Population Health
Management
Brian Jacobs, MD
Children’s National Health
System
January 14, 2016
Physician Community Webinar Series
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Welcome to the Physician Community
Webinar Series Sponsored by the HIMSS
Physician Community
• A complimentary virtual event that will be held
monthly.
• Covers a wide range of topics on Medical Informatics,
HIEs (Health Information Exchange), Standards and
Interoperability, eMeasures and Quality Initiatives, and
how it affects, impacts and involves physicians.
• For more information see www.himss.org/physician or
contact Yvonne Patrick at ypatrick@himss.org.
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Welcome to the Physician Community
Webinar Series Sponsored by the HIMSS
Physician Committee
• Please insert all questions in the chat box located
on the bottom right of your screen.
• A copy of the recording and slide set will be
available for download within 5 business days on
the Physician Community Webinar Series Archive
Page www.himss.org/physician
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Moderator
Patricia L. Hale MD, PhD, FACP, FHIMSS
Associate Medical Director for Informatics
Albany Medical Center
HIMSS Physician Committee Member, 2015-2017
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Population Health Management: Using
Geomapping to Enable Data-Driven Decisions
Brian Jacobs, MD
VP, CMIO & CIO
Children’s National Health System
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Conflict of Interest
I have no real or apparent
conflicts of interest to report
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Learning Objectives
• Understand the process involved in converting EHRderived data into geospatial information.
• Learn how geospatial analytics can be used to
understand regional variations in health conditions
• Develop an approach to the management of hospital
readmissions using EHR-derived data
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Healthcare Cycle
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Healthcare Cycle
• Healthcare encounters impact a small fraction of
health factors, others include:
– Race
– Diet
– Gender
– Exercise
– Stress
– Med compliance – Relationships
– Pollution
– Climate
– Substance Abuse
– Climate
– Etc…
– Genetics
– Socioeconomics
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Why Geospatial Analytics?
• Healthcare conditions have geographic & environmental
variation
• Many co-variables effect the expression of healthcare
conditions
• Understanding geographic & co-variable distribution can
impact targeting of epidemiology, prevention, treatment &
research efforts
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Geospatial Analytics & EHR
(Crime Reports)
11
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Geospatial Analytics & EHR
(Military Applications)
12
Geospatial Analytics & EHR
(Geology/Geography)
Geospatial Analytics & EHR
(Healthcare)
EHR represents rich source of essential health
data to power similar work
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Students
Restaurants
• Dining
• Take out
• Fast Food
Groceries
• Delis
• Convenience
Stores
• Supermarkets
Education
• Elementary
Schools
• Middle
Schools
• High Schools
Health
Services
• Clinics
• Hospitals
Demographics
• Population
Data
• Economic
Data
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GIS Methodology
Identify EHR
Data Fields
Write Data
Query
Upload Data to GIS
Run Data
Query
Filter/Clean
Data
De-identify &
Geocode
Data
Map Data Against
Covariables in GIS
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Representative Conditions
Burns in Infants
Childhood Obesity
Sickle Cell Disease
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Epidemiology of Burn Injuries in
Infants
Lorch M, et al. Pediatric Emerg Care 2011;27:1022-6
• Studied factors determining the ED disposition of infants
sustaining burn injuries
• 344 patients treated in the ED – Analyzed EHR data,
environmental & socioeconomic variables
• Scalds (53.2%) & contact burns (39.8%) were most common
• Race played a significant role in mechanism & severity of burn
• Focal geographic distribution
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Burn Data – DC Neighborhoods
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Childhood Obesity
•
Patients presenting to Children’s National
Inpatient, Inner City Clinics & Suburban Clinics
•
Weight, Height, Gender, Race, Age & Address
extracted from 3-regional EHRs
•
Primary extract cleaned, de-identified &
analyzed
•
CDC BMI percentile equations applied
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Percent of Regional Population
3.2 million Children in VA, MD, DC
400,000 Immediate Population (12.5%)
49,713 unique patients (12.4%)
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Results - Total Population
Children Ages 2-20
CP&A, Goldberg, and Inpatients
October 1, 2009 - October 1, 2010
49,713 Unique Patients
7769
16%
2238
5%
Healthy
Morbidly Obese
6145
12%
2788
6%
Obese
30773
61%
Overweight
Underweight
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Obese by Zipcode
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Obesity Cases
Obesity Rates
Fast Food Overlay
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Sickle Cell Disease
Readmission
• Retrospective analysis using EHR-derived data on
children with SCD-related pain crises
• Readmissions described and geospatial analysis
conducted
• Models constructed to obtain readmission risk factors
• 373 subjects, 125 with at least one 30-day readmission
compared to no readmission group.
• Readmission risk factors: Older, decreased LOS,
increased pain scores, >3 hospitalizations in 12-months
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Readmitted Sickle Cell Patients
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Conclusions
• Improved health cannot rely solely on
encounters with healthcare providers &
organizations
• Care model redesign must harness other
factors
• Geospatial analytics represents a model to
bring qualitative & quantitative information
forward in augmenting traditional
approaches to healthcare
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? Questions ?
bjacobs@childrensnational.org
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Continuing Education Credit
• This program has been designated for 1 hour of
CAHIMS credit.
• This program has been designated for 1 hour of
CPHIMS credit.
• Download forms at www.himss.org/physician.
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SAVE the Date: HIMSS16 EVENTS
• AMDIS/HIMSS Physicians' IT Symposium:
Consolidating Gains and Driving Future Value
Monday, Feb 29, 2016 | 8:00am – 4:30pm
• Population Health Reception
Tuesday, March 1, 2016 | 6:00-7:00pm
Population Health Knowledge Center
Casanova Meeting Room, Booth 14000
For more information, visit: http://www.himssconference.org/
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