Identifying collaborative care teams through electronic medical record utilization patterns

• Published in: Journal of the American Medical Informatics Association : JAMIA 2017-04, Vol.24 (e1), p.e111-e120
• Main Authors: Chen, You, Lorenzi, Nancy M, Sandberg, Warren S, Wolgast, Kelly, Malin, Bradley A
• Format: Article
• Language: English
• Subjects: Cooperative Behavior; Data Mining; Electronic Health Records - statistics & numerical data; Humans; Interprofessional Relations; Patient Care Team; Patient-Centered Care; Research and Applications
• ISSN: 1067-5027; 1527-974X; 1527-974X
• DOI: 10.1093/jamia/ocw124

Objective: The goal of this investigation was to determine whether automated approaches can learn patient-oriented care teams via utilization of an electronic medical record (EMR) system. Materials and Methods: To perform this investigation, we designed a data-mining framework that relies on a combination of latent topic modeling and network analysis to infer patterns of collaborative teams. We applied the framework to the EMR utilization records of over 10 000 employees and 17 000 inpatients at a large academic medical center during a 4-month window in 2010. Next, we conducted an extrinsic evaluation of the patterns to determine the plausibility of the inferred care teams via surveys with knowledgeable experts. Finally, we conducted an intrinsic evaluation to contextualize each team in terms of collaboration strength (via a cluster coefficient) and clinical credibility (via associations between teams and patient comorbidities). Results: The framework discovered 34 collaborative care teams, 27 (79.4%) of which were confirmed as administratively plausible. Of those, 26 teams depicted strong collaborations, with a cluster coefficient > 0.5. There were 119 diagnostic conditions associated with 34 care teams. Additionally, to provide clarity on how the survey respondents arrived at their determinations, we worked with several oncologists to develop an illustrative example of how a certain team functions in cancer care. Discussion: Inferred collaborative teams are plausible; translating such patterns into optimized collaborative care will require administrative review and integration with management practices. Conclusions: EMR utilization records can be mined for collaborative care patterns in large complex medical centers.