Breakthrough in data-sharing leads to better practices

Generating quality improvements from data analysis just got an order of magnitude easier for the Centre Intégré universitaire de santé et de services sociaux du Centre-Ouest de l’ile-de-Montréal (a Montreal-area health region) and the Nova Scotia Health Authority, following their recent acquisition of the ADAMS platform, a ground-breaking analytics solution from Israeli health-tech startup MDClone.

“My takeaway following our launch in July is that data analysis is no longer the overwhelming, daunting task that it was before,” said Sabine Cohen, associate director of digital health with the Montreal health network.

“It’s like night and day,” agreed Dr. Matthew Clarke, the Nova Scotia Health Authority’s associate chief medical information officer. “My ability to access data in the past was extremely limited, very cumbersome and time consuming.

“If I wanted to know how many patients were being admitted for Chronic Obstructive Pulmonary Disease (COPD) and what their length of stay was, I’d have to apply, get approval and then manually go in and look at all the records. It could take a couple months. With MDClone’s ADAMS platform, I can log onto the platform in five or 10 minutes and run a query to see how we’re doing compared with peer averages.”

The ADAMS platform speeds data analysis by generating data sets in response to a query that are statistically equivalent to the real source data but truly synthetic, eliminating concerns relating to the protection of patient privacy. The real patient data is never exposed.

An acronym for Ask, Discover, Act, Measure, Share, the ADAMS platform provides users with a self-serve environment that allows front-line health practitioners to perform data analysis without the involvement of the data team. Nor do they require a technical background themselves.

“In order to ask an intelligent question, you often need data from different systems, and bringing that data together – especially for health networks that have older systems, or systems that are not connected – was really challenging, so it often required whoever is asking the question to work with the data team,” explained Dr. Justin Cross, chief digital health officer with the CIUSSS West-Central Montreal.

The ADAMS platform brings together data from different sources into one longitudinal data lake and leverages natural language processing capability to extract information from large amounts of unstructured text documents.

With the acquisition of the ADAMS platform by The Ottawa Hospital in 2020, there are now three Canadian medical organizations able to collaborate and share data to solve common healthcare issues.
Representatives of the three organizations met in Montreal in early July to discuss how they can work together on data-enabled operational performance and quality improvement projects.

“Collaboration is key because it’s naïve to think you can always solve your own problems, so having meaningful conversations about how we can share data and ideas for improvement is really exciting,” said Dr. Alan Forster, executive vice-president and chief innovation and quality officer at The Ottawa Hospital.

More than 300 users, including students, clinicians and researchers are currently using the ADAMS platform to access data from The Ottawa Hospital’s Epic EMR, as well as laboratory, pharmaceutical, diagnostic imaging, demographic and case costing data from as early as 2003.

“We’ve worked on a number of initiatives, ranging from population health to hospital costs by diagnosis,” said Dr. Forster. One research project he cited linked reduced lung cancer costs, hospitalizations and morbidity more to quality improvement practices by thoracic surgeons and medical oncologists than to a reduction in smoking rates. Another study validated the use of an expensive drug based on better outcomes and a reduction in overall costs to the hospital.

Canadian users of the ADAMS platform are also able to collaborate with ease across international borders. The Ottawa Hospital, for example, shared data with an ADAMS platform user in St. Louis, Missouri. “In the past,” said Dr. Forster, “that kind of work would have been years in the making. Using synthetic data from the ADAMS platform, it took one month.”

Having just launched the ADAMS platform in July, the CIUSSS West-Central Montreal has access to a half dozen data sources from the Jewish General Hospital, the health network’s acute care institution, but there are also plans to eventually add data from its rehabilitation hospitals, long-term care centres, community health centres, family practices and home care services.

“We started by positioning the platform to be used for internal quality improvements and inviting our administrative leadership to become familiar with its capabilities,” said Dr. Cross. “We will then move on to our clinical leads, including our physician and nursing champions. Then we’re going to open it up to the rest of our community because you never know if someone on the front line has a great idea for a quality improvement project. We want to empower everyone to ask questions and create positive change.”

As of mid-August, 79 users at the CIUSSS West-Central Montreal were registered for training, half of whom were already up to speed.

Queries can focus on improving access to care, reducing length of stay and improving outcomes following surgery. “We’re just getting started,” said Dr. Cross, “but one ADAMS platform user in the U.S., Intermountain Healthcare, was able to identify patients at risk of progressing toward impaired kidney function.

With chronic kidney disease, it’s important to intervene early and get patients on the right treatment to prevent unplanned ER visits and hospital admissions, so that’s an example of the quality improvement we’re going to be looking for.”

The Nova Scotia Health Authority went live in June with a subset of 35 clinicians and researchers who have access to 12 years’ worth of data from a variety of sources.

As an example of a possible query, Dr. Clarke cited the possibility of comparing the average length of stay for a COPD exacerbation across various hospitals to identify best practices and replicate them at other sites.

Using social determinants of health data from across the province, there is also the potential “to develop programs and services in those areas of need,” said Nelson Ventura, acting director of innovation with Nova Scotia’s Health Innovation Hub.

Eventually, the plan is to train front-line staff to use the platform because in their day-to-day work, they are aware of the challenges, inefficiencies and quality issues from anecdotal experience and may have ideas for resolving them but don’t have the data to back them up, noted Dr. Clarke.

Each user of MDClone’s ADAMS platform interviewed for this story offered advice for Canadian health networks and hospitals interested in taking advantage of their data for quality improvement and patient care.

The Ottawa Hospital’s Dr. Forster, who has had most experience with the platform, emphasized the need to first extract data from their EMR to make it accessible, claiming “most organizations believe that data within their EMR is immediately available for analysis, but that’s a fallacy.”

Dr. Cross’s team in Montreal stressed the importance of unique patient identifiers and Dr. Clarke of Nova Scotia underlined the need for data standardization, warning “if front-line clinicians are inputting data differently in the system, it affects the output and what we’re able to glean from it.”