Andey Nunes-Brewster @ Oregon Health Authority | Data Science Hangout

Happy Thursday, everybody. Welcome back to the Data Science Hangout. If it's your first time joining us here today, it's so nice to meet you. I'm Rachel. Thanks for spending your Thursday with all of us. And so the Hangout is our open space to chat about data science leadership, questions you're facing, and getting to hear what's going on in the world of data across different industries. So if this is your first time here, we are here every Thursday at the same time, the same place. And if you're watching this recording on YouTube later, you can also add it to your calendar if you want to join us virtually here on Zoom as well.

Curtis, I'm going to make sure that I made you a co-host so you can help me with the waiting room as people are coming in here. Okay, awesome. But together, we're all dedicated to making this a welcoming environment for everybody. So we love to hear from everyone, no matter your years of experience, titles, industry, or languages even that you work in. And so every week at the Hangout, I'm joined by a different leader from the community who joins us to share their experience and answer questions from you all. So it is totally okay to just listen in if you want, but there's also three ways you can jump in and ask questions or provide your own perspective on certain topics. So you can raise your hand on Zoom and I'll be sure to be on the lookout here. You can put questions in the Zoom chat and put a little star next to it if it's something you want me to read out loud instead, or else I'll just call on you to jump in here and join the party. But third, we also have a Slido link where you can ask questions anonymously. And I see Hannah just shared that right as I said it.

Thank you. But I'm so excited to be joined by my co-host today, Andy Nunez Brewster. Andy is the EMS and Trauma Research Analyst at Oregon Health Authority. And Andy, I'd love to have you jump in here and introduce yourself, share a little bit about your role and also something you like to do outside of work too.

Introducing Andy and his role at Oregon Health Authority

Sure. Okay. So I've been with the Oregon Health Authority since January of 2020 in this role. I work with a team that coordinates the emergency medical services throughout the state of Oregon. And so our program licenses healthcare professionals who are first responders, including EMTs and paramedics of all kinds, all shades. And we also regulate ambulance services. We have a data system for electronic patient care records for field responses. So ambulance calls that do patient care or transport a patient. Every one of those patient records is in a repository that we get. That data comes in practically real time. We have all those within 48 hours of an event. And then we also have several time-sensitive emergency registries that we manage, including trauma and cardiac arrest and stroke. Some of those have integrations with the EMS data. And one of the things I'm really excited about getting to work on is a project with the Oregon Department of Transportation, where we're looking at the feasibility of interoperability between the various EMS datasets that we have and crash data.

And so that's really exciting too. And then outside of work, I do play a couple of musical instruments from time to time. That's a topic that comes up often in this space. And I have a couple of kids. One of whom is about to move into a dorm at the University of Oregon in Eugene. And we just got to take him there for a couple of orientation sessions. And I'm excited about that. He's sort of interested in data science, which I'm crossing my fingers, but also go have fun and have an adventure. And then I also have a two-year-old, or soon-to-be two-year-old. So it's daycare and college at the same time for me. So I'm happy to have a permanent government position at this time.

Building an internal R community

Well, thank you so much, Andy, for joining us. I was thinking back to when we first got to chat one-on-one. And I think it was because you were building up your own community internally. When we first got to chat one-on-one. So I'd love to learn more about that experience and what led you to start an internal group as we're waiting for questions to come in from everybody.

Yeah. And I'm correcting a couple of acronyms. If folks, if I start peppering the acronyms, I'll try to throw those in the chat too. So yeah, our community group really arose out of a couple of sections got together, the injury and violence prevention section, and the EMS folks in my program. And we wanted to do some training in R relating to kind of upskilling the team to be able to collaborate. And really, we were working on a procurement for Posit, for enterprise solutions, so that we can use Connect and do more with the data that we have. And so out of this training, we ended up creating a Teams group. So our whole organization, our primary way of communicating with each other is email through Outlook and then chat through Teams. And we have lots of channels that support various working groups. And so there was a team channel that was created for that RStudio Academy cohort. And after the 10 weeks of us together, we all felt like we just wanted to share everything we had learned with everyone else.

