Page 1 of 2 These notes are intended to provide a summary of action & follow up items; a few discussion highlights are included

RESEARCH ADVISORY BOARD (RAB) March 1, 2016

8:30-10am Medical Sciences Building, Chancellors Conference Room S-118

Attendees: Chip Chambers, Pam Den Besten, Clarice Estrada, John Ellis, MC Gaisbauer, Jennifer Grandis, Vanessa Jacoby, Jean Jones, Mounira Kenaani, Jim Kiriakis, Larisa Kure, Georgina Lopez, Wallace Marshall, Synthia Mellon, Teresa Moeller, Suzanne Murphy, Michael Nordberg, Theresa O’Lonergan, Bill Seaman, Matt Springer, Paul Volberding Not here: Jane Czech, Xiao Hu, Gretchen Kiser, Steven Lazarus, Irene McGlynn, Thomas Neylan, Christine Razler, Nirao Shah, Brian Smith Guests: Alice Chen, David Dobbs, Liz Goldman, Jim Greer, Tina Lee, Kristen McCaleb, Roger Mohamed, Mae Moredo, Neda Ratanawongsa, Delphine Tuot

PRESENTATION: Mandatory Trainings, Jennifer Grandis See PowerPoint presentation attached • Louise Hendrickson and Kristen McCaleb have reviewed 36 of 76 of the training modules, looking for those that can

be omitted, restricted in use, shortened, or otherwise changed to reduce the heavy load of required training Questions/Comments: • Have you looked at VA/SFGH trainings?

o Not yet • IRB is looking into how to eliminate their training modules. Next Steps: • Louise and Kristen work with Roger Mohamed in the SFGH Dean’s Office around SFGH trainings PRESENTATION: Addressing Pathways to Enhance Data Access Supporting SFGH-based Clinical Research, Neda Ratanawongsa See PowerPoint presentation attached • Paul Volberding noted there are a variety of electronic medical record systems in use at the ZSFG, and these are

generally not accessible for research. • The CTSI has been involved in this issue. Going forward, the hope is that the SFGH will adopt UCSF’s APEX system,

administered by UCSF, effective 2018. This would assure that progress in the use of APEX for research will be available not only at Parnassus/Mt. Zion but also at ZSFG. (Note, since the RAB meeting, the ZFGH board has approved this, pending legal negotiations.)

• Concerns regarding a combined UCSF/ZFGH system include privacy, data ownership, city of SF indemnification, governance, financial terms, and ability of partners to withdraw from the partnership.

• Also involved: SF Health System. Their current system can capture data from a large number of systems (including SFGH, local jails, clinics, etc.)

• RAB can help by supporting: o That SFGH get onto EPIC (APEX) and that data should be available for all researchers with approved human

studies protocols Recommended that a governance group be created to help coordinate the shared use of APEX,

especially around HIPAA, resources and cultural concerns o Resources: UCSF can help create and share templates that have been successful in research at

Parnassus/Mt. Zion. o Additional funds: for SFGH for APEX updates and additional staff o This could be taken to the EVCP as something that RAB supports

• Lessons Learned with APEX implementation o Initially, the development of APEX focused on improving billing for patient care. Researchers were not at the

table, especially for smaller, developmental meetings. Because of this, templates for use with APEX are being revised for use with research.

o Need to ensure that we are utilizing all parts of the systems and have access to the people that can help o Researchers can help to inform clinical care

We need to listen to the people on the ground

Page 2 of 2 These notes are intended to provide a summary of action & follow up items; a few discussion highlights are included

With smaller groups working on this, we can be very careful with updates and changes o We need to figure out funding as soon as possible and establish what we are missing

I.e. when looking at grants, we should provide the information we have, not just what we need. Next Steps: • RAB co-chair Seaman to work with Dr. Volberding in drafting a letter of support.

