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25.10.2018 1
Using electronic health records
in studying spatial disparities and quality of care
among chronic patients in...
Content
1. Electronic health records in health research
• General information
2. Electronic health records in geospatial h...
1. Electronic health records in health research
General information
• The use of electronic health records (EHRs) have inc...
2. Electronic health records in geospatial health research
Background
• Siun Sote utilizes regional electronic patient reg...
2. Electronic health records in geospatial health research
Pros and cons & experiences from Siun Sote
• Pros
- Cost-effect...
2. Electronic health records in geospatial health research
Screening of type 2 diabetes has improved in the region.
25.10....
3. Implementing research experiences in operational use
Interface between research and operational use
1. Useful spatial i...
3. Implementing research experiences in operational use
Possibilities and challenges
1. Choosing the health information to...
4. Conclusions
• Spoiled for choice
- EHRs provide countless opportunities for spatial health research
- Can be easily lin...
Thank you!
Comments, questions?
25.10.2018 10
References
• Casey, J. A., B. S. Schwartz, W. E. Stewart & N. E. Adler (2016). Using electronic
health records for populat...
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Maija Toivakka ja Teppo Repo: Using electronic health records in studying spatial disparities and quality of care among chronic patients in Siun Sote region

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Geospatial data in health and welfare research -seminar in Helsinki 23rd October 2018.

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Maija Toivakka ja Teppo Repo: Using electronic health records in studying spatial disparities and quality of care among chronic patients in Siun Sote region

  1. 1. 25.10.2018 1 Using electronic health records in studying spatial disparities and quality of care among chronic patients in Siun Sote region Maija Toivakka​, maija.toivakka@uef.fi Teppo Repo, teppo.repo@uef.fi Department of Geographical and Historical Studies, University of Eastern Finland Seminar on geospatial data in health and welfare research 23.10.2018 1
  2. 2. Content 1. Electronic health records in health research • General information 2. Electronic health records in geospatial health research • Background • Pros and cons & experiences from Siun Sote • Screening of type 2 diabetes has improved in the region 3. Implementing research experiences in operational use • Interface between research and operational use • Possibilities and challenges 4. Conlcusions 25.10.2018 2
  3. 3. 1. Electronic health records in health research General information • The use of electronic health records (EHRs) have increased in the past decade. • EHR: a software platform that contains individual-level patient-provider data captured during health care encounters. • Partly patient transactions are routinely collected to health records and partly health professionals are responsible for recording them. 10/25/2018 3
  4. 4. 2. Electronic health records in geospatial health research Background • Siun Sote utilizes regional electronic patient register including primary health care and specialized care – the only regional jointly used register in Finland at the moment. • In Finland, Current Care Guidelines form the basis of the treatment and management of diseases and risk factors in health care. → The information on treatment outcomes and equity in service use is scarce. → It is poorly known how well the clinical guidelines are implemented in practice in different geographical contexts and what are the real outcomes of care. • Patient data from regional electronic patient database - Age, gender, date of birth, address information, laboratory and measurement results, visits in primary care and special care, diagnosis of diseases, prescriptions - Geocoded locations of the patients → EHR data becomes spatial data 25.10.2018 4
  5. 5. 2. Electronic health records in geospatial health research Pros and cons & experiences from Siun Sote • Pros - Cost-effective data acquisition - Large “real-world” datasets - Data is available in near-real time - Can be easily linked to other data when geocoded - Comparability to international studies (ICD-10 codes) • Cons - Data is not designed for research purposes - Data quality issues - Privacy protection 25.10.2018 5 • Large comprehensive patient groups but includes only patients who have been diagnosed with the disease or have been treated in the primary/specialized care. • EHR data becomes spatial data - Information on the place of domicile. - Information on current place of domicile only. - Demographic differences in the region makes interpretation difficult. • Enables to use lot of data, but not everything is possible - EHRs have no personal information on diet or physical activity - Duration of the disease not available • Missing data • Quality of records • What is a relevant scale for analysing and reporting sensitive EHR data? • Strict regulations in using and combining other sensitive data (e.g. Statistics Finland).
  6. 6. 2. Electronic health records in geospatial health research Screening of type 2 diabetes has improved in the region. 25.10.2018 Presentation title / Author 6
  7. 7. 3. Implementing research experiences in operational use Interface between research and operational use 1. Useful spatial information about the current situation of health outcomes and disease burden comes as a "side product" of academic research. 2. Manually going through patient register data for reports is labor intensive and lacks continuity. - Some of the information could be refined automatically and integrated in electronic heath records (EHR) reporting systems and visualized in a web map services or equivalent. 3. Research should focus also in issues related to operational use and distribution of geospatial health information. What further research is needed? - What kind of (spatial) analysis of (chronic diseases) is meaningful in operational perspective? 25.10.2018 7
  8. 8. 3. Implementing research experiences in operational use Possibilities and challenges 1. Choosing the health information to be presented in geospatial/map format - What subjects and spatial scale are relevant for each stakeholder? (decision makers/health professionals/patients) 2. How personal devices, mobile applications and GEO tracker data could be used, for example, in T2D/CHD prevention programs and screening? - New ways to fill the gaps of health-related behavior information in EHR? 3. Is advanced spatial analysis needed in health care planning? - Location-cost links and spatial econometrics? - GIS tools developed for other disciplines (e.g. in forestry) could be applied in health care analytics. • What kind of GIS system or geospatial data is needed in social and welfare sector in Finland? 25.10.2018 8
  9. 9. 4. Conclusions • Spoiled for choice - EHRs provide countless opportunities for spatial health research - Can be easily linked to other geospatial data • Quality of the recordings is improving - Less missing data, better comparability locally, regionally, nationally and globally • Spatial visualizations and spatial analysis could probably be utilized more in operational use - Geospatial features should be integrated in EHR reporting systems and data processing automated • New ways to fill the gaps of EHR data should be tested - Supplementary data sources: MyData, individuals privately collected data about health behavior and locations from mobile apps and (health monitoring) devices, customer satisfaction data 10/25/2018 9
  10. 10. Thank you! Comments, questions? 25.10.2018 10
  11. 11. References • Casey, J. A., B. S. Schwartz, W. E. Stewart & N. E. Adler (2016). Using electronic health records for population health research: A review of methods and applications. Annual Review of Public Health 37, 61–81. • Farmer, R., R. Mathur, K. Bhaskaran, S.V. Eastwood, N. Chaturvedi & L. Smeeth (2018). Promises and pitfalls of electronic health record analysis. Diabetologia 61: 6, 1241–1248. • Anselin L. Thirty years of spatial econometrics. Papers in Regional Science. 2010;89(1):3-25. doi:10.1111/j.1435-5957.2010.00279.x. 25.10.2018 11

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