And so we opened up the group to everybody. And the first week we had, there was, so there was eight of us to start with, we had about six people join in that first week when we finished and said, let's just invite everyone and let's share what we've learned. The next month, there was about 40 people in that group. And by the second month, we had over 100 people in that group. And that was, then that's only word of mouth. There isn't anyone running the group right now. We have, it's all sort of like, we just get together and, and what do people want? What do people need? What can folks bring? Who can we find to help bring that? And so it's, it's fairly organic. And we're doing a little bit of work now to try to make it a little more formal. But it's still very much a work in progress.

And by the second month, we had over 100 people in that group. And that was, then that's only word of mouth. There isn't anyone running the group right now. We have, it's all sort of like, we just get together and, and what do people want? What do people need? What can folks bring? Who can we find to help bring that? And so it's, it's fairly organic.

That's great. So it all started with those people who are the academy together? Yeah, the academy cohort. I figured it'd probably be helpful for anybody who hasn't heard of what academy is to just explain what that process was the team went through too.

Sure. So we, we learned about it through the website, and then got in touch with, with the folks at Posit and learned that it's, it's 10 weeks where we get them, where our group is assigned a mentor and we get a, we get some healthcare data to work with. And we go through some tutorial modules. Some of this is asynchronous, some of this we could choose to work together. It was really kind of up to the group how to manage getting through the tutorial materials. And then we would do a, an exercise each week where you reproduce something, right, either a table or a way to clean the data and arrange it or a visualization. And then from there, build on it on your own, right, to do something to expand upon that topic that week. And so our group really got a couple things out of that experience, sort of drops the barriers and some of the initial hesitation about sharing code with one another. And we learned how to support each other in improving code and how to, it's not just about speaking, you know, kindly or, you know, sandwiching your, your critique with some positive things. Like it's, it's more than that. It's about understanding where each other is in the learning process and really helping each other, you know, achieve our goals. And, and so there's a lot of, a lot of learning how to listen to each other too. So that was really, I felt that was really, a really great thing to come away with.

Leadership sponsorship and community growth

Ted, I think you had a question about the, the group. Yeah, I mean, well, Andy and I know each other. So, hey, Andy. Hi, Ted. So one of the things that I've heard a lot with, like, starting these groups is people really want to, want to participate, but they're so busy. Like, so I found that one of the routes to kind of improving that is to get sponsors among leadership. Do you have any experience with that?

No, that's a really interesting idea. And I'm curious about what the role of the sponsor really would be, because I would want to be able to articulate that too. I'm, in my head, it sounds like kind of, like, mentoring, like someone who's in a leadership position that can say, you know, go ahead and participate because we're getting this value back out of it, or something along those lines. And then folks feel like they have the space to ask for that, right?

Yeah, I think, I think just someone who can formally say that for, like, you know, an entire group, that it's okay to spend time on this. I think also, it's just people, like, people who are willing, like, if your supervisor is willing for you to dedicate time to it, the organization, things like that.

Yeah, I mean, right now, one of the things we're working on is getting leadership. And when I say leadership, I mean, the Oregon Health Authority Director's Office, like our overall agency leadership is getting some support there. We've got a couple of advocates right now. But when I mean formalizing the support, like having something where someone's got a project they're working on, they're spending time supporting this community. And so, that's coming from not just, you know, our folks in public health, but that's coming from all over the agency. So, I think we're heading in that direction. But the idea of sponsors sounds really interesting to me. It's also similar to where it kind of, I guess it has a different level of where in the power hierarchy that it's that it's using. But I also like the idea of having sort of like a mentor network, right, where I know of a few folks who are working on some things that I'm trying to learn. And also, I can share back with folks who are trying to learn some of the things that I'm working on.

Really, it's about fostering connections and creating a culture of inclusivity where everyone can do data science. Anyone here who's working with data, whether that's, you know, language and surveys and qualitative information, or it's, you know, our quantitative epi stuff that everyone is welcome. Everyone is here to learn. We're here to support each other.

