Title: EHR%20Functionality%20and%20the%20Patient-%20Centered%20Medical%20Home:%20%20Charting%20a%20Course%20When%20Charting%20Isn't%20Enough
1EHR Functionality and the Patient- Centered
Medical Home Charting a Course When Charting
Isn't Enough
- Redwood Health Information Collaborative -
Webinar Series - January 21, 2009
2- Jason M. Mitchell, M.D.
- Assistant Director
- AAFP - Center for Health IT
- Leawood, KS
3AAFP - Center for Health IT
- Established October 2003
- Mission To assist family physicians in acquiring
and using EHR systems and other HIT that are
affordable and standards-based, for the purposes
of improving quality, enhancing safety and
increasing efficiency in clinical practice
Steven E. Waldren, MD Director
Jason M. Mitchell, MD Assistant Director
David C. Kibbe, MD Senior Advisor
www.centerforhit.org
4Objectives for this session
- Understand the origins and key components of the
patient-centered medical home (PCMH). - Understand the central role of information
technology as a tool to enable the PCMH. - Highlight the core functionalities that
electronic health record (EHR) systems must bring
into the ambulatory practice.
5EHR Adoption Paradigm
Family Physicians
All Physicians
Rand Study 2016 before 80 physician adoption
Rand Health. The Diffusion and Value of
Healthcare Information Technology. 2005.
6Building Success in Your Practice
Health IT
Change Management, Process Redesign
Leadership, Management, Teamwork
Financial Stability
7Jumping Ahead...
Current Health Care Sector
Future Health Care System
8Medical Home Definition
- AAFP Board of Directors - 2008
- "A patient-centered medical home integrates
patients as active participants in their own
health and well-being. Patients are cared for by
a personal physician who leads the medical team
that coordinates all aspects of preventive, acute
and chronic needs of patients using the best
available evidence and appropriate technology.
These relationships offer patients comfort,
convenience and optimal health throughout their
lifetimes."
9Technology Hype Curve
?
Where is EHR?
Where is the PCMH?
?
?
?
Source Gartner Consulting
10Origins of the Medical Home
- "Wherever the child is cared for, the question
should be asked, Where is the childs medical
home? and any pertinent information should be
transmitted to that place" - AAP, 1967 - Crossing the Quality Chasm A New Health System
for the 21st Century (the Chasm Report). IOM,
2001 - Future of Family Medicine Project, 2002-2004
11Chasm Report(2001)
- Care based on continuous healing relationships
- Care is customized for patient needs and values
- Patient is source of control
- Knowledge is shared and information flows freely
- Decision making is evidence-based
- Safety is a system property
- Transparency is necessary
- Needs are anticipated
- Waste is continuously decreased
- Cooperation among clinicians is a priority
- Safe
- Effective
- Patient-Centered
- Timely
- Efficient
- Equitable
12Characteristics of the New Model of Family
Medicine (2004)
- Personal medical home
- Patient-centered care
- Team approach
- Elimination of barriers to access
- Redesigned offices
- Whole-person orientation
- Care provided within a community context
- Emphasis on quality and safety
- Enhanced practice finance
- Commitment to provide family medicines basket of
services
AND...
13Characteristics of the New Model of Family
Medicine (2004)
- Advanced information systems
- "A standardized electronic health record, adapted
to the specific needs of family physicians and
the patients they serve, will constitute the
central nervous system of the New Model practice."
