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greenbutton [2020/02/12 10:26]
nigam [Learn More]
greenbutton [2023/07/12 09:54] (current)
nigam [Learn More]
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-====== Clinical Informatics Consult at Stanford ======+====== Informatics Consultation Service at Stanford ======
  
-The **Clinical Informatics Consult** service was an IRB approved project to study the use of routinely collected data on millions of individuals for providing better careGiven a specific clinical question, we provided a report with a descriptive summary of similar patients in Stanford’s clinical data warehouse, treatment choices made, and observed outcomes.+The **Informatics Consultation service** was an IRB approved project to study the use of routinely collected data on millions of individuals to provide on-demand evidence in those situations where good evidence is lackingWe informed clinical care decisions by summarizing “what happened to patients like mine” in the form a report with a descriptive summary of similar patients in Stanford’s clinical data warehouse, treatment choices made, and observed outcomes. 
  
-We used demographicsdiagnosesprocedures, medications, laboratory values, clinical notes, mortality, and length of stay information for millions of patients to answer "What happened to other patients like mine?" This [[https://www.youtube.com/watch?v=zRwKm-Uhkiw | 3 minute animation]] summarizes the service we offered and this [[https://www.youtube.com/watch?v=6oEFK24s8yUshort video]] demonstrates the search engine that enabled the service.+The service embodied the [[https://shahlab.stanford.edu/greenbutton_idea | Green Button Idea]] outlined in a [[https://www.healthaffairs.org/doi/10.1377/hlthaff.2014.0099 | Health Affairs article]] in 2014. The study concluded in August 2019. We responded to 100 consultation requests by 53 users from multiple specialties. Of the 83 requests we fulfilled52 consultations guided further research17 led to follow up investigations and 10 directly informed patient care. This [[https://www.youtube.com/watch?v=zRwKm-Uhkiw|3 minute animation]] summarizes the workflow of the service we offered during the study and the results are described in [[https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0224 | a NEJM Catalyst article]]. 
 + 
 +To scale the concept nationally, we launched [[https://www.atroposhealth.com/ | Atropos Health]] and lay out the journey ahead in a [[https://hbr.org/2023/05/how-medical-records-can-close-the-information-gap-in-patient-care | Harvard Business Review article]].  
 + 
 +===== How to use ===== 
 + 
 +  * If you are a stanford physician, please see the [[https://stanfordhc.service-now.com/esm?id=kb_article_view&sysparm_article=KB0578398 | quick start guide]] on our intranet. 
 +  * For setting up such a service at your institution, reach out to [[https://www.atroposhealth.com/contact | Atropos Health]].
  
-The study ended in August 2019, and we are writing up the findings. To know more about setting up such a service at your institution, please e-mail **[[greenbutton@stanford.edu|]]**. 
  
 ===== Learn More ===== ===== Learn More =====
  
 +[[https://stanmed.stanford.edu/2016winter/on-the-button.html|Read the story]] of how the [[https://med.stanford.edu/news/all-news/2015/10/the-promise-of-personalizing-medical-practice-guidelines-in-real-time.html| Green Button]] idea, [[https://shahlab.stanford.edu/doku.php?id=service_details| step-by-step]] became the [[https://stanmed.stanford.edu/2019summer/millions-ehr-harnessed-ultimate-consult-each-patient.html| Informatics Consultation Service]],  as an IRB approved study. This work is part of the larger vision of being Digitally Driven at [[https://stanfordhealthcare.org/stanford-health-now/ceo-report/biomedical-insights-putting-data-science-to-work-for-patients.html| Stanford Health Care]]. Learn about the [[http://shahlab.stanford.edu/ACE|Advanced Cohort Engine]] (ACE) that enabled the service. 
  
 {{youtube>fuyVriaq5Vk?small | One minute video on the Informatics Consult Service}} {{youtube>fuyVriaq5Vk?small | One minute video on the Informatics Consult Service}}
  
-One minute video on the Informatics Consult Service.+One minute video on the Informatics Consult Service. Read about [[https://stanmed.stanford.edu/millions-ehr-harnessed-ultimate-consult-each-patient/ |harnessing millions of de-identified patient records for the ultimate consult]].
  
 ---- ----
  
-{{vimeo>375462436?small | NIH Collaboratory}}+{{youtube>w9Jm04ZxPLw?small | Three minute video on the Service featured by the National Library of Medicine}}
  
-Grand Rounds at the NIH Collaboratory on Nov 22, 2019+Three minute video on the Service featured by the National Library of Medicine. Including congressional testimony by Dr. Patricia Brennan.
  