Git adoption and learning as productivity

A few other questions coming in on like this learning process for your team. And I see Ben asked a question about around Git. Ben, do you want to jump in here?

Yeah, we, there's a lot of interest in R, but then there's this, obviously, backbone of education, which is Git, which I'm struggling introducing to them, because a lot of the analysts and data scientists, you know, they're not quote, unquote, engineers. So just curious if you address that hurdle, if you've seen it, and if the process you went through helped.

Right. So there's a couple of things happening with our access to Git right now. Sorry, I just bumped my chair. And we have limited access to it at this point. There's ongoing conversations between IT and data engineers, and the informatics side of the house, where informatics is, is, you know, convincing and showing the business case that we need to be able to do DevOps. That's not been understood, you know, by IT in the past. And so, so we're, we're trying to get access to, you know, Git. And right now we can use Azure DevOps, but not many of us are, most of us are more familiar with GitHub.

So most of that learning is really focused out of all of us as state employees have access to the a resource at the state of Oregon library. It's a library that's part of the state government. And it's, so it provides resources to state agencies. And one of our resources is the O'Reilly learning platform. And so we can go on to O'Reilly and take any of those asynchronous courses and live courses. And, and, you know, we're supported in, in learning through, through that resource as well. And I've taken a handful of like Brent Laster, I think does some, some Git courses through O'Reilly that have been really helpful, like just learning command line Git.

But, you know, it's even the part where we're convincing folks to, you know, you do want to spend this kind of time learning R. We have to also have the discussion about how learning is part of your productivity. Right. And that if we're not learning, we're actually, you know, we're actually losing ground on building capacity for our future work, because we're not going to ever have less work to do. Right. And so a lot of what we're doing is trying to find ways to be more efficient with the work that we do. But as soon as we're doing, you know, we save, oh, I automated this report and I saved myself, you know, 10 hours every quarter from re-running this report. Well, those 10 hours are like, as soon as you say that, like that, that time is going to another project that also really needs to get done. Right. So, so we do have to say, well, even though you have that pressure, your learning is part of the productivity. And so there's time that, that time that you're spending there, isn't just, you know, there there's meeting your learning objectives as part of, you know, what we're here to do. And it's just as part of much part of your outcome. Right. Or output.

The EMS and trauma data landscape

Yeah, sure. Hi, Andy. So like big picture, I'm super fascinated at how, like I conceive of emergency services as being like this whole other like ring of service providers in the medical like landscape. And I'm curious how they interact like with, with you as an agency. And then like tactically, how does, how does their data become, come into your landscape? And then, and I know I'm sort of rolling on and on, but I'm really curious, like what kinds of problems are you solving with that data? Is it about like research? Is it about, is it about where people are in terms of location, like distribution of services and, and that kind of stuff? I realize there's, there's a bunch there, whatever is kind of interesting in there that you want to speak to, I'd love to hear about.

Yeah. So, so our, our program is the regulatory body. We're the regulators, folks that provide these services are licensed through our office and the, and there are standards of care in, in place for providing those services. And we collect the data for that to be able to do quality improvement and to do compliance work. So we, we do compliance for, for ambulance services. And part of that is a, you know, reviewing your records and are you completing your, your patient care records? You know, are you appropriately checking the right boxes for, you know, particular cases? So there's, and then we, and we also do that for trauma hospitals as well. So certified trauma centers that data is used to, you know, verify aspects of the, of the patient care itself, and also verify aspects of their performance improvement because all trauma hospitals are required to have an ongoing performance improvement program.

So, so essentially the, the data is used for compliance and safety, but it is also used for, in the field, it can be used for decision-making in, in patient care. So one of the problems that we've tackled recently is documentation of weight for patients who receive a weight-based medication in the field. And so this is especially important in pediatrics. And our program was able to collect data to see, you know, when there's a weight-based medication that is administered in the field, how often is the weight documented in the record? We developed a performance metric out of this, and we did a letter writing campaign to our ambulance agencies. And now our, our expectation was that this would be, you know, a pretty conventional thing. We'd see a 20% response rate or something super low, but it was, it was off, it was off the chart. We went from, you know, somewhere in the, you know, below our threshold to almost 100% within like a couple of months of implementing of that letter writing campaign and sharing back with everyone their performance metric and where they were compared to where we are as the state. And we're now doing multiple performance metrics. And so we do them for both EMS and trauma. A lot of that is on our website.

