Visualizing collaborative electronic health record usage for hospitalized patients with heart failure

Abstract

Objective: To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure.

Materials and methods: We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient's EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques.

Results: We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network.

Discussion: Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers.

Conclusion: EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure.

Keywords: Care collaboration; electronic health records; heart failure; network analysis.

Figure 1::

An illustration of the pipeline used in this study.

Figure 2::

(A) An example of a provider-patient network for a single patient. Number of providers = 85; Number of order-placing providers = 15; Other = Administrative staff and Quality Assurance; PCSN = Patient Care Staff Nurse; R/F = NMH Resident/Fellow; PCAS = Patient Care Assistive Staff; Resp. = Respiratory; APC = Advanced Practice Clinician; Hosp. = Hospitalist; PA = Physician Assistant; Rad. = Radiologist; US = Unit Secretary. An edge connects a provider and the patient if the provider accessed the patient’s record. Provider nodes in closer proximity to the patient node indicate that the provider placed a higher number of orders for the patient. (B) A network for the same patient including only providers designated as physicians (number of physicians = 24).

Figure 3::

Two representations of the patient-sharing network are shown. Node colors identify module membership. Edges are assigned the color of the source node. (A) Network view: nodes are providers and edges between providers indicate ≥ 10 shared patient record accesses. The edge weight was calculated using the shared patient index (see Materials and Methods section). (B) Modular view: nodes are groups of providers (modules) and edges between modules indicate patient record sharing between members of 2 modules and are weighted by total number of interactions between members. A total of 7 modules were identified.

Figure 4::

The results of clique identification for the provider collaboration network in Figure 3A are shown. “Number of providers in clique (n),” or clique size, is plotted against “clique count,” or the number of cliques of size n. Cliques are defined and illustrated in the upper left hand corner. Nodes represent providers and an edge between 2 providers indicates that they accessed at least 10 of the same patient records. The clique identification algorithm did not take the shared patient index edge weight into account. The red bars indicated by the arrows designate the number of cliques of size 2, 3, 4, 5, 6, and 100 identified in the network.

Figure 5::

A screenshot of the browser interface for the Neo4j graph database, showing an example query for a subset of patients in the provider-patient network. Provider nodes are dark blue and patient nodes are blue-green. Directed edges are from providers to patients, indicating that a particular provider accessed a patient’s record. Database information including node types, relationship types, and property keys (attributes) are shown on the left side of the figure. The query used to generate the subnetwork is shown at the top of the screen. The black box on the right lists the attributes of the highlighted patient node (circled in gray). This query identifies patients in the data set for whom providers in both the Dietary 1 and Rehab PT positions accessed their record. All protected health information has been deidentified.