 ---- ----
  
-[[https://stanmed.stanford.edu/2019summer/millions-ehr-harnessed-ultimate-consult-each-patient.html|Read our story]], [[:service_details| learn how we got started]], check out our [[https://stanfordhealthcare.org/stanford-health-now/ceo-report/biomedical-insights-putting-data-science-to-work-for-patients.html| CEO's annual report]] and {{:shc_data_science_for_patients.pdfbrochure}}, or NLM Director Dr. Patricia Brennan's [[https://www.youtube.com/watch?v=h-d7LPCxtHo&t=2220 | Congressional testimony]] on Investments in Medical Research at Five Institutes & Centers of the NIH.+{{vimeo>375462436?small NIH Collaboratory}}
  
-===== Example Consultations =====+Grand Rounds at the NIH Collaboratory on Nov 22, 2019. Read about the impact of [[https://catalyst.nejm.org/doi/full/10.1056/CAT.21.0224 | Using Aggregate Patient Data at the Bedside via an On-Demand Consultation Service]] in the NEJM Catalyst. 
  
-  How frequently was a positive procalcitonin (defined as a result ≥ 0.5 or ≥ 2.0) associated with a positive blood culture in adults between 2013 and 2017? [[https://drive.google.com/file/d/1Za2raSDIwDaDQj_tVTN0fKqeLyhwQZz9/view?usp=sharing|See report]]. +----
-  Of patients administered opioids as inpatients or prescribed opioids as an outpatient and discharged with adequate, inadequate, or no bowel regimen, how many suffer constipation, bowel perforation, or colitis within the 30-day post-discharge period? [[https://drive.google.com/file/d/1--fXMkiW2_cmp3jZCIcKMcg0dLkTjjXe/view?usp=sharing|See report]]. +
-  - In female patients at least 18 years old and diagnosed with a urinary tract infection, and prescribed a sulfonamide antibiotic, is there any difference in peak blood glucose after treatment compared to patients prescribed a cephalosporin antibiotic or penicillin derivative antibiotic? [[https://drive.google.com/file/d/1jg0jwH9MivsIneOQ1SKWa65WEBzgONh1/view?usp=sharing|See report]]. +
-  - What is the population of admitted children (age 1 year - 17 years inclusive) who have acute kidney injury (AKI; defined as > 1.5x their baseline creatinine value) within the first 7 days of admission? [[https://drive.google.com/file/d/1_3_CugtlEpwMKxzJkYjanZ6VUV-NOOZq/view?usp=sharing|See report]]. +
-  - How many patients aged 0 to 17 years received a new diagnosis of fever of unknown origin (FUO), Kawasaki disease, apparent life-threatening event or brief resolved unexplained event (ALTE/BRUE), or seizure (febrile, simple partial, complex partial, generalized idiopathic epilepsy) in the year 2016? [[https://drive.google.com/file/d/1ttu3CKyZKa2VS8u2jvUFJxLapoTuQ5YS/view?usp=sharing|See report]].+
  
-===== Consult Team ===== 
  
-  * [[https://med.stanford.edu/profiles/166781|Saurabh Gombar MD, PhD]] +===== Example Consultations =====
-  * [[https://med.stanford.edu/profiles/alison-callahan|Alison Callahan, PhD]] +
-  * Vladimir Polony +
-  * Ken Jung, PhD +
-  * [[https://med.stanford.edu/profiles/nigam-shah|Nigam Shah MBBS, PhD]] (Principal Investigator) +
-  * [[https://profiles.stanford.edu/robert-harrington|Robert Harrington, MD]] (Executive Sponsor)+
  
-===== Data Science Collaborators =====+  - In a young patient presenting with mononeuritis multiplex what is their ultimate diagnosis? [[https://drive.google.com/file/d/12hXIH1T7IoAN2SR0lAVIpN5tOiPeZXeo/view?usp=sharing|See report]]. 
 +  - Is there a relationship between HSV or VZV infection in patients treated with PD-1/PD-L1 inhibitor immunotherapy? [[https://drive.google.com/file/d/1Mr8sB8DA7I9jXoOq7uSWYXefZYEIvKoq/view?usp=sharing|See report]]. 
 +  - Between 2013 and 2017, in women, men, adults ≤ 45 years old and adults > 45 years old, how frequently was a positive procalcitonin (defined as a result > 0.5) associated with a positive blood culture?[[https://drive.google.com/file/d/1UEsKDuaSj226EZJrDjIYxZyZs_ZJ2Nb8/view?usp=sharing|See report]].
  
-  * [[https://profiles.stanford.edu/robert-tibshirani|Robert Tibshirani, PhD]] 
-  * [[https://profiles.stanford.edu/trevor-hastie|Trevor Hastie, PhD]] 
  
  
greenbutton.1581532011.txt.gz · Last modified: 2020/02/12 10:26 by nigam