Title: Erie Family Health Center All Staff Meeting July 5, 2000
1 Opportunities to facilitate community based
research through Community Health Center
Tim Long, MD Andrew Hamilton, RN, BSN, MS NCRR
Meeting May 15, 2007
2What are our goals
- Promote community based/translational research
- 2. Develop an information network that can
promote research and facilitate translation of
evidence based interventions into practice.
3Potential of HIT enabled translational research
- Description of fully functional Electronic Health
Record System in a network of Community Health
Centers - State of adoption of Electronic Health Records
Systems - Synergies of HIT enabled quality and research
- Opportunities for translational research enabled
by HIT
4Challenges to Research in Clinical Settings
- Limited ability to look at population level data
to suggest questions - Labor intensity of baseline and study data
collection - Inefficiency of subject identification/recruitment
- Clinical pressures limiting ability of
clinicians to focus on research interventions - Limited ability to prompt or support clinicians
to enroll subjects and implement test
interventions - Logistics limit communication between academic
setting and clinical site/clinicians
5Challenges in the Healthcare Setting
- Increasing complexity of Health Care
- Challenges in coordination/communication among
medical providers and between supportive services
and disciplines - Limited time for interactions
- Difficulty accessing information in
timely/organized fashion for use in decision
making at the point of service - Labor intensity limiting population based data to
inform system change
6Capabilities of Electronic Record Systems
- Basic
- a storage and retrieval system
- VS
- Advanced
- a sophisticated interactive database
-
7Considerations in implementing higher level
functionality
- Acceptance of common vision of quality
- Adoption of evidence based standards against
which to judge care quality - Agreement to conform to standardized ways of
recording data - Ability to capture and process relevant data
- Relevant care elements are captured as structured
information - Implies that order entry is computerized
- Data is clean and consistent
8What is the Alliance?
- BPHC/HRSA funded Network
- Essentially a joint venture of four independent
organizations with the desire and ability to work
together on building some common infrastructure - Ability to access higher quality, efficiency and
economy of scale - Dedication to quality
- Desire to ultimately share with others
9Community Health Centers
- first funded by the Federal Government as part of
the War on Poverty in the mid-1960s. -
- designed to provide accessible, affordable
personal health care services for people living
in medically underserved communities where
economic, geographic, or cultural barriers limit
access to primary health care. - Mission encompasses quality, access, and
responsiveness to particular needs of the
community served.
10/3/2014
10- principal services include primary and
preventive health care, behavioral health care,
outreach, and dental care -
- ancillary services include laboratory tests,
X-ray, environmental health, and pharmacy
services - related services such as health education,
transportation, translation, and legal services - currently more than 900 nationally with
presidential initiative to increase number
10/3/2014
11Who CHCs Serve
- 91.1 of clients are below 200 poverty
- 40.1 are Uninsured
- 63.5 are Racial/Ethnic minority
- 726,813 Migrant/Seasonal Agricultural Workers
- 703,023 Homeless Clients
2/9/2007
11
12CHC Profile
- 952 Community-Based Organization
- 1356 Sites of Care across US
- 14.2 Million Patients Served
- 90,000 MDs/NPs, RNs, Dentists
2/9/2007
12
132/9/2007
13
142/9/2007
14
15Alliance HIT project goals
- 1. Implement EHRS in a network of Community
Health Centers in a manner that ensures
consistency and accuracy of health information
across all practitioners, sites and populations. - 2. Develop a data warehouse that will monitor,
aggregate, and provide data to be used for
clinical and system quality improvement. - 3. Utilize the EHRS/data warehouse to facilitate
and encourage the use of evidence-based practice
measures at the point of care.
16HIT project goals
- 4. Utilize the EHRS/data warehouse to facilitate
continuous improvement of health care quality and
safety and develop its function as a patient
registry. - 5. Promote and support the realization of the
full potential of EHRS use in ambulatory care
settings, particularly among safety net
providers, to improve health care quality and
safety.
17HIT Partnership
- American Medical Association
- Health Information Management Systems Society
- GE Healthcare Clinical Data Services
- First Consulting Group
- Health Research and Education Trust
- Funding agencies
- HRSA ? AHRQ ? Chicago Community Trust ?
Michael Reese Health Trust ? Robert Wood
Johnson Foundation Commonwealth Fund ?
Illinois Department of Public Health ? Chicago
Department of Public Health
18Clinical consensus
- Chronic Care Model to manage disease and
populations of patients. - Network wide clinical standards.
- Utilize national experts and evidence based
protocols as basis for standards of care. - Utilize internal/local subject matter experts to
review standards and support development of the
screens.
