bill to see O2 Sat % over time.
Figure 2 – Encounter Data
The provider sees encounters from 2015, but the tabular data doesn’t facilitate a way to see larger trends.
With visualization tools, the provider can see the trend in a graph:
Figure 3 – Visualization of Vitals
The provider can immediately see that Bill’s O2 Sat % was relatively low in November 2015. She can also narrow the visualization date range:
Figure 4 – Visualization for a Date Range
The data shows only one incident of an O2 Sat < 92%, so the data doesn’t seem to indicate a significant problem. But since this historical data is available, the provider looks around a bit more. She checks to see if there’s more profile information that may aid in determining the proper care. [/av_textblock] [av_image src='https://fdiinc.com/wp-content/uploads/2020/02/5-ProfileData.png' attachment='5921' attachment_size='full' align='center' styling='' hover='' link='lightbox' target='' caption='' font_size='' appearance='' overlay_opacity='0.4' overlay_color='#000000' overlay_text_color='#ffffff' animation='no-animation' admin_preview_bg='' av_uid='av-tfspk'][/av_image] [av_textblock size='' av-medium-font-size='' av-small-font-size='' av-mini-font-size='' font_color='' color='' av-desktop-hide='' av-medium-hide='' av-small-hide='' av-mini-hide='' id='' custom_class='' template_class='' av_uid='av-97hfbs' sc_version='1.0']
Figure 5 – Profile Data
The provider notices that Bill has a family history of COPD. She then looks at Bill’s medications as reported in the historical patient records stored in Flatirons Digital Hub:
Figure 6 – Medications
She notices an Albuterol prescription, which gives her an insight that Bill may have previously been diagnosed with respiratory issues.
The provider then filters for opiates and looks at medications across all encounters. She sees significant use of both morphine and oxycodone:
Figure 7 – Opiate Prescriptions
Having gotten a view of all of Bill’s encounters and zeroed in on one encounter, she can now look at that encounter to see what assessments were provided.
Figure 8 – Encounter Assessments
From looking at admission notes and plan of care, she determines that Bill fell at home, hurt his hip, and was admitted to the hospital through the ED.
Looking at assessments of mobility, bowel function, and cognition, the provider determines that at the time of that encounter, there was no clinical indication suggesting a COPD diagnosis. However, the family history of COPD and Bill’s current shortness of breath suggest a possible disease progression. The prolonged use of opiates during that period is cause for concern.
By using visualization and other data reporting tools available in Flatirons Digital Hub, our hypothetical provider now has a solid historical context for this patient to provide well-informed care. The ability to both access and visualize historical patient data in a wide variety of formats allows the provider to optimize the delivery of care.