We actually manage, we have third-party vendors who provide electronic patient care record software. And we have, so we have a vendor who provides us software for our electronic medical records systems, and then also for our licensing management system, and then also for the trauma registry. And the folks that do the EMS system also provide our stroke and care registry integrations as well. And so we do a lot of vendor management and a lot of user support between our users and things that we can do with the vendor, but things we also have to ask the vendor to do for us, you know.

Yeah. And R is really crucial to that whole workflow because without it, you know, we're using the vendor's tools to assess how those software are performing, but that's not always even possible. And so having a way to, you know, pull data from one table, look at where things are moving into a submissions table from the other side, look at what was received on the other side. I've, since joining this team, I'm learning XML and HL7 and some of these other, you know, ways of moving data between systems that, you know, it's definitely not where I thought I was headed, but it's super exciting.

Governance, policies, and navigating bureaucracy

One of the link questions there was what kinds of governance or policies do you have for using R across your agency? So for example, deployment guidelines or software upgrade policies, approved packages.

Yeah, that is really loosely defined at the moment. At the moment it's R is only supported at the individual desktop level. And you have to go through an exceptions process to be able to download it. And then everyone is on their own for managing their own package libraries. It's pretty, you know, incongruous in terms of being able to collaborate there. You have to do a lot of your own lift to ensure that, you know, that everyone can open and run the same projects if that's what you're trying to do. And so we're really trying to work towards having an enterprise supported solution. And that's been a long haul. There's a lot of grant money that's going in to support it, but there's also bureaucracy and transparency that, you know, that we are in that we have to, we just have processes we have to go through. And so it takes longer than we think it should sometimes. But, you know, we're spending taxpayer money.

Yeah, I mean, so I guess it's a matter of, I guess, accepting the things we can control and focusing on the areas where we have some agency. And so, you know, if we're told you can't use that tool right now, you have to go through this process of approval that is, you know, 12 steps deep and 14 different programs are going to touch that process. I'm kind of exaggerating here, but it's a lot. And, you know, for a lot of really good reasons, a lot of legal reasons too. And at each one of these roadblocks, we just say, okay, so we're not able to move forward with this in this way. Now we're going to try to keep moving in this direction. What can we do with the resources and the time that we have? And then we brainstorm a little bit and see what ideas are in the room. And then just kind of go from there. So a lot of this isn't me doing it. I'm just asking questions. And then I'm, you know, doing what I can to support folks in us, you know, following up and supporting each other.

Training people and retaining talent in the public sector

Yeah. So I've worked with the government too. And I would never suggest, like, don't train people because they'll leave. Like, that's terrible. But like, how do you think about the training piece? And when you're training people in some skills that will make them able, you know, more able to leave possibly for more money? How do you think about supporting them and what you can do to keep them after they're trained up?

That's a really good question. And I'm not a manager. So I don't really know what they do to keep people engaged, even without the learning. Right? Just the fact that we're doing this work, it pays more in the private sector. Like, it just does. Especially for folks who want to live in Portland, like, you know, where Portland has a higher, there's areas in the state that have a much higher cost of living than other areas in the state. And for a lot of us, we're working remotely. And so there was, you know, a lot of folks decided to move to smaller towns because the cost of living and inflation just, you know, really kind of took a lot of progress from, you know, folks in public, you know, in public sector pay in the last couple of years.

I don't really have a good answer for that. What I, the only thing I will say is, in terms of what we can do for each other on a team, is that, is creating the culture that, that keeps people engaged. And that makes people feel like they're a part of something larger, right? And feeling connected. One of the things we hear a lot from folks in this group is, I feel like I'm the only one on my team using R. And 100 people after two months just is showing us that that's not really necessarily the case, that there are other people potentially using it, or even wanting to learn. And we're just not able to connect with one another. And so I think having these communities is one of these ways that we can start to engage folks.

