Like most surgeons, Jonathan Silverstein, MD, MS, worries about infections, avoidable readmissions, operating room workflows, and the likelihood that surgery will lead to a patient’s cure. Unlike most, he uses a computer to work out his concerns.
Silverstein is vice president of clinical research informatics at NorthShore University HealthSystem. He heads NorthShore’s Center for Clinical and Research Informatics (CCRI), founded two years ago with the mission to improve human life through the innovative collection and use of clinical data.
CCRI is building on NorthShore’s leadership in electronic health record (EHR) and data warehouse technologies. The health system adopted EHR technology in 2003, achieved HIMSS Stage 7 status for all four hospitals by 2010, and was the nation’s first health system to connect hospitals and physician offices with one database.
Silverstein and his 25 colleagues at CCRI are using that ever-growing repository of data to fundamentally change the way medicine is practiced. They are pursuing both peer-review research projects and quality improvement initiatives with their clinical colleagues. But, to them, quality improvement is not just about bumping up quality scores on Hospital Compare. “I look at quality as industrial research and development— identifying opportunities for standardization and other initiatives that are much more ad hoc than meeting the quality measures of the national organizations,” Silverstein says.
For example, NorthShore’s chief of surgery wanted to research the factors needed to predict short-term surgical outcomes and longer-term clinical cures for pancreatic cancer surgery. This would allow, among other things, better decision making about which patients should have surgery.
To get started, Silverstein and his colleagues modified the way NorthShore’s EHR system collects surgery data into what he calls “structured clinical documentation,” or point-and-click data entry with no text necessary. This means that every single factor is a data point. That makes the data analyzable, but it also improves workflow by automating the creation of physician notes, generating auto-fill referral letters and, in a way, prompting surgeons to think about their decisions. “It requires you to ask the value of everything you do,” he says.
When word got around that the new documentation process also improved workflow and made life easier for residents—in addition to helping address important research questions—more than 20 other projects related to structured clinical documentation were proposed. Then came a question from the very top of the organization: Can CCRI scale its resources so that structured clinical documentation becomes the standard throughout the health system?
“Is this the next major phase for us—collecting all this discreet information for everything?” Silverstein says. “We’re in the thick of about 10 of these projects right now. I’m very committed to the fact that the answer will be ‘Yes.’”
The term “informatician” had probably not been coined when Silverstein started programming computers as a seventh grader, using his Apple computer to solve a domino game called Catch 21. He was in medical school at Washington University in St. Louis, when an informatics pioneer predicted his future: “He said, ‘Your career is in informatics. You just don’t realize it. That’s what you’re trained for, and that’s where you going.’”
In 1994, when his surgical residency was nearly finished, the Internet appeared—and the truth of that prediction was sealed. To gain a broader understanding of medicine, Silverstein earned a master’s degree in clinical epidemiology. Then he practiced surgery for seven years, was heavily involved in two EHR implementations, and served as associate director of the Computation Institute at the University of Chicago and Argonne National Laboratory, where he became internationally known for applying advanced computing architectures to biomedicine.
Those former roles prepared him to seize the opportunity at CCRI, where research and quality improvement are focused on improving health care. Because of NorthShore’s work before he arrived, the data are available. “Now we need to focus on asking the right questions,” he says.
Jonathan Silverstein, MD, MS, is vice president of clinical research informatics at NorthShore University HealthSystem, Evanston, Ill. (JSilverstein@northshore.org).
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