wiki:Community and Public Health

Allen Greiner and Kim Kimminau June 22, 2010 (Russ Waitman, scribe) CTSA

Funding RI announcements don't work

  • Kim, started at Wichita state
  • RI equivalent at Wichita state would focus tailor funding announcements to the key words of the investigator.
  • Other people could see other investigators key words and what announcements they received.

Allen G and Kim excited about eIRB.

Allen: On a small scale they have some really strong relationships. Some of those would share data with us. Jen Brull, getting her iPads to collect data. 21 med students out right now working and collecting data.

  • Jen needed help from Kim and Allen on how to set up a survey on the iPad.

Kim Richter's study uses telemedicine for smoking interventional research

Eve-lynn Nelson Child psychology counseling via tele-medicine

Telemedicine sounds good, but the reviewer may realize there is no excess capacity in the system. None of the mds here want to do more clinical work and if so they want to do it for high dollar for the hospital.

On the receiving end, if you try to ramp up research, can the hospital/clinic/nursing staff on the receiving end handle it? Don't want to over build when the next grant doesn't get funded.

What are T2 researcher needs?

  • lots of siloing of efforts
  • clinical data, telemedicine,

-- technical problems with firewalls between KUMC and the rural practices

HRSA H-cap grants. Health Resources and Services Administration. Had one with the community and access to care surrounding the ED ~2003. KCCarelink got set up on missouri side to track high utilizers. Didn't see the potential of increasing its robust methods for research, quality improvement. Were interested in neonatal, specialty referral program….

Reach Healthcare Foundation - 3 counties in Kansas.

Consultation services: need more brainpower to move things forward.

  • get advice on what is new and what is unique.

What are we doing to help KU ? versus What are we doing to help the communities?

  • needs to be a 2-way street.
  • to be effective at community at research need to be in a 2 way relationship with the community about their needs

-- consult with internal KUMC researchers but also consult with rural practices on EMR adoption.

  • think about how we step in and fill holes with the REC if they won't do their job.
  • Public Health KDHE isn't proactive. Especially for informatics.

Community has needs making sure they are on top of meaningful use

  • Have needs with just understanding their diabetic patients and how well they are doing

Kim: many people are saying they are there to help the community people adopt EHR.

Kim: we'd be better being a broker where they would contribute their data to benchmark.

  • Jen Brull is open to sharing her data with others and seeing where he practice needs to improve.

-- we then provide her with tools to analyze her data. She will want to be at the table to do the comparisons. Unfair to compare her with an integrated group practice. Different kinds of rural primary care providers.

eMD with Jen:

  • noticed that the decision support in eMD is lacking or not tailored towards her needs.
  • different levels of evidence based care receptiveness among community physicians

Have colleagues, 5 providers then 10 providers.

For the grant, we have to say we are at the table KFMC - Allen help picking EHR HIE - Helen driving the effort

but, also work with targeted interventions based on 10-15 year relationships.

Data - KHPA Data - HIE, or direct relationship with 5 practices. -- colorectal cancer screening with Allen.

  • State run diabetes collaborative. KD&HE. They get the data CDC cDEMS. Challenge getting report data out of Centricity to then feed to the state. State wanted aggregate reports.

-- Medical Advisor is David Robins in endocrinology here. He thinks Kansas is pretty good in this area.

  • Kim doesn't see the telemedicine connection…..

-- don't néed the whole telemedicine set up to conduct an interview? --- how much could be mediated by technology? Kim not so much… would drive to garden city --- Judy Johnston - at Wichita, preventive medicine. May be using telemedicine to interview patients post breast cancer.

Eve Lynn, Kim Richter, Judy Johnston are the telemedicine

Use the actual telemedicine encounter record as a source of research?

Kim: it's an under-leveraged tool. Allen: it's been used by historical accident, Gary Doolittle.

Side: allen - analyzing doctor patient email exchanges.

Broadcast classes?

90% of CME via AHEC. How to break CME model open. How to distribute evidence. "Just in time CME". Podcast things.

  • how would we actually do that with David Cook? David would be interested in doing that but how would it actually get done.

T3: evaluating the community. Kim: the cancer registry is impenetrable. She's wanting all the population level health data. Have poor registries in other areas. Poor immunization data. WebIZ took forever. No birth defects well recorded. No diabetes. Kim: ideally beyond meaningful use criteria, we, KUMC researchers, would define the data we want to collect to build registries

No idea what Kansas incidence is for overweight obesity in people under the age of 19.

  • all that sports exam data, child visits, where's the data?
  • no way to pull them together for population assessment.

Overweight and obesity is 2x worse for hispanics? No idea though for Kansas and thus ignorant of disparities and ignorant of how to correct disparities.

  • School nurses record weight. Siloed in education.

Shireman, integration of educational and KHPA data (kids on anti-psychotics issues). Kim worries it won't happen that the state board of education and the Kansas department of education are loathe to share data. GPAs, suspensions, all collected in a new system called KIDS. The ability to see an illnesses impact on school performance is possible but hamstrung by roadblocks. She will probably have better inroads with juvenile justice.

How does the CREDO know to send the new investigator to work with Allen and I? How do we make the connections?

Allen: people will always need help. The requirements change, how we store data changes. Talking about how we do NIH research with the community as cutting edge and then how informatics will gain from the work by Family medicine.

If Allen can reimburse off his phone, he'll do that instead of telemedicine. He's been doing insecure emails.

  • right now telemedicine can only work if the patient also goes to a health care facility on the other end.

-- having a unit do research around what ever comes up next. --- wish there was a medical home model in KS we could experiment that kind of model with.

  • managed care backlash problem

The Kansas Academy of Family Practice has about 15 early adopter mds. They are innovating in their rural practices with informatics.

  • the problem is the folks out there are not interested in building in a research measure component.

Last modified 10 years ago Last modified on Jun 30, 2010 10:16:51 AM