I'm not sure that there's a really easy answer for that. Because, of course, folks are, you know, willing to, or, you know, we have agency to work for whomever we want to. And public sector just has to, I don't know, it's, I think nonprofits have this, have a similar, you know, a similar challenge in that, like, you want to support your people to learn and grow. And you want to keep them. And sometimes that means we have to pay them what they think they're worth. So, like, that's just a challenge of how to, how to make that fit.

Part of what keeps me here is that our organization really does focus on racial justice. We do focus on equity work, we do focus on these other pieces that make me feel like I'm contributing to the community in a way that's beyond just improving our, you know, our healthcare system. And that's part of what keeps me here.

Isn't the quote, like, what if I train them and they leave? But what if you don't, and they stay? Yeah, right. Yeah.

Community responder programs and Oregon's EMS advisory structure

Let's jump over to one other question from Slido was Oregon is known for great community responder programs. How does this impact your work?

Yeah, I think that there's a lot going on in Oregon with expanding community paramedicine and having support for behavioral health crises that isn't, you know, the first person responding is a is a behavioral health specialist and not a medical provider, right? So there's some, and as regulators, we kind of have to be, you know, we have to be really clear with here's the line at which if you're doing patient care, you have to have patient care record systems. You know, these are the rules, right? We have to be really clear with what the rules are.

We have several, we have regional trauma advisory boards. We have a state trauma advisory board and a state EMS advisory board. We have a couple of data working groups that we run with, you know, folks that are kind of our data super users in both EMS and trauma. And so really in terms of community involvement, we're more of like providing information and helping connect resources and not doing a whole lot of the, like the community's doing the work and then coming to us and saying, hey, we're seeing this, what can we do? And we try to put together some resources and work with them.

HIPAA, data governance, and cross-state collaboration

Hi, Eddie. Sorry. Yeah, I, I think for me, it's like I've, you speak on so many things that I, I've dealt with, but how do you manage to, like on a public health level, do you talk with other states or even at a national level to like, like collaborate on future kind of future initiatives or future endeavors where, where those like, you know, when I, when I was in my role, like HIPAA was not as much of a concern with a lot of the data we were, we were collating and bringing together. But I feel like in your role, it's got to be a lot more, an important, like kind of staple that may prevent collaboration from happening. So I just didn't know if you could kind of speak on how that all has kind of come into your fold and how you've managed it.

Yeah. So for the most part, our vendors are required to be compliant under a handful of things. HIPAA is just one of them, right? And there's other cybersecurity things that they have to be compliant with. And so, so we're very much like, it's very much part of our data governance, right? Is that we're all of our systems are compliant with those requirements. It definitely also comes into play when, with our fulfilling data requests. But it's, at this point, it's not so much an obstacle as just part of the framework that we're operating under. And so, you know, we have to use secure, you know, secure tools for doing any data sharing when we're doing our compliance work with hospitals, for example. Right. And so that's, you know, I have a cybersecurity team that I call them and say, Hey, this is what we're doing. Are we good? And, and there's either. So there's, it's a, it's a huge team effort. The HIPAA stuff is really just part, is just part of our data governance.

And we, we certainly do that. There's, so there are national standards for EMS data. I dropped a link in the chat for the, the NEMSIS, the organization that, that handles all that. There's also national data standards for, for trauma. And definitely like one of the things that I'm, I feel like I'm really good at is like, I get to a situation where I'm like, Hmm, this is something I haven't done before. And I have a sense of what I'm going to do, but I want to talk to somebody who's done this before. I have no problems going onto a bunch of websites, trying to find my counterparts in other states. You know, I've connected to folks in Iowa. In fact, this weekend at the Cascadia R conference, I was able to connect with some of our counterparts at Washington, state of Washington department of health. And so, yeah, definitely.

