Frontline physicians must think on the fly, relying on their most current knowledge to provide effective clinical care. Oftentimes, though, it is difficult for them to access, filter, and harness the overwhelming amount of healthcare information that is available in order to stay up to date. Two clinical informatics fellows at The Children’s Hospital of Philadelphia brainstormed about this problem and created an award-winning technology-based solution to help doctors make better decisions based on the very latest public health guidelines and recommendations.
Marc Tobias, MD, and Naveen Muthu, MD, of CHOP’s Department of Biomedical and Health Informatics (DBHi) were inspired by what they had learned during their fellowships about clinical decision support and the challenge of knowledge maintenance. Realizing that public health officials and agencies have poor channels of communicating rapidly and efficiently with clinicians, they began in the fall to conceptualize a way to bridge that gap. Their idea quickly evolved into a prototype: The Population Health Risk Assessment Support Engine (PHRASE Health).
PHRASE is an electronic health record (EHR)-agnostic system designed to identify at-risk populations and provide clinical decision support to healthcare providers at the point of care. The portal allows for a two-way flow of data: public health provides timely updates about evolving disease and patient risk factors through the system, while clinicians consume these recommendations in the EHR and utilize one-click reporting of disease cases back to the public health department.
They submitted PHRASE in December to the “Closing the Data Divide” Virtual Challenge, jointly sponsored by the de Beaumont Foundation, which seeks to transform the practice of governmental public health, and the Practical Playbook, which works to increase collaboration between public health and primary care. Drs. Tobias and Muthu received a prize of $30,000 for their first place finish.
"Dr. Tobias and Dr. Muthu are leading the way in this new medical subspecialty," stated Anthony Luberti, MD, medical director for Informatics Education in DBHi and director of CHOP’s Clinical Informatics Fellowship Program, in a press release. "PHRASE Health is an example of the kind of innovative technology solutions that can impact health outcomes for patients. We are extremely proud of their efforts."
Dr. Muthu used the developing story of the Zika virus as a real-world example to demonstrate how PHRASE could be a valuable tool. As recommendations continue to evolve for screening patients in the U.S. who may have been exposed to the virus, PHRASE could help physicians identify which patient populations are most at risk for complications and notify them through a message generated in their EHR.
“We’ve had the opportunity to talk to a variety of public health officials at the city, state, and national level,” Dr. Tobias said. “It’s been an amazing experience to get all of the positive feedback from bringing the newest technologies to a historically frustrating problem.”
Here’s how the platform could work: When a physician opens a patient’s chart or places a specific order for that patient, the EHR would call out to the PHRASE web server. Based on certain data, such as demographic, geographic, or social factors, PHRASE will determine what specific diseases or conditions a patient is currently at risk for, based on determinants defined by public health officials. It also will issue patient-specific recommendations that the clinician needs to be aware of and alert them via the EHR. The platform is based on interoperability standards, which means it will be compatible with multiple types of EHRs.
“The big picture is that public health officials, guideline makers, and other domain experts will be fully integrated with frontline providers so that providers can receive the best decision support at the point of care,” Dr. Muthu said. “We can also use current data from the EHR through the same platform for reporting purposes to send data back to public health entities.”
The prototype is functional but needs to be refined and tested at CHOP with the support of CHOP’s Office of Entrepreneurship and Innovation before a sustainable model will be ready to be implemented. The development process has engaged a wide range of partners from both healthcare and public health, including collaborations with the Philadelphia Department of Public Health and the Pennsylvania Department of Public Health.
“We’re thrilled for the opportunity to show our work and get feedback from the larger public health community and excited to move forward,” Dr. Muthu said.