Improving Population Health Through Enhanced Targeted Regional Decision Support

Agency for Healthcare Research and Quality (AHRQ)
September 30, 2011 – September 29, 2016

The objective of this proposal is to improve the effectiveness of acute and preventative care processes by streamlining information sharing and enhancing information quality among healthcare providers and population health stakeholders using novel decision support and clinical messaging tools. The central hypothesis of this proposal is that automated data capture and provider alerts will improve time-to-treatment, simplify provider-based population health reporting workflows, and result in a more accurate assessment of population-based disease burden.

Indiana PROSPECT

Agency for Healthcare Research and Quality (AHRQ)
September 30, 2010 – September 29, 2013

The Indiana PROSPECT builds on the nation’s largest, most sophisticated health information exchange that already contains over 4 billion structured observations and 75 million text documents for over 12 million patients. This resource is already used for a variety of clinical outcomes and clinical effectiveness research.  Based on our analysis of gaps in the infrastructure and experience gained by conducting a specific CER study as part of the PROSPECT, we will enhance this infrastructure to capture richer clinical data and particularly enhance our ability to incorporate patient outcomes, improved capture of device utilization data, capabilities to incorporate genomic and other high throughput results, advanced technologies to identify patient for recruitment and enrollment technologies.

In order to demonstrate the usability of this environment and to inform its further development, we propose to conduct a novel CER project evaluating treatment for Alzheimer’s.  The CER study will evaluate of medication treatment for behavioral symptoms of Alzheimer’s disease. Alzheimer’s disease has been identified as a first quartile CER priority. We will build on our established governance approach to test and improve approaches for sharing access to these research databases and financial models for sustainability based on value created.

IN Challenge Grant Supplemental (Challenge Category Theme #4): Aspiring to Awesome: Advanced Query for Patient Care

Federal pass-through source: IHIT – Indiana Health Information Technology, Inc.

May 1, 2011 to March 31, 2014

The goals of this proposal towards having a national health IT ecosystem are to:  Firstly, surface “deep” content from EMRs and other clinical systems as individual data elements and associated metadata, normalize the EHR data to facilitate sharing, and expose the normalized data for search. Secondly, create an ethics framework that encourages patient autonomy, privacy, and trust, while optimizing medical care of the individual and the public, and create a usable, browser based user interface that will allow patients to specify sharing and privacy preferences. And lastly, demonstrate the utility of our data element based approach by creating a sophisticated web based search and parallel filtering user interface for providers that incorporates patient preferences and is supported by the ethics framework.

Center of Excellence in Public Health Informatics (ICEPHI)

September 1, 2009 through August 31, 2013

Funding source: Centers for Disease Control

This collaborative seeks to enhance the ways public health practitioners exchange information effectively with other community partners, such as healthcare providers, regional health information organizations, and health plans, and respond to the information. 

Clinical Decision Support Consortium

March 5, 2008 through March 4, 2012

Funding source: Agency for Healthcare Research and Quality

Investigators and developers of electronic health records from both academia and industry have come together to form the Clinical Decision Support (CDS) Consortium. Members are intimately involved in creating and providing CDS tools and services in electronic health records used in both academic settings as well as community-based physician office practices. The goal of this contract is to assess, define, demonstrate, and evaluate best practices for knowledge management and clinical decision support in healthcare information technology at scale – across multiple ambulatory care settings and HER technology platforms.

Creation, Maintenance and Distribution of Logical Observation Identifiers Names and Codes (LOINC®)

February, 2003 through July, 2008  and

August, 2008 through July, 2013

Funding source: NIH – National Library of Medicine

The Regenstrief Institute has been a leader and active participant in medical informatics standards development. Regenstrief investigators organized the first medical informatics effort in 1984, wrote the ASTM and HL7 chapters for orders and observation reporting, were the lead authors of the unified (USAMP) data HL7 data model, the HL7 version 3 data types, and the proposed HIPAA claims attachments documents. IU/Regenstrief Institute initiated the LOINC® vocabulary standards for observations which have been adopted by the largest commercial laboratories and most Federal agencies (CDC, DOD, HCFA). Fellows will have opportunities to develop research projects related to any of the above.

Advancing Patient Identity Management in the Context of Real-World Health Information

October 1, 2009 through September 30, 2012

Funding source: Agency for Healthcare Research and Quality

Healthcare information is increasingly distributed across many independent databases and systems, both within and among organizations as separate islands with different patient identifiers. Regenstrief Investigators seek to create a more robust and efficient global patient matching algorithm. Aggregation is important not only to determine a patient's health care status, but also for clinical effectiveness research, drug safety research and other population-based studies requiring comprehensive data.

Improving Medication Adherence in Type 2 Diabetes Using Integrated e-Technology

September 21, 2011 through August 31, 2013

Funding source: National Institute of Diabetes and Digestive and Kidney Diseases

Increasing evidence illustrates a discrepancy between system‐level disease management strategies and outcomes in terms of risk factor control. In patients with type 2 diabetes, one potential factor is adherence to their pharmacologic therapy. Growing evidence suggests that patients with diabetes do not take medications as prescribed. To address this need, we propose to develop, implement and evaluate a novel and sophisticated method to assess patients’ levels of adherence to their prescribed medications and communicate this information to their primary care providers at the time of their clinical encounter so that they can initiate appropriate interventions.

Regenstrief Medical Informatics Research Fellowship

July 1, 1997 through June 30, 2002 and

July 1, 2002 through June 30, 2007 and

July 1, 2007 through June 30, 2012

Funding source: NIH – National Library of Medicine

This fellowship program is designed to prepare post-doctoral fellows for academic careers in medical informatics. Research fellows will obtain a broad array of general research skills, improve writing skills, learn the responsible conduct of research, and the structure content and design of medical information systems. Each fellow will be expected to gain competency in a modern programming language so that they can understand the strengths and limits of the systems with which they work.