Are the data manager for my program is right now at a conference for national EMS data managers. Like there's, you know, there's, there certainly is supported a national level and we are really trying to connect with other, our users in those, at the, in those places, because the data does have national standards. We've got a lot of our code that, you know, is works with those data dictionaries that, you know, we're using for doing things that are both human and machine readable. And we would love to share some of that with other folks that are our users. And so I'm packaging it. Thank you, Ted. That's, that's my big thing that I'm working on right now is building some internal packages and I'm, I need to learn how to do better testing and, and all that. So anybody else learning that stuff right now, I'm, I'm game for, for study, study buddies.

API challenges and cross-team communication

Um, I, I guess what I, what I was bringing up is the challenge of, you know, feeling alone working with R. I am totally the, the one man team, three quarter stack ML engineer, I'll call it. And I could be full stack, but we, you know, we don't have a good sort of like Posit, um, shiny server, you know, enterprise solution where I could just put my stuff up there. So, um, I'm sort of, you know, clunking through with open source, uh, shiny server and allowing one person at a time to use my, my app for the one use case. But anyway, have HTTR, you know, is, is a very well full featured API HTTP request, uh, package. And I went through some issues trying to figure out why I was automatically being dropped by, I'm also in government, I'm a government contractor. So I'm pulling from the VA, I'm pulling from Vista, which is this monster monster database. And there's a few layers of abstraction between it. And we built our, I should say some people in our company built a wonderful, uh, soap API standard that allows me to do multiple types of requests. And all of them yet, um, thrown in my arguments and, you know, there's an iteration, you kind of have to do one thing to open your connection, get the cookies, you got to do another thing to follow up and select your patient. And then you got to select, you know, what you want to do with that page or how you want to get that patient's data. And these things, depending on the time of day, it drops at night, but it doesn't drop during the day or you know, something with Neil shoddy. So I keep, you know, texting back and forth, hey, this is what I'm getting. What what do you need to see to help me help you debug why this connection keeps dropping? And it just turned into well, the people that are using this are using, you know, Python, they're doing it with this request package. I don't know what you're doing. I don't know how it works. I don't know what HTTR is. And you must you have to change to a fully featured API request, you know, type of package if you're if I'm going to continue supporting you, period. And that like, I've always had good interactions with this person until this just really broke the mic. Okay, fine. I'll do it all myself. You know, so it was that statement. I don't know if there's the right question for how to do it. But I am building a little R markdown report right where I'm going to extract every little freaking thing that HTTR can produce from a the request object that comes back and I will put it out in PDF format and hand it over and just say, please go figure out what to do because you know, I, I don't know what else to do from a dialogue point of view. I'm going to just produce technical documentation errors and send it right back to them and say, hey, I need help.

No, I was just gonna say I'm having some feeling. Some of my feelings are being reflected in the chat right now. So I'll just say that.

Yeah, I'm going to agree that it sounds like there's a communication piece there, layer to that in addition to the technical aspect. If I had a question about API stuff and why something isn't working for me, I would ask Ted. If I couldn't Google it.

I just I guess we if I found a limit where I'm finding that someone is running out of ideas for helping me work through a technical problem, I guess there's you know, I don't know. Pointing out all the things that are wrong with something someone's working on is probably not going to help them be motivated to help you fix what you're trying to do with the thing they're working on. So I try to adjust how I'm seeing it and say, okay, we're on the same team here and we just are seeing this from a different, you know, it's the elephant. I'm seeing the I'm seeing the the trunk only and I'm trying to get to this other part of it and the and the person doesn't see how what what it is that I'm seeing. And so maybe the process of doing all that documentation, you'll find something else there that you didn't see before and then sharing that process with this other person might also open the door. I don't know.

Kind of remind it's my memory is being triggered back to a hangout with Matt Frazier when he was talking about like non-violent communication that book. But talking about how like when you get into this position, like listen for needs and express needs. So starting with like just explaining I'm trying to do this for the organization like like I'm trying to help the company. This is why I think this is valuable. Like do you agree that this is valuable like taking the technical part of it but like getting by and first that what you're trying to do is going to be helpful and then saying like in order to do that. I have these needs that aren't being met like how can we get to that next step.