19Considerations for EHRS development and
implementation
- Promote use of standardized templates
- Structured data entry
- Ease of data entry to encourage providers to
capture needed information as part of care
delivery - Mapping of data elements to care protocols
- Content to include full spectrum of care (eg,
mental health/case management)
20Structured Data Entry
21Consideration for Report Development
- Competing/Multiple Performance Measurement Sets
with unaligned performance measures. - Lack of Clinical Data Standards for many
important medical concepts (such as Foot Exam,
Pt. Education, etc) - Inconsistent data definitions across EHR Vendors
22Measure Example
- Diabetes Measurement Set (foot exam)
- Measure Percentage of patients who received at
least one complete foot exam (visual inspection,
sensory exam with monofilament, and pulse exam) - Numerator patients who received at least one
complete foot exam (visual inspection, sensory
exam with monofilament, and pulse exam) - Denominator All patients with diabetes 18-75
years of age
23Technical SpecificationsNumerator
- Patients who received at least one complete foot
exam (visual inspection, sensory exam with
monofilament, and pulse exam) - Note All three components must be completed
within the reporting period but they do not have
to be completed at the same visit.
24Technical SpecificationsDenominator
- All patients with diabetes 18-75 years of age
- Codes to identify patients with diabetes include
- ICD-9-CM Codes 250, 357.2, 362.0, 366.41, 648.0)
(DRGs) 294, 205 - Prescriptions to identify patients with diabetes
include - Insulin prescriptions (drug list is available)
and Oral hypoglycemics/ antihyperglycemics
prescriptions (drug list is available)
25Technical SpecificationsExclusions
- Exclude patients with a diagnosis of polycystic
ovaries (ICD-9-CM Code 256.4) who do not have a
diagnosis of diabetes, in any setting, during the
measurement year or year prior to the measurement
year. - Exclude patients with gestational diabetes
(ICD-9-CM Code 648.8) or steroid-induced diabetes
(ICD-9-CM Code 962.0, 251.8) during the
measurement year - Patients with bilateral foot/leg amputation
- ICD-9-CM exclusion codes for 2.9 Foot Exam
896.2, 896.3, 897.6, 897.7 - Other reason documented by the practitioner for
not performing a complete foot exam
26Considerations of Technical Architecture
- Hosting in a secure level 3 facility
- Redundant architecture and secure backup
- Ability to access system anywhere via internet
- Interface engine to build and manage interfaces
- Export of data to a data warehouse
27Potential of EHRS Research
- Decision Support
- Client recruitment
- Study protocols
- Performance Measurement
- Data collection
- Study protocols
- Remote hosting
- Communication between study sites
- Off site intervention
- Data warehouse/reporting
- De-identification of data
- Aggregation and analysis of data
28Status of System use
- Live at main sites of all 4 Health Centers
- 125 concurrent users, approximately 225
individual users. - Big Bang - All staff, with full functionality
of the system - Productivity at pre-implementation levels
- Next wave of Alliance sites to go-live beginning
in June - Planning implementation at first non- Alliance
sites
29System Use Measures
- Pediatrics
- Developmental assessment documented
- Weigh percentile documented
- Height percentile documented
- Head circumference percentile documented
- OB/GYN
- Prenatal visit with documented EDC
- Prenatal visit with FHR documented
- Prenatal visit with genetic history documented
- Mental Health
- Established treatment plan date documented
- Treatment plan revision date documented
- Signed metal health assessment documented
- Substance abuse screening documented
-
- Adult
- Use of diabetes disease management form
- Use of cardiovascular disease management form
- Use of HIV disease management form
- Use of Asthma disease management form
- Mammogram BIRAD score documented
- PAP Results documented
- Colonoscopy Screening documented
- Adolescents
- Sexual Activity documented at office visit
- Violence risk documented at office visit
10/3/2014
30System Use Measures
10/3/2014
31Use of Diabetes Disease Management Forms
10/3/2014
32 Performance Measures
-
- AMA/HDC Diabetes
- AMA/HDC CVD
- HIV/HIVQUAL
- AMA/HDC Asthma
- AMA/HDC Preventive Care
10/3/2014
33Pre/Post EHRS Go Live Diabetes Data
10/3/2014
34(No Transcript)
35Data Warehouse
36Alliance Reports Folder
- AMA and HDC reports developed
37HDC Diabetes Report
- HDC Diabetes measures along left side
38Can Export Report to Excel
- File will download locally
39Can Export Report to Excel cont.
- Minimal re-formatting, then submit to HDC
40Can Also Drill Down to Patient Detail
- Note patient ID is encrypted in Portal Reports
41Can Also Drill Down to Patient Detail cont.
Re-ID will link Pt Name to this
- Need to run Re-ID macro in Excel to link
encrypted patient ID to EHRS patient information
42Correlation between EHRS elements and research
plan
- Evidence based practice guideline
- Research protocol
- Data elements defined
- Subject criteria, pre and post data elements
- End user form designed to provide decision
support at point of patient care - Study protocols
- Measures defined and Data elements mapped to
reports - Baseline and study data collection plan
43Benefits of CHC Sector
- Representation of disparate populations
- Complete spectrum of health services
- Stability of service population
- Quality orientation desire to implement
evidence based practice and contribute to
improvement - Network infrastructure to support multiple site
studies - Experience with HIT
444/4/2006
44
454/4/2006
45
464/4/2006
46