Erie Family Health Center All Staff Meeting July 5, 2000 - PowerPoint PPT Presentation

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Erie Family Health Center All Staff Meeting July 5, 2000

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Can Also Drill Down to Patient Detail Can Also Drill Down to Patient Detail cont. Correlation between EHRS elements and research plan Benefits of CHC Sector ... – PowerPoint PPT presentation

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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
2
What 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.

3
Potential 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

4
Challenges 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

5
Challenges 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

6
Capabilities of Electronic Record Systems
  • Basic
  • a storage and retrieval system
  • VS
  • Advanced
  • a sophisticated interactive database

7
Considerations 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

8
What 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

9
Community 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
11
Who 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
12
CHC 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
13
2/9/2007
13
14
2/9/2007
14
15
Alliance 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.

16
HIT 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.

17
HIT 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

18
Clinical 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.

19
Considerations 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)

20
Structured Data Entry
21
Consideration 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

22
Measure 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

23
Technical 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.

24
Technical 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)

25
Technical 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

26
Considerations 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

27
Potential 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

28
Status 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

29
System 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
30
System Use Measures
10/3/2014
31
Use 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
33
Pre/Post EHRS Go Live Diabetes Data
10/3/2014
34
(No Transcript)
35
Data Warehouse
  • Login screen

36
Alliance Reports Folder
  • AMA and HDC reports developed

37
HDC Diabetes Report
  • HDC Diabetes measures along left side

38
Can Export Report to Excel
  • File will download locally

39
Can Export Report to Excel cont.
  • Minimal re-formatting, then submit to HDC

40
Can Also Drill Down to Patient Detail
  • Note patient ID is encrypted in Portal Reports

41
Can 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

42
Correlation 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

43
Benefits 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

44
4/4/2006
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4/4/2006
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4/4/2006
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