Browsing by Author "Kunjan, Kislaya"

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    A big data augmented analytics platform to operationalize efficiencies at community clinics
    (2016-04-15) Kunjan, Kislaya; Jones, Josette F.; Toscos, Tammy; Wu, Huanmei; Holden, Richard
    Community Health Centers (CHCs) play a pivotal role in delivery of primary healthcare to the underserved, yet have not benefited from a modern data analytics platform that can support clinical, operational and financial decision making across the continuum of care. This research is based on a systems redesign collaborative of seven CHC organizations spread across Indiana to improve efficiency and access to care. Three research questions (RQs) formed the basis of this research, each of which seeks to address known knowledge gaps in the literature and identify areas for future research in health informatics. The first RQ seeks to understand the information needs to support operations at CHCs and implement an information architecture to support those needs. The second RQ leverages the implemented data infrastructure to evaluate how advanced analytics can guide open access scheduling – a specific use case of this research. Finally, the third RQ seeks to understand how the data can be visualized to support decision making among varying roles in CHCs. Based on the unique work and information flow needs uncovered at these CHCs, an end to-end analytics solution was designed, developed and validated within the framework of a rapid learning health system. The solution comprised of a novel heterogeneous longitudinal clinic data warehouse augmented with big data technologies and dashboard visualizations to inform CHCs regarding operational priorities and to support engagement in the systems redesign initiative. Application of predictive analytics on the health center data guided the implementation of open access scheduling and up to a 15% reduction in the missed appointment rates. Performance measures of importance to specific job profiles within the CHCs were uncovered. This was followed by a user-centered design of an online interactive dashboard to support rapid assessments of care delivery. The impact of the dashboard was assessed over time and formally validated through a usability study involving cognitive task analysis and a system usability scale questionnaire. Wider scale implementation of the data aggregation and analytics platform through regional health information networks could better support a range of health system redesign initiatives in order to address the national ‘triple aim’ of healthcare.
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    Large-Scale Data Mining to Optimize Patient-Centered Scheduling at Health Centers
    (Springer, 2018-09-04) Kunjan, Kislaya; Wu, Huanmei; Toscos, Tammy R.; Doebbeling, Bradley N.; BioHealth Informatics, School of Informatics and Computing
    Patient-centered appointment access is of critical importance at community health centers (CHCs) and its optimal implementation entails the use of advanced data analytics. This study seeks to optimize patient-centered appointment scheduling through data mining of Electronic Health Record/Practice Management (EHR/PM) systems. Data was collected from different EHR/PM systems in use at three CHCs across the state of Indiana and integrated into a multidimensional data warehouse. Data mining was performed using decision tree modeling, logistic regression, and visual analytics combined with n-gram modeling to derive critical influential factors that guide implementation of patient-centered open-access scheduling. The analysis showed that appointment adherence was significantly correlated with the time dimension of scheduling, with lead time for an appointment being the most significant predictor. Other variables in the time dimension such as time of the day and season were important predictors as were variables tied to patient demographic and clinical characteristics. Operationalizing the findings for selection of open-access hours led to a 16% drop in missed appointment rates at the interventional health center. The study uncovered the variability in factors affecting patient appointment adherence and associated open-access interventions in different health care settings. It also shed light on the reasons for same-day appointment through n-gram-based text mining. Optimizing open-access scheduling methods require ongoing monitoring and mining of large-scale appointment data to uncover significant appointment variables that impact schedule utilization. The study also highlights the need for greater "in-CHC" data analytic capabilities to re-design care delivery processes for improving access and efficiency.
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    Missing links: challenges in engaging the underserved with health information and communication technology
    (ACM, 2016-05) Wright, Maria D.; Flanagan, Mindy E.; Kunjan, Kislaya; Doebbeling, Bradley N.; Toscos, Tammy; BioHealth Informatics, School of Informatics and Computing
    We sought to understand underserved patients' preferences for health information technology (HIT) and examine the current use of personal health records (PHRs) in Community Health Centers (CHCs) serving low-income, uninsured, and underinsured patients. Forty-three patients and 49 clinic staff, administrators, and providers from these CHC systems were interviewed using open-ended questions assessing patient experience, perceptions of the CHC, access barriers, strategies used to overcome access barriers, technology access and use, and clinic operations and workflow. All seven CHC systems were at some stage of implementing PHRs, with two clinics having already completed implementation. Indiana CHCs have experienced barriers to implementing and using PHRs in a way that provides value for patients or providers/staff There was a general lack of awareness among patients regarding the existence of PHRs, their benefits and a lack of effective promotion to patients. Most patients have access to the internet, primarily through mobile phones, and desire greater functionality in order to communicate with CHCs and manage their health conditions. Despite decades of research, there remain barriers to the adoption and use of PHRs. Novel approaches must be developed to achieve the desired impact of PHRs on patient engagement, communication and satisfaction. Our findings provide a roadmap to greater engagement of patients via PHRs by expanding functionality, training both patients and clinic providers/staff, and incorporating adult learning strategies.
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    A Multidimensional Data Warehouse for Community Health Centers
    (2015-11-05) Kunjan, Kislaya; Toscos, Tammy; Turkcan, Ayten; Doebbeling, Brad N.; BioHealth Informatics, School of Informatics and Computing
    Community health centers (CHCs) play a pivotal role in healthcare delivery to vulnerable populations, but have not yet benefited from a data warehouse that can support improvements in clinical and financial outcomes across the practice. We have developed a multidimensional clinic data warehouse (CDW) by working with 7 CHCs across the state of Indiana and integrating their operational, financial and electronic patient records to support ongoing delivery of care. We describe in detail the rationale for the project, the data architecture employed, the content of the data warehouse, along with a description of the challenges experienced and strategies used in the development of this repository that may help other researchers, managers and leaders in health informatics. The resulting multidimensional data warehouse is highly practical and is designed to provide a foundation for wide-ranging healthcare data analytics over time and across the community health research enterprise.