The National Intrepid Center of Excellence here received special recognition from Government Computer News for successful innovation of the continuity management tool that NICoE launched in 2014.
The center provides cutting-edge evaluation and treatment to service members diagnosed with traumatic brain injuries as well as psychological health disorders.
The continuity tool, also known as the NICoE Continuity Management Tool project, enables NICoE clinicians to collect thousands of data points per patient, electronically.
Electronic Collection of Clinical, Research Data
The continuity management tool also pulls additional sets of information from large clinical and research databases to form a robust repository of TBI-related health data in the Department of Defense dated from 2008 to the present, supporting researchers in studies and clinicians in formulating new treatment options to maintain excellence in TBI care.
The development of the NICoE continuity management tool had been something that was underway from the very building of the center of excellence, and the original intent of that tool was very expansive, according to Navy Capt. Sara M. Kass, who serves as special assistant for the NICoE to Walter Reed Bethesda Director Army Brig. Gen. Jeffrey B. Clark.
Managing All Resources
“The goal was to have one tool that could really manage all resources including personnel, space, and supplies, as well as collect clinical data and have that data be available for research purposes and allow for case management of patients,” Kass said.
Kass named Dr. Jesus J. Caban, chief of clinical and research informatics, along with Eddy Bueno, NICoE chief of administration, as the “heavy lifters” of the effort.
She said the model built by the two and their team serves as a model for similar tools being used by or under development at the Hearing Center of Excellence, the Vision Center of Excellence and the Amputee Center of Excellence. In partnership with the Defense Health Agency, the developers of the project expect to soon provide other DoD organizations with tools and systems for their registries.
“We are now advocating this as a model for other would-be registry managers across the Military Health System,” Army Col. (Dr.) John S. Scott, director of clinical informatics policy, health affairs, stated in his Oct. 16, 2014, correspondence with the Office of the Assistant Secretary of Defense for Health Affairs.
Caban led the NICoE team to develop the powerful tool that standardizes data collection across clinical specialties at the NICoE. Researchers and clinicians, Caban said, don’t translate data the same way -- a huge challenge for the project.
Meshing Clinical, Research Information
Researchers want forms where detailed clinical information could be captured, and clinicians prefer free text to better describe the patient’s condition, Caban said. The NICoE Continuity Management Tool meshed together both clinical information and research so that both can maximize benefit from this data, “for collecting information, particularly both on clinical and research elements, to allow us to better understand the complex patients that we have coming through,” explained Dr. Joseph Bleiberg, senior scientific advisor of NICoE.
Bleiberg said the NMCT project helps to develop a series of subgroups by analyzing data it provides and helps provide an understanding of those patients. The successful project generates data into queries for research, dashboards providing visual analytics, and allows data sharing.
“By using the NCMT, we can leverage info that’s captured by all our providers here on the clinical side and be able to understand their clinical condition in that elemental form. In other words, we can get the information about the patients in a much more detailed form that goes into the database that allows us to understand the patients better than we were ever able to do before,” explained Dr. Thomas J. DeGraba, deputy director and chief of medical operations at NICoE.
Transformative Process
“We’re doing things that were impossible to do otherwise,” Bleiberg added. “This is transformative; it’s not just [efficient].”
“We’re allowing the process of taking care of patients [to] produce research as we’re taking care of patients,” Bleiberg said. “We’re using a clinical model that has been used at the National Institutes of Health in the past [and] we’ve incorporated here as part of a clinical research institute that allows us to change the face of clinical research.
“It’s a pilot-capability test case as it were: Can this be done utilizing/incorporating the advances that are being made by Dr. Caban and his team but still utilize the legacy system?” he continued. “We’re still leveraging the Armed Forces Health Longitudinal Technology Application system. We’re just using it in a better way.”
Dr. Greg Morgan, a neurologist and sleep specialist who serves as director of the sleep medicine lab at NICoE, has used the new system, and he explained how the system is helping providers.
Organizes Acquired Patient Data
“I like it because it organizes the data that we acquire, which is a lot, in a systematic way so it’s reproducible from patient to patient, rather than typically when you take a history you may stray in one direction or another,” Morgan said. “When you try to do research, you need reproducibility data points from patient to patient. Structurally, I like the organization of it.
“It helps me take what I thought at first was a very unwieldy note when I first got here and consolidate it into chunks that are more organized and digestible,” he continued. “I’ve gotten comments from some outside providers that they like the format of our notes -- they think they’re easier to navigate than the old, long paragraph after paragraph, after paragraph. Having it in sections, and labeled, they know what they can jump to to get the nuggets that they think are interesting.”
Morgan said he liked the way NCMT collects self-reports from the patients.
“I reference that before I even go and see the patient, populating my notes,” he said. “It gives me a framework on how to aim the discussion. I think it adds efficiency with the patient because I’m already primed with good information that they filled out. It sort of extends the history beyond the time you have [with them during the appointment] … you can efficiently focus on what they’ve already written down. I like that aspect of it.”
The NCMT taps into the existing medical systems: Armed Forces Health Longitudinal Technology Application and Composite Health Care System.
Caban said the challenge was to develop something that physicians were already using in their clinical practice -- not adding to the tasks they already have.
He added, “We don’t want to interrupt or interfere with that, that’s why we’ve been letting the provider do what they do best -- taking care of patients.”