Proposals Awarded to Build UCSF's Path to a Continuously Learning Healthcare System

Photo credit: Mark Citret

Two proposals selected by campus collaborative to help inform UCSF’s transformation into a Learning Healthcare System

With the aim of developing UC San Francisco (UCSF) as a Learning Healthcare System as envisioned by the Institute of Medicine and NIH Collaboratory, a multi-sponsor committee at UCSF tapped into the experience and knowledge base of the campus community to solicit demonstration project proposals that would support this initiative.

The committee, composed of UCSF’s Chief Medical Information Officer Michael Blum, MD; Chief Innovation Officer Ralph Gonzales, MD, MSPH; Enterprise Information Analytics Executive Director David Dobbs, Institutional Review Board (IRB) Director Christopher Ryan, PhD; and Director of the CTSI Informatics and Research Innovation (IRI) program Mark Pletcher, MD, MPH, represents a cross section of UCSF’s clinical and research offices. It received 14 proposals that elicited more than 90 comments from the UCSF community online through UCSF Open Proposals.

Ari Hoffman, MD

The two selected proposals will receive funding for up to one year and various in-kind support from the above stakeholders:

An Epic COPD Care Pathway” proposed by Ari Hoffman, MD, aims to improve the quality and adoption of order sets clinicians receive via UCSF’s electronic health record system APeX to deliver care to patients with Chronic Obstructive Pulmonary Disease (COPD). Ordering providers will see different versions of the order set, the standard one versus test versions utilizing drop downs and algorithms to help clinicians follow best practices based on patients’ history and disease severity.

A more effective order set will hopefully prompt changed physician behavior resulting in reduced readmission rates of COPD patients at UCSF, which is nearly double the national average.

“The community forum gave us important feedback on the scope of our project and communication strategy, helping us hone our message for the second round. We are excited for this opportunity to leverage the power of our electronic record system to improve care,” said Hoffman.

Robert Rushakoff, MD, MS

The other awarded proposal also utilizes electronic health records as a pathway for better care. “Leveraging the Power of the EMR: Using a real time prediction model to decrease inpatient hypoglycemic events proposed by Robert Rushakoff, MD, MS, will evaluate and run real-time alerts through APeX to warn providers when a patient is at risk for a hypoglycemic event. The providers will be prompted to adjust the patient’s orders to reduce the risk for hypoglycemia, with the goal of entirely avoiding this event at UCSF.

“This is the type of project that just does not get done without internal support. Without this funding we would not be able to coordinate programmers, analysts and biostatisticians,” stated Rushakoff.

Regarding the open proposal experience, Rushakoff added, “After our initial short proposal, we received comments from ‘fans’ who spoke to our past successful inpatient diabetes programs and the importance of the current proposal. There were also several comments and questions from senior, experienced researchers. In each case, the questions were insightful and specific – the answers to their comments were incorporated into our final proposal.”

Learning Healthcare System Committee Shares Thoughts on the Demonstration Project Proposals

“The award committee is very enthusiastic about these innovative projects.  Given the consortium arrayed to help support them, which includes UCSF’s leaders in medical center IT and digital health, healthcare delivery innovation, research ethics and study design, we are really optimistic that these projects will succeed, and will help UCSF learn to be a Learning Healthcare System.” - Mark Pletcher, MD, MPH

"One of the central lessons from the past decade is that simply installing an electronic health record doesn't, by itself, lead to major jumps in quality, safety, and productivity. Rather, just as apps take advantage of the iPhone as a platform, a learning healthcare system creates an environment in which people have the skills and motivation to reimagine care, using the EHR as a platform. These demonstration projects are superb examples of this, and they give me great hope for the future." - Robert Wachter, MD

“I was impressed with the diversity and ingenuity reflected in the proposals submitted to the LHS Demo Project. The projects selected for funding will help address critical gaps in care that we currently experience with our patients, but each will also establish a platform for using the EHR in ways that can be adapted to a variety of conditions. Going forward, I’m also excited to see how the LHS Demo Project sponsors work together to expedite project design, implementation and evaluation." Ralph Gonzales, MD, MSPH