Mandatory Trainings - Update 1 March 2016

Online Training Evaluation Plan • Recommendations from EVCP review 12/4/14:

Assign an overarching unit and resources to own training at UCSF Push notifications Explore integration with current Medical Center training requisition

process (use same process for reviewing new trainings)

• Current: Review of all online trainings In progress by Louise Hendrickson & Kristen McCaleb 36 of 76 trainings have been reviewed Reaching out to owners of reviewed trainings with corrections &

questions

Detailed Online Training Evaluation Plan

Item Description

1 Detailed review of each eLearning: • Regulatory Agencies – link to requirement for training - Short explanation of agency /

requirement • Frequency of renewal requirement • Specify the relevant audience for each training • Contact Person for updates / questions / corrections

3 Continue to make trainings mobile-device compatible

4 Develop a standard template for trainings so all trainings look official

5 Dashboard for Campus to view training status (if possible, merge with RIO dashboard)

6 Tool for searching for which trainings are required based on activities

8 Push notifications from RIO Base NIH-related notifications on renewals of completed trainings

Findings to Date

• Statute describing reason for training listed; need to verify that it is current: 6

• Information on why training is required not provided / inadequate: 17

• Training not relevant to faculty / staff / is outdated / can be removed from inventory: 8

• Not an eLearning, in-person training only: 5

Building a Collaborative Informatics Infrastructure

No conflicts of interest to disclose. Funded by AHRQ Grant 1K08HS022561 and National Center for Advancing Translational Sciences of NIH under KL2TR000143 .

Neda Ratanawongsa, MD, MPH Chief Medical Informatics Officer for CareLinkSF

San Francisco Health Network Associate Professor, UCSF DGIM and Center for Vulnerable Populations

Zuckerberg San Francisco General Hospital and Trauma Center

Overview

•  UCSF / SFDPH / CTSI Retreat (Jan 2015) •  Progress to Date •  Ongoing Needs

January 2015 Retreat •  Participants:

–  SFDPH medical and informatics leadership

–  UCSF Dean’s Office at ZSFG

–  UCSF Academic Research Systems

–  CTSI

•  Goal: determine steps & resources for building an effective, efficient, and sustainable informatics infrastructure to support research, QI initiatives, medical education, and clinical operations

Diverse Research with SFDPH Data •  ZSFG

–  More than 20 UCSF research centers, affiliated institutes, and major laboratories

–  > $200 million research funding per year –  > 250 researchers, including leadership within CTSI programs

•  San Francisco Bay Area Collaborative Research Network •  SFDPH Population Health

–  Bridge HIV –  Applied Research, Community Health Epidemiology, and

Surveillance –  Center for Public Health Research –  And more …

International Impact •  M Kushel, Lancet : “The health of homeless people in high income countries” •  J Yazdany, Arthritis Rheumatol: “Thirty-day hospital readmissions in systemic lupus

erythematosus” •  BM Howard, J Trauma Acute Care Surg: “ The effects of alcohol on coagulation in

trauma patients” •  ME Kutcher, Ann Surg, “The natural history and effect of resuscitation ratio on

coagulation after trauma” •  S Aksel, Obstet Gynecol: “Postabortion hemorrhage and risk of other complications in

women with second-trimester fetal demise” •  U Sarkar, JAMA: “Care partners and online patient portals” •  V Jain, J Infect Dis: “Antiretroviral therapy initiated within 6 months” •  AH Chen, NEJM: “eReferral – a new model for integrated care” •  LE Goldman, Ann Intern Med: “Support from hospital to home for elders: a randomized

trial” •  MB Potter, Ann Fam Med: “Cultivating a cycle of trust with diverse communities in

practice-based research” •  AY Liu, J Acquir Immune Defic Syndr: “Sexual risk behavior among HIV-uninfected

MSM participating in a tenofovir prophylaxis trial”

Retreat Finding #1: SFDPH EHR

•  Actively investigating enterprise EHR •  Multiple EHRs with varying levels of

complexity for data extraction •  Interim EHR implementation has limited

utility of THREDS

SFHN Electronic Health Record Systems SFHN

Invision /LCR

(Siemens) eClinical Works Avatar

(NetSmart)

