Query+Health+--+Trends+in+Use+of+Medical+Products+in+the+Inpatient+Setting+User+Story

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=Trends in Use of Medical Products in the Inpatient Setting=

Problem: Local, State, and Federal public health authorities do not have a reliable mechanism for evaluating trends in the use of medical interventions in the inpatient setting. Transactional systems such as insurance claims data provide high-level information on inpatient encounters and procedures but do not routinely capture more detailed information on care and treatments provided during inpatient stays.
 * Background:** This User Story focuses on querying information typically found electronically coded in an inpatient EHR. The intent is to describe a distributed query that is achievable without new data collection efforts or substantial new concept mapping. The description below doesn’t select a specific medical treatment. Implementation of this user story should target one or more treatments that are best suited for distributed querying in the current environment as the intent is to illustrate value in querying across data sources and not how to incorporate new data collection efforts, new approaches for data normalization, or new mechanisms of creating searchable information. That is, keep it simple and achievable.


 * Definition:** Medical products can include any medical intervention such pharmaceuticals, vaccinations, and blood products, implantation or use of medical devices, and surgeries. For the purposes of this user story, we limit consideration to medical interventions that can readily be identified in existing EHR systems and that cannot be easily captured in other more routinely used data sources such as claims data.


 * Uses:** Without knowledge of inpatient medical product utilization it is difficult for Local, State, and Federal public health officials to develop plans to monitor the safety, efficacy, and effectiveness of such products. Just as it is important for public health officials to understand trends in the diagnosis of asthma, gestational diabetes, and influenza-like illness, these officials also need the capability to assess use and trends in the use of medical products and interventions in the inpatient setting. This information is a necessary condition in developing plans to monitor the safety, efficacy, and effectiveness of such products.


 * Example 1: Vaccination Rates: Allow authorized users (e.g., FDA, CDC, State DPHs) to determine inpatient vaccination rates, including which vaccinations are most common, thereby providing more refined estimates of vaccination coverage and also identifying a possible new source of exposure information needed to monitor vaccine safety. If vaccination rates are low in the inpatient setting, officials will know not to devote resources to better capture and evaluate the information, conversely, if vaccinations are more common than expected it will help direct resources appropriately.
 * Example 2: Medication Rates: Allow authorized users to determine the rate of medication use in the inpatient setting, including the types of medications administered. Inpatient medication exposure is a topic of interest for agencies such as FDA, but few data sources provide detailed information on such use. Understanding the use of medications in the inpatient setting will allow authorized users to monitor trends in use, better design safety evaluations, and determine the extent of possible exposure misclassification in observational safety evaluations.


 * Implementation:** This user story is consistent with the generic user story that targets identification of stratified counts of numerators and denominators. Distributed queries would need to describe the exposure of interest using standardized codes available at the distributed partners. Once coding is determined, the query can be distributed via several mechanisms under consideration.

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 * Enhancements:** Once developed, an inpatient distributed querying capability could be expanded to take advantage of other types of structure and unstructured data. For example, the rate of MRSA infection in ICUs, the safety of specific orthopedic impacts, and acute adverse events associated with inpatient treatments could be evaluated using a distributed query system.

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