Each fellow chooses to focus on one of the following three areas of enhancement: (1) high performance computing and communications, (2) health services research, or (3) cancer informatics. By the end of their second fellowship year, fellows will have performed a clinical epidemiologic project, designed and conducted a developmental research project, performed their own data analyses, and written papers to be submitted to peer-reviewed publications. 

Improving Management of Test Results that Return After Hospital Discharge

October 1, 2009 through July 31, 2013

Funding source: Agency for Healthcare Research and Quality

Poor follow-up of tests whose results are not back at the time of hospital discharge leads to many medical errors. This project seeks to create, implement, and evaluate two health information technology interventions aimed at improving communication and follow-up of these tests. Through these interventions, it is hoped there is a reduction medical errors and a demonstrated improvement in safety for patients discharged from the hospital with pending results.

OpenMRS: Open Medical Record System

March 16, 2008 through August 31, 2011

Funding source: Northrop Grumman Company (through Centers for Disease Control)

OpenMRS® is a community-developed, open-source, enterprise electronic medical record system framework. The community has come together to specifically respond to those actively building and managing health systems in the developing world, where AIDS, tuberculosis, and malaria afflict the lives of millions. The mission is to foster self-sustaining health information technology implementations in these environments through peer mentorship, proactive collaboration, and a code base that equals or surpasses proprietary equivalents.

Testing Techniques to Radically Reduce Antibiotic Resistant Bacteria (Methicillin Resistant Staphylococcus Aureus, or MRSA)

August 1, 2008 through July 13, 2013

Funding source: Agency for Healthcare Research and Quality

Our long term goal is to reverse the trend of hospitals serving as sources of infection.  By creating learning collaboratives of front-line workers using lean-six sigma approaches to benchmark, identify, adapt and implement solutions, and continue to feedback performance, we can assure both initial and long-term success in systematically changing work processes. 

An Evolving Statewide Indiana Information Infrastructure

September 30, 2004 through March 31, 2010

Funding Source: Agency for Healthcare Research and Quality

This project builds on existing statewide initiatives of the Indiana State Department of Health (ISDH), the State's Medicaid program and Indiana University School of Medicine.  We will work to achieve our region's goals by building on these established local and regional health information infrastructure initiatives.  We have been very active in sharing our learning points with others across the country through presentations, testimony and publications and believe we can provide an excellent example for other states.

Accelerating Public Health Situational Awareness through Health Information Exchanges

February 6, 2008 – April 5, 2011

Funding source: Centers for Disease Control

Regenstrief Institute is working with state, regional and non-geographic health information exchanges to enable access to clinical care information at all levels of public health for the purposes of improved public health situational awareness and case reporting in the context of the emerging Nationwide Health Information Network (NHIN) (see NHIN project for additional details).

Impact of Using Nurses Instead of Clinicians to Care for Stable HIV-infected Patients

October 1, 2008 through September 30, 2009

Funding source: Tibotec’s REACH Initiative

Investigators with the Regenstrief Institute are evaluating the impact of using staff other than physicians to care for stable HIV-infected patient at two clinics in Western Kenya.

Improving Laboratory Follow-up by Delivering an Enhanced Medication List to Outpatient Physician Practices

September 28, 2007 through April 30, 2010

Funding source: Agency for Healthcare Research and Quality

Investigators at Regenstrief Institute are seeking to improve laboratory follow-up by providing outpatient primary care clinicians with a Medication List, based on the medications that have been dispensed to the patient at a pharmacy. Some categories of Decision Support alerts will also be provided with the Medication List. This will be available to the physician prior to the patient encounter and can be used as an important tool to improve health care quality and safety.

Indiana State Department of Health Public Health Emergency Surveillance System (PHESS)

July 12, 2004 through August 1, 2009 and

August 10, 2009 through August 9, 2011

Funding Source: Centers for Disease Control and Prevention/ISDH

Because of Regenstrief Institute Inc.'s long-term experience with and expertise in electronic clinical data capture, standard clinical vocabularies, clinical terminology mapping, HL7 messages, system interfacing, its long term history of successful linking of many hospitals in Indiana, and its understanding of public health and biosurveillance needs, the Indiana State Department of Health ("ISDH") contracted with Regenstrief Institute Inc. to develop, maintain and operate a system for capturing hospital emergency department admission data and transmit it to the ISDH Public Health Emergency Surveillance System ("PHESS").

Modeling the Effect of Drugs in Intergromics by Linking Drug Ontology and Pathways

December 1, 2008 through November 30, 2011

Funding source: NIH – National Institute of General Medical Sciences

Regenstrief Institute investigators are working to link drug therapies found in the clinical data with biologic pathways data used for the integrated analysis of high-throughput experimental results. This will be done by integrating the clinical drug vocabularies by which drug therapies are recorded in clinical data. Additionally, they will integrate a small set of high-quality pathway network resources that contain models of the drug targets and affected pathways of the currently available drugs.     

Nationwide Health Information Network Trial Implementation (NHIN)

September 30, 2007 through January 23, 2010

Funding source: DHHS – Office of the National Coordinator

Regenstrief Institute is working with other state, regional and non-geographic health information exchange consortia to become components of the “network of networks” that is the Nationwide Health Information Network (NHIN). The consortia will cooperatively develop specifications for, and trial implementations of, the NHIN and test these trail implementations with each other to ensure that they can all work together to implement an interoperable “network of networks” built on top of the Internet.