Diagnostics

SFGH Campus

Specialty Care

SFGH Campus

Behavioral

Health Center

SFGH Campus

PulseCheck

(Picis)Other Vendor

Systems (not all)

LHH

Residents

SFGH InPatientSFGH Primary

Care / Ambulatory

(not all yet)

COPC

(not all yet)

LHH Outpatient

(in process)

CHART

Jail Health Services

WatchChild

SFGH OB

ICIP

SFGH ICU

ORMIS/SIS

SFGH OR

Trauma One

SFGH Trauma

Health Information

Exchange

(in process,

Meaningful Use)

GetCare

(DPH Care

Coordination

Program Transitions)

Internally Developed

Applications

eReferral

Specialty referrals

Enterprise Med List

Pharmacy Faxing

from Invision

HERO – to sunset

(Positive Health/

Ward 86, UCSF)

Psych Emergency

Services

(UCSF)

DPH Main Clinical Application/Data Sources

Coordinated Case

Management

System

Quantim

Medical Records

SFGH and LHH

Community

Behavioral Health

Services

I2i

Chronic Disease

Registry

SFGH ED

CalNoc, Program

Certification and Pt

Safety Initiatives

(Sepsis, Stroke,

Diabetes, Falls etc)

Primary Care (most sites)

Speciaty Care

LHH Outpatient

Behavioral Health

SFHN EHR Future

•  Goal: interoperability across EHR (all settings), telehealth, communication, business analytics, etc.

•  2016: –  Infrastructure foundation –  Effective IT and clinical support teams –  Due diligence and planning

•  2018+: –  Next Generation EHR –  Integrated health information system across continuum

of care

Retreat Finding #2: SFDPH Analytics •  SFDPH Metrics & Analytics partners actively with UCSF

Academic Research Systems to facilitate data requests –  Significant time to help ARS understand data structure

–  Regulatory and operational reports prioritized

–  Hard to meet research timeline, particularly if not established extraction mechanisms

THREDS Data Requested

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

Yes 74%

No 26%

Identifiable PHI Requested

Source : 62 data requests via ServiceNow form 6/13 – 11/14

Additional data elements to consider •  Medication prescriptions (eCW) •  Health behaviors (eCW) •  Procedures not in LCR, i.e., Endoscopy (various databases) •  Emergency department data (PulseCheck) •  ICU and anesthesia data •  Surgical procedures (Invision, ORMIS) •  Public health data

–  Behavioral health (Avatar) –  Jail health (CHART) –  Maternal child and adolescent health –  Rehabilitation (Invision) –  Dentistry –  TB clinic

•  Trainee-level information (eCW, Invision) •  eReferral (eReferral database) •  Patient reported outcomes (patient portal, eCW) •  Meaningful use (eCW) •  Quality metrics, processes of care (eCW, Invision, i2itracks)

SFHN

Invision /LCR

(Siemens) eClinical Works Avatar

(NetSmart)

Diagnostics

SFGH Campus

Specialty Care

SFGH Campus

Behavioral

Health Center

SFGH Campus

PulseCheck

(Picis)Other Vendor

Systems (not all)

LHH

Residents

SFGH InPatientSFGH Primary

Care / Ambulatory

(not all yet)

COPC

(not all yet)

LHH Outpatient

(in process)

CHART

Jail Health Services

WatchChild

SFGH OB

ICIP

SFGH ICU

ORMIS/SIS

SFGH OR

Trauma One

SFGH Trauma

Health Information

Exchange

(in process,

Meaningful Use)

GetCare

(DPH Care

Coordination

Program Transitions)

Internally Developed

Applications

eReferral

Specialty referrals

Enterprise Med List

Pharmacy Faxing

from Invision

HERO – to sunset

(Positive Health/

Ward 86, UCSF)

Psych Emergency

Services

(UCSF)

DPH Main Clinical Application/Data Sources

Coordinated Case

Management

System

Quantim

Medical Records

SFGH and LHH

Community

Behavioral Health

Services

I2i

Chronic Disease

Registry

SFGH ED

CalNoc, Program

Certification and Pt

Safety Initiatives

(Sepsis, Stroke,

Diabetes, Falls etc)

Common data into local repository on DPH servers. Updates nightly, need for some model reports and snapshots. Select data in flat files to end user.