National EMS data standards and interoperability

Yeah so nationally in the US you've got a lot of data integration obviously across hospitals and what I heard you saying Andy was that you've got vendors and you've got EMS systems implemented separately for each hospital or each state. Is that like that? If it is separate then how do you integrate the data across states?

That's a really really great question. So yes each state implements the national state data standard in the way that they want to do it. So California a lot of larger states that have a lot more hospitals trauma centers than than Oregon does they tell everybody okay you're required to do this data you're required to submit this data to the state here's the state repository go out and get your software and send it to us because we're the regulators you know and so that's really left up to those organizations they go and they they procure software they those vendors set up you know data pipelines between the databases and then it works right supposedly.

What ends up happening is because of requirements for data validation and which a lot of this is built into the software and requirements for certain hospitals level ones level twos and level there's four levels of trauma accreditation and those are based on the levels of trauma care that can be provided those hospitals and so everything but your level four is on the national level is recommended that they provide that data to not only their state agencies but the national database and so those software vendors that are supporting that provide the service to either state agencies like our program or the hospitals they have you know widgets within there that provide that do that national data validation and submissions for national data.

With the most recent version of the EMS data there is now a data field that is a universally unique identifier for the record itself not the patient but the record and that can now be linked at the national level to the the trauma record and so there there's an effort now within the data standards to be able to link these at a national level. That work is ongoing it's Oregon was I think the seventh or ninth state to adopt the new standard and start to implement this this UUID which means that our our interoperability between EMS data and trauma data you know like we really have to focus on that when when the linkage doesn't work that UUID doesn't move between the data systems and you know and and we're gonna we're gonna just have for this first year or two some some data that isn't quite as completely linked as we want it to but it's just a matter of improving that as we go.

With the most recent version of the EMS data there is now a data field that is a universally unique identifier for the record itself not the patient but the record and that can now be linked at the national level to the the trauma record and so there there's an effort now within the data standards to be able to link these at a national level.

What made RStudio Academy different

I know this hour goes by so quickly um but we were when we were talking about academy and in the beginning I'd love to see all the the great feedback that you've shared Andy and and I was just curious how did you feel uh academy was different from other training programs that you tried?

Yeah so the collaboration piece was was big um because we were working together on a weekly basis um you know we were able to just form these relations these working relationships with one another in a way that probably wouldn't have happened if we were just asynchronously doing tutorials together. And having the mentor available for answering questions and um you know that's also it's it's not that there's someone who's like the the teacher providing this content and we are you know taking this content in and doing a thing with it it was almost like um having a coach instead right um and so the group was able to lean into places where we wanted to learn and maybe it was outside of the content a little bit and they're just I haven't really experienced that kind of flexibility with you know with other other platforms.

When you mentioned mentor I realized I missed a question from Ben a bit earlier too. Ben do you want to jump in here? I think you asked about like what it meant to have a defined mentor.

Yeah I'm sitting over here shoving my face full of chips. Right yeah the mentor thing is really interesting in that um it's a different role and so I'm more I'm curious how influential it was through the process you mentioned coach but it really is a different aspect to it and so I was curious how you're carrying that on and if there is something that you're looking to in the future as you develop the community if there is something you could clearly define to the internal team this if you might fill that role with.

Yeah um so I guess the the coach aspect of it it just feels like there's a slightly different power dynamic than with the instructor and student and um it's like there's a little more um the I guess as a learner I'm able to be a little more self-directed um than than like I'm here to take a class I guess um even though it really is focused on you know here you're learning goals and stuff as far as mentors um we haven't really um had I feel like we've we've sort of rather than leaning on that one mentor that we had during that academy session we've sort of branched out and developed a network of mentors um several of whom are just Posit employees that are here to support us right um and so um so we've asked Jeremy Allen to come and give our group a um a Quarto demo you know um and I probably could have put together a Quarto demo but like Jeremy's just really good so having you know having someone come in and and and kind of step up to that is has been really great um in terms of how we're going to support each other you know I think that that's that mentor is really just a hat that we can wear and sometimes I'm the mentor and sometimes I'm the mentee right and just um trying to establish the relationships where we can take those hats on and off and I'm not required all the time to answer someone's questions right like we we're all here to get our work done also right so um I think one thing we might try to do as the group is um is do like some computer lab uh office hour study hour kind of things where we can all show up and we can work on our own things but then we can be there to sort of support each other and answer questions like that's been a thing that I thought would be um fun and amazing to do um be nice to figure out how to do that in a hybrid setting so that you know folks who are living in other parts of the state and working in different programs throughout the state could still participate and learn with us.