14HIT Expectations of the New Model
- Integration of information from multiple, diverse
sources into a single system to support the
comprehensive information needs of primary care - Based on common health information technology
standards - Up-to-date and accurate problem and medication
lists and information about each patient
encounter - Export functionality to share standardized data
elements for quality parameters and assessment
measures - Evidence-based clinical practice guidelines
- Order entryReferral tracking
- Disease and population based registriesIntegration
of clinical and practice management functions - Web interface for patients to provide clinical
data and facilitate self-care processes
(1 of 2)
15HIT Expectations of the New Model
- Support practice based research concerning costs,
processes and outcomes of care - Clinical decision support systems for application
of the latest evidence at the point of care - Collection, analysis and reporting of clinical
decisions and their outcomes - Informatics infrastructure to support
practice-based research, quality improvement and
generation of new knowledge - Easy integration in the daily practice of family
physicians - Reasonable cost
- Major enhancement to the efficiency and quality
of care that is delivered - User friendly
- Flexible
- Stable and reliable
- Delivered with appropriate training for
physicians with varying levels of technical
expertise
(2 of 2)
16"Required" features of an ambulatory care EHR
system
- Harvard Expert Panel (NEJM article - 7/3/2008)
- Basic EHR - 15
- Patient demographics, problem list, medication
list and clinical notes - Prescription ordering
- View lab and radiology results
- Fully functional EHR - 6
- Notes include medical history and follow-up
- Lab and radiology orders are created and sent
electronically - Prescriptions are created and sent electronically
- Digital images of ordered radiology tests can be
viewed - Drug interactions or contraindications
- Abnormal test results are flagged
- Reminders for guideline based interventions or
screenings - (No mention of registry or data analysis
functions)
17"Required" features of an ambulatory care EHR
system
- Patient-Centered Medical Home
- An "EHR system" isn't just a "system" but a
"system of systems - Identity management system - (EMPI)
- Communication/messaging system - (eVisits)
- Schedule/resource management system - (Workflow
optimization) - Medication management system - (eRx)
- Care coordination/integration system -
(Referrals/Consultations/Results) - Advanced data analysis and visualization system -
(Registries) - Diagnostic ordering and results management system
- (Lab/Xray) - Advanced data capture and documentation system -
(Notes) - Patient education system - (not crumpled, dated
handouts) - Practice web portal - (patient self-service)
- Point of care clinical decision support system -
(Evidence-based) - Point of care financial decision support system -
(Efficiency/Value) - Practice administration/management system -
(Integrated)
18"Required" features of an ambulatory care EHR
system
- Patient-Centered Medical Home
- "Infrastructure" Tools
- Semantic Interoperability
- Not just the ability to view others
"documents", but to incorporate and understand
clinical data from other sources into your own
system - Primary Care Data Model (Ontology)
- Defining and organizing the "nouns" and "verbs"
of family medicine and their relationships - System design and dependencies
- Workflow analysis and management tools
19NCQA PPC-PCMH Recognition
- Nine Standards
- PPC 1 Access and Communication
- PPC 2 Patient Tracking and Registry Functions
- PPC 3 Care Management
- PPC 4 Patient Self-Management Support
- PPC 5 Electronic Prescribing
- PPC 6 Test Tracking
- PPC 7 Referral Tracking
- PPC 8 Performance Reporting and Improvement
- PPC 9 Advanced Electronic Communications
http//www.ncqa.org/tabid/629/Default.aspxpcmh
20NCQA PPC-PCMH Recognition
- Without an EHR / Electronic registry /
e-Prescribing - Level 1 PPC-PCMH may be possible
- Level 2 and Level 3 will not be achievable
without full-featured, well-implemented, and
optimally-utilized HIT systems
21Conclusions
- Semantic Interoperability remains the IT
(clinical?) priority - Its just so darn hard
- Quality and Safety are the "hallmarks" of the
Medical Home - It's not the paper that kills, it's the process
- An "electronic" version of the "paper chart"
won't cut it - Its about data not documents
- EHR central nervous system of the New Model
practice - Wont get above NCQA Level 1 without it
- Do current EHRs represent the needed system of
systems?
(1 of 2)
22Conclusions
- EHR for Family Physicians
- No longer a matter of "IF" but "When" and "What"
- Most implementation failures are not due to the
technology - "Sociotechnical" factors
- Plan for organizational and user process issues
- No reports of problems due to "over" training
- This is not a one time, big bang process
- Ongoing adaptation and updates
- Annual updates are not an "option" but a
"necessity" - Choose carefully, Implement wisely, Use optimally
(2 of 2)
23Questions? - Comments!
- www.centerforhit.org
- Jason M. Mitchell, M.D.
- jmitchell_at_aafp.org
- (800) 274-2237 x 4102