Limited data extracted by I/S for JCAHO or regulatory projects. Internal ED resource for reporting requests.

Some departments internal reporting resources. Requests to vendor beyond model. Limited extraction by DPH I/S for Core Measures.

LHH Outpatient

Specialty Care

Primary Care

(most sites)

Behavioral Health

Vendor reporting tools, some limited data extraction into local server. Additional privacy requirement.

Vendor reporting front end for users is limited. Weekly copy of database with targeted daily updates

Metrics & Analytics Group

Retreat Finding #3: Researcher Needs

•  Training to understand data •  Self-service tools to explore data in

safe, secure environment •  Advice in preparing specifications and

budget for grants •  Transparency about mechanisms and

status of data requests

Needs assessment/survey results •  Inability to perform rapid data pulls for QI/

PDSA cycles •  Limited UCSF analyst familiarity with

THREDS data •  Limited documentation about DPH data

available •  Data dictionary/documentation of SFDPH

data to train analysts to use data systems

Retreat Finding # 4: General Principles

•  Knowledge of clinical workflows/operations needed to understand data

•  Strong collaboration is critical among investigators, analysts, and clinical leadership

•  Feedback from research can enhance quality of the data & show value – iterative and interactive process

•  Need to prioritize and build foundation from research that aligns with clinical / QI, operational, educational, and regulatory/reporting objectives

Retreat Action Items •  Online data dictionary for currently available

SFDPH data •  Short list of high priority, often requested data

elements that are not yet available •  Trainings on SFDPH data systems •  Analyst position in SFDPH Metrics & Analystics

group to support data access •  Working group for governance structure/process

for how research planning integrated with enterprise EHR

Progress to Date •  Data sharing agreement signed •  Data dictionary & protocols online

https://wiki.library.ucsf.edu/display/IDRG/Investigator+Data+Request+Guide

•  DPH IS & ARS monthly mtgs to prioritize requests & address questions from submitted data sets –  LCR/Invision and Intellivue (ICU) done

–  eCW pending

•  ZSFG Dean’s Office posting analyst position •  SFDPH working toward EPIC as enterprise EHR

Hospital Clinical Business Intelligence & Regulatory

Office of Managed Care, Financial BI and Utilization Management

Patient Financial Services SupportAmbulatory Care Reporting & SFHN BIU

Noah Carraher1053 Ambulatory Care

Jackie Haslam 1054 Lead OMC, UM

and Financial BI

Maria De Vera 1054 Lead Hospital

Clinical BI & Regulatory

Jon Hicks 1054 Regulatory

Acute Care

Mike Jula 1063 Infection

Control

Steven Yoder 1054 Financial BI

Karine Ezikyan 1064 UM and OMC

La Phengrasamy1053 Financial BI

Sumita Rao 1064 OMC and

Financial BI

Lorrie Tanioka 1054 Lead INVISION

Revenue Cycle and PFS Operations

Carine Rompante 1052 PFS Operational

Support

Manny Narona 1063 PFS Operational

Support

CCSF Department of Public Health Information Technology: Metrics, Analytics and Data Integration

Tina Lee 0933 Business Metrics, Analytics and

Data Integration Manager

Michelle Tom1054 Lead PHNIX

Vijay Pawar1054 Acute CareStart: 10/5/2015

David Murotake1054 PFS Operational

Support

Gemma Deocampo1051

Shameem Mohamed UC-PA4 Lead SFHN &

Ambulatory BI

Steve Solnit1054 Acute Care

David Fischer 9910 HIT Coach

Stephen Lai9910 HIT Coach

Todd Riley1070 MADI Manager

Revised Date: February 9, 2016

Next Steps •  Continue the conversation •  Development and support for research

informatics champions within SFDPH •  Integrate research & analytics into

enterprise EHR planning