Analytics structure across the agency

Could you talk a bit more about the team aspect of the work is the analytics in the agency centralized or do teams get put together for specific projects?

That's a really great question there's a little bit of both so we have a data team in EMS and um there is also a like like a health policy and analytics section in division in the in the agency um where they really are focused on just like data and statistics um as it relates to policy and programs um but uh and then there's specific like analytics and informatics teams within programs like our acute and communicable disease program has an analytics team where they've got a data integrator they've got a data visualization specialist um you know they've got um reporting specialists who build you know some of these dashboards that injury dashboards and things um so it's it's kind of a little bit of both it's really dependent on the needs of the program and the resources that the agency has to kind of support um where that work is I think there's a couple of programs that probably really need analysts and they're you know working on kind of building that capacity and stuff.

Great thank you so much Andy yeah um I feel like we're like standing on stage and people are chanting for encore because I see people asking do we have a bonus hour right now um so I know people have to drop to other uh meetings here so I always want to say thank you all so much for joining us today and thank you Andy.

I just want to say thanks for this opportunity I get so much from this group um when whenever I'm here and even if I'm like you know having to work on other stuff and I'm just kind of you know here to to to listen and learn I just get so much from this group and so it's just really been awesome to be able to um you know share back so thank you.

After the hangout: data quality and timestamp discrepancies

No I was just well I guess my curiosity if Andy's still around is um where I know we have an issue with um our regulatory body in L.A. County like they have different accounting for um their upload time as opposed to like ours in the EHR so I wonder like just how you guys have kind of negotiated like when you have discrepancies depending on who's reporting what.

so like discrepancies in just um like we're seeing certain records coming over and we're not seeing other records or like actual within the record discrepancies like the record has this over here and it's something else in this system um the idea is more like when it comes to like patient offload times um maybe like the um maybe the EMS will like start the we'll start like there we we arrive at your time at a different point than we would in EMR so like there's they're saying like you know the moment they like pull into the parking lot is like when they started and maybe you're saying it's like the moment they're entered into the system or something like that it's kind of like how do you kind of back and forth because you know they'll be like hey you know you're um you know 15 or 20 minutes over the ideal and it's like well.

Yeah I wonder so one of the things that we work on pretty um consistently is um having a demographics profile from every vendor that's participating in providing data to the EMS system and then they're required to have their system set up under like really tight specifications for how each data element is collected and then mapped to the state registry and we do um like schema validation to ensure that you know that the date that is shown in your record is what comes over in our record and if it's the same time it's actually the same time if it's the you know um transport time it's you know it's uh and so aside from like working with those vendors on you know really drilling into what information is being stored where and how that's moving from one system to another and just really getting into those details like we just have to do that one vendor at a time sometimes it's one agency at a time right and we're we're dealing with you know over 200 agencies and a you know half a dozen different vendors um with each of different you know instance in a different agency so yeah it's really just um the data quality is just kind of seems like a never-ending uh source of work.

It's almost like emergencies are a giant data mess you know for particular reasons like maybe the fact that there are emergencies.

But yeah there was actually one time i think we figured out that the discrepancy was because like they weren't they were not like starting their route until after their smoke break and this was one of the private us companies that like drops off patients here and we're like so that's the issue but it's not the issue all the time.

Yeah yeah when the data's right but you don't like what's in the data like that's a different situation than a mapping issue.

The human element of the data was making me think of the the iceland the city of reykjavik customer story they were like why is this data for who's entering the different pools across island across iceland