Health Services Research & Development

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CREATE: Improving Therapeutic Decision-Making through Veteran-Centered Population Analytics


Director: Matthew Samore, M.D.

Principal Investigators:

About the CREATE

Medication management comprises a substantial part of clinical practice, and clinical reasoning regarding treatment decisions relies on forecasting future events under multiple possible courses of action. Further, a large amount of potentially valuable information lies dormant within VA databases—information that has the potential to help clinicians and patients make more informed medication choices in the face of uncertainty. The goal of this CREATE is to implement tools and methods that will make VA medication management data accessible in a consumable form.

 

Partners

Each CREATE works closely with operational partners throughout the VA system. The partners associated with this CREATE include:

  • VA Informatics and Computing Infrastructure (VINCI)
  • Interagency Electronic Health Record (iEHR)
  • Health Informatics Initiative (hi2)
  • Infectious Diseases Services (IDS)
  • Pharmacy Benefits Management Services (PBM)
  • Specialty Care Services (SCS)
  • Patient Care Services (PCS)
  • Office of Informatics and Analytics (OIA)
  • Office of Nursing Services (ONS)
  • Geriatrics and Extended Care (GEC)
  • Bar Code Resource Office (BCRO)
  • Office of the Assistant Deputy Under Secretary for Health/Clinical Operations (VHA)
  • Integrating Data for Analysis, Anonymization, and Sharing (iDASH)

Partner Quotes

"The goal of hi2 is to shape the future of VHA clinical information systems through health informatics and health information technology to deliver solutions that transform health care delivery to our Veterans. The work proposed in these CREATE projects synergizes with ongoing hi2 efforts to bring population analytics to front-line clinical care, particularly in the area of cognitive support for managing uncertainty. These informatics tools, integrated with hi2's platform for deployment, will provide an unprecedented level of support for VA providers for therapeutic decision making, particularly in the realm of antibiotic prescribing." - Dr. Michael Rubin, MD, Clinical Leader of the VA Health Informatics Initiative (hi2)

"We are looking for Veteran focused prototype tools that use population analytics to deploy to iEHR. I am also interested in the science that can help guide design of other applications." - Dr. Jonathan Nebeker, MD, Interagency Electronic Health Record (iEHR), and Director, VA Informatics and Computing Infrastructure (VINCI)

"[Cognitive Support Informatics for Antimicrobial Stewardship] will both compliment and extend the ongoing activities of the Antimicrobial Stewardship Task Force which has been chartered to optimize the care of Veterans by developing, deploying, and monitoring a national-level strategic plan for improvement in antimicrobial therapy management." - Dr. Gary Roselle, MD, Director, National Infectious Diseases Service

"[Cognitive Support Informatics for Antimicrobial Stewardship] will positively impact and build upon the operational initiatives of the Antimicrobial Stewardship Task Force." - Cathy Rick, RN, Chief Nursing Officer, Office of Nursing Services

"[Cognitive Support Informatics for Nurse Medication Stewardship] is particularly in alignment with the ONS's strategic goals of enhancing Evidence-Based Practice and Practice Transformation and will be especially useful in addressing a difficult and recalcitrant clinical problem, delirium." -Francesca Cunningham, PharmD, Director of the Center for Medication Safety, Department of Veterans Affairs Pharmacy Benefits Management Services; and Director, National Center for Patient Safety

"The proposed outcomes [of Cognitive Support Informatics for Nurse Medication Stewardship] will help clinicians detect and mitigate acute mental status changes directly helping us better care for geriatric patients." - Kenneth Shay, DDS, MS, Director of Geriatric Programs, Geriatrics and Extended Care

"The deliverables from these projects will provide innovative informatics tools for clinicians and patients to improve clinical care for our veterans." "The goals of these projects will maximize shared situation awareness of all members of the team as well to inform both patients and staff decision support." "[Veterans Like Mine will] help clinicians to bridge gaps between personal experience, literature, and peer support." - Dr. Gavin West, MD, Special Consultant and Clinical Liaison, Office of the Asst Deputy Under Sec for Health/Clinical Operations

"Natural Language Processing (NLP) is needed to make clinical data accessible and interpretable, and [Natural Language Processing (NLP) Software Ecosystem] addresses some fundamental aspects of this challenge."- Lucila Ohno-Machado, MD, PhD, Principal Investigator, Integrating Data for Analysis, Anonymization, and Sharing (iDASH)

"There is potential synergy between the goals of [Natural Language Processing (NLP) Software Ecosystem and Information Extraction and Visualization Toolkit (IE-Viz)] and the goals of the OIA in regard to quality and performance measurement." - Joseph Francis, MD, MPH, Director of Clinical Analysis and Reporting, Office of Informatics and Analytics


Projects

Projects within this CREATE seek to characterize clinical problems, information needs, and communication patterns associated with therapeutic decision-making for medication management, with examples focusing on appropriate use of antimicrobial drugs, mitigation of medication-induced mental status changes, and the choice of chronic anticoagulation therapy. Funded projects include:

  • Cognitive Support Informatics for Antimicrobial Stewardship
    Inappropriate antimicrobial use is of concern as it can contribute to the growth of resistant microbial strains. This project targets inappropriate antimicrobial use by characterizing existing practices in antimicrobial use. Investigators will develop quality measures for visual analytic support tools, which will be implemented and tested. (PI: Peter Glassman, M.B.B.S., M.Sc.)
  • Cognitive Support Informatics for Nurse Medication Stewardship
    This project seeks to target problems of drug-induced mental status change by characterizing the information and communication processes among nurses. Investigators will also design, test, implement, and evaluate cognitive support interventions. (PI: Charlene Weir, Ph.D., R.N.)
  • Veterans Like Mine--Cognitive Support for Therapeutic Decision-Making
    This project will use population analytics to support clinical decision-making in infectious diseases. Investigators will retrieve and analyze population data to create visual displays of case-matched inquiries; conduct a demonstration of VLMine; and then integrate VLMine displays with knowledge summaries. (PI: Matthew Samore, M.D.)
  • A VHA NLP Software Ecosystem for Collaborative Development and Integration
    This project seeks to accelerate clinical NLP research and development by developing an NLP Software Ecosystem that enables more effective collaboration and benchmarking for NLP developers and researchers, leading to improved performance of methodologies based on sublanguage analysis of clinical text. (PI: Qing Zeng, Ph.D.)
  • Information Extraction and Visualization Toolkit (IE-Viz)
    This project seeks to develop an information extraction and visualization toolkit that assists VA researchers in applying information extraction techniques to patient records. (PI: Wendy Chapman, Ph.D.)

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