Karen Nitkin

Date: 02/07/2019

As a Joint Commission-certified facility, the Comprehensive Stroke Center at The Johns Hopkins Hospital is required to track performance improvement data in the American Heart Association’s Get with the Guidelines stroke registry, a national database that allows hospitals to measure quality of care and highlights areas of potential improvement.

Now, the process of getting the information into the heart association’s registry is more efficient and accurate, thanks to a collaboration among an Epic project team, Johns Hopkins clinicians and software engineers.

The change has saved the equivalent of two full-time positions, and the team that designed the improvements says other departments across Johns Hopkins Medicine could be eligible for similar benefits.

The stroke center, directed by Victor Urrutia, sees about 500 patients a year, and has been collecting patient data for the registry since 2004, says Brenda Johnson, assistant director of the stroke center and assistant professor of neurology. The heart association’s registry requires some 300 pieces of data for each patient, including information on demographics, vital signs and medications, she says.

To gather that information, Hopkins clinicians used to search through the Epic electronic medical records system and other sources. Each data point then had to be mapped on a spreadsheet before it was manually entered into the heart association registry.

The process, which required two full-time stroke nurses and two quality improvement nurses, was inefficient and had chances for human error.

In the fall of 2018, Urrutia and Johnson learned that the two quality improvement nurses would be reassigned at the end of the year. They decided there had to be a better way.

“We decided to get the database automated,” Johnson says. “We wanted to ensure we had safety and quality for the patients, and we wanted to guarantee data integrity. We also wanted an ease of use for the clinicians.” They began working with Peter Dziedzic, founder and director of the Johns Hopkins Center of mHealth and Innovations and a research associate in neuroimmunology.

Johnson then requested approval from the Data Trust Registry Review Committee, a group that reviews requests to submit Johns Hopkins Medicine data to external clinical registries. The committee advised Johnson to work with the Epic team to extract the data, and it put her in touch with Epic project manager Joseph Eapen.

Additional collaborators included Niteesh Potu, a software engineer on the mHealth team; Epic specialists Tony Millar and Peggy Neidlinger; stroke data nurse Jaime Butler; and other nursing informatics and quality improvement clinicians.  

The mHealth team got in touch with the heart association to learn about its formatting requirements, and the team observed how clinicians extracted data for the registry.   

“Our clinicians were basically going into the electronic medical records system and looking for data that were already stored somewhere, so they could pull it out for a different purpose,” says Dziedzic. “We came in with software engineering skills to put the information in a format that can be used for the heart association registry and other purposes as well.”

Now, the information is extracted from Epic and formatted to align with American Heart Association requirements. When clinicians are ready to send it to the heart association, they look over what has been automatically compiled and revise if necessary, says Potu. Over time, the engineers say, the system will become more automated.

“I hope this project gives time to clinicians so they can be more focused on the patient rather than how to extract data,” says Dziedzic.

Considering participation in a clinical registry? Contact Valerie Smothers or Stephanie Busam for information about the review process.