Virtually Priceless Thoughts

Reflections on Health, Informatics, and Research

Types of Questions to Ask A Research Network

with 13 comments

Here’s the question:

What would your question be of a practice based primary care research network?

Consider that you are involved in establishing some of the first research questions that would be answered by a group of engaged, networked, and interested primary care practices – what would those questions be?

For this thought experiment, you could be a funder or a participant (clinician or patient) or an outside researcher.

Assume the network could collect whatever kinds of data you would need to answer your question.

Assume, also, for your quantitative types, that the network has 80 primary care providers (mostly family doctors, some nurse practictioners) across multiple sites both rural and urban and that these were full service primary care practices. Amazingly, all patients consent to participate and there are 120,000 patients. All practices are using an EMR and data from the charts would be encoded to support your question(s).

I will start with one of my questions:

What is the impact on overall capacity* of practices where patients with mental illness (mood disorders such as depression and anxiety) are given a proactive program and the tools to self manage their condition through a Personal Health Record (PHR)? Is there a difference if the PHR is integrated with their primary care provider’s practice EMR? Does self management also change quality of care (perceived and objective) for the patients involved?

* capacity should be examined both in terms of financial cost to the practice to run the program and changes in number of patients seen by providers over time compared to matched controls.

If this is interesting to you, add your own question as a comment or join the discussion by supporting / adding to other questions.

My goal here is to collect the types of questions people want answered not to focus on how to answer them (that comes later).

Written by priceless

March 27th, 2011 at 6:53 pm

Posted in Informatics,Medicine

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13 Responses to 'Types of Questions to Ask A Research Network'

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  1. An interesting question would be to collect information on patients from 2 months prior to hospital admission. The term ‘predictive medicine’ is starting to appear but usually related to genomics. There is also Archimedes Inc. which is a spin off from Stanford and has used data on about 3 million patients going to Kaiser. They have built detailed clinical models that can be used to predict outcomes.

    It would be interesting to collect lab and Pharmanet data and relate that to hospital admissions. Then to combine this with physicians data; visit dates, diagnosis,… and then see what things look like. The initial phase could be limited to some of the common reasons for expensive admissions.

    Raymond Simkus

    27 Mar 11 at 8:10 pm

  2. What would the clinical and economics benefits (or adverse consequences) be if all primary care providers had access to a single record for each patient (including all of their hospital data) as opposed to data on the patient being stored in multiple EMRs and EPRs?

    Denis Protti

    29 Mar 11 at 1:42 pm

  3. I’d like to investigate patient clinical outcomes for practices remunerated on a fee-for-service basis compared to those that are funded on a capitation model.

    Glen McCallum

    29 Mar 11 at 6:10 pm

  4. Where are the gaps in primary care EMR data for clinical decision making? How can these gaps be closed? This could be linked to how long it takes for data from multiple sources (e.g., hospital, pharmacy, drop-in clinic) to make it into the EMR.

    How can a Personal Health Record improve shared management (EMR/PHR) of chronic disease?

    The urban and rural information has potential for comparisons across those environments (e.g., treatment options and outcomes).

    I’m always keen on researching the entity itself…How can a primary care research network improve patient care? What are the barriers and facilitators to implementation? What are the benefits and drawbacks?

    Nicole Kitson

    29 Mar 11 at 7:23 pm

  5. As a health informatics researcher, I would like to find out the extent to which EMRs are able to: (a) help with preventive care; (b) identify and manage high risk patients; (c) improve care coordination; (d) enrich the patient and provider experience with the healthcare system.

    I know that is more than one question but to me they are interrelated …

    Francis Lau

    29 Mar 11 at 7:38 pm

  6. As I pondered this, I was wondering about how to tie the EMR and PHR into (pro)active tools such as SMS/Twitter to stimulate ‘next actions’ (per David Allens’GTD approach) to dynamically act on health improving steps. However, that is an ‘add-on’ to the state described.
    The other questions are interesting. Let me add a query to look at positive variance (towards more positive health/functioning status,from whatever initial state), summed per physician and also per EMR system, in a range of domains in preventive health and chronic disease management. Are there EMR systems associated with more positive variance; are there practices associated with more positive variance? How is this achieved?

    Jim Thorsteinson

    30 Mar 11 at 10:56 am

  7. Thank you for the examples so far — these are great!

    Here’s a question from Dr. Steve Edworthy (posted with permission):

    “The general slant of my first question will be: how many of rheumatic disease patients are “registered” in this hypothetical cluster of FPs? and is there any way to evaluate whether inflammatory rheumatic disease patients in this population are missed, or underserved?”


    31 Mar 11 at 7:40 am

  8. I am interested in the complexity of the average general practice visit. I think an EMR can capture some of that complexity. For example, how many different problems does the patient have and how many are addressed during a visit? My hypothesis is that the current method that most EMRs rely on for diagnostic coding (manually by the doctor for billing purposes) is unreliable and inaccurate. A solution to this problem obviously is very dependant on how thorough our notes are, but perhaps this information could be captured by an intelligent program that searches free text looking for disease-specific words and also tracks visit actions like prescriptions written, referrals made, and investigations ordered, etc. to grade the overall complexity of a visit.

    Eugene Leduc

    31 Mar 11 at 5:19 pm

  9. Can “failure to correctly diagnose” be aided by clinician coding and review of their patients’ persisting or recurring problems when these remain “as-yet-insufficiently-explained”?

    For what I mean, see the following attempt to define something that could be evaluable:


    Jim Busser

    1 Apr 11 at 5:10 pm

  10. Mimic interoperability and then evaluate the quality of the resulting combined dataset…

    Search for patients who have been seen by more than one of the participating primary care providers. Combine their documented observations, actions, etc and attempt to assemble a medical history for that patient based solely on this EMR data. Then find the patient and interview him/her to determine a “best possible” medication history. Compare the two in order to determine the quality and utility of the EMR data currently being collected.

    Mike Bowen

    4 Apr 11 at 4:24 pm

  11. I would like to identify the interoperability needs at both the data and process levels to support coordinated care. EMRs can certainly facilitate data interoperability but I am more interested in how providers, patients and administrators interact with the EMR. I guess I am really asking how to get both interoperable systems AND interoperable people.

    Craig Kuziemsky

    4 Apr 11 at 4:39 pm

  12. Primary Care research network to improve patient care involves the basic information patient data base,risk factors continually adjusted for age, family history,occupation ,environment and lifestyle issues.A complex system of information that requires alert systems built in to complement the diligent physician who wishes to monitor all aspects of his patients care.This should be possible

    con rusnak

    6 Apr 11 at 10:50 am

  13. […] you all for offering up example questions for a potential research network – these are an interesting set of wide ranging […]

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