Together.Today. Tomorrow.

The BLUES ProjectKaren C. Fox, PhD

Chief Executive Officer

BLUES Overview

Better Life Utilizing Better Life Utilizing Electronic SystemsElectronic Systems

PurposePurpose Demonstrate the effects of

diabetes management practices

Ambulatory clinics in rural and urban settings

Utilizing well-designed, comprehensive health information technology

What are the major factors that are driving a need for EHR systems from a

management/administrative perspective?http://www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

0 10 20 30 40 50 60 70 80 90

Facilitate Workflow Improvement

Improve documentation to support billingservice levels

Improve patient safety

Share comparable patient data amongdifferent sites

Meet the requirements of legal, regulatory,or accreditation standards

Contain or reduce healthcare delivery costs

Establish a more effective informationinfrastructure

Retain health plan membership

Percent

Total Respondents

IT Managers and professionals

Physicians and nurses

Non-IT management

Significant increase over last year In solo and small practices motivated to

implement EHRs Increase in the use of almost all data

capture methods Especially structured data entry

High level of implementation plans for e-prescribing, remote access to EHRs, and order entry placed by nurses or staff

The Current State of EHR The Current State of EHR Implementation in the USImplementation in the US

http://www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

The BLUES Target Service Area

BLUES Overview Research AimsResearch Aims

Successfully implement EHRs in diabetes management clinics, focusing on integration of the EHR into clinician workflows.

Evaluate the impact of the EHR system on clinical processes of care and patient outcomes.

Produce and distribute a generalizable, replicable model of care for implementing an integrated health IT system for diabetes management care throughout the U.S.

BLUES Overview

HypothesesHypotheses Provider use of an EHR system will

increase Patient use of EHR will increase Adding an EHR system to an existing

model will significantly improve medication management.

Adding an EHR will also improve other process-of-care measures.

Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

Understanding Data:Understanding Data:Road Maps to Successful Road Maps to Successful

OutcomesOutcomes

BLUES Overview

Create Systems

Collect Baseline

Track Outcomes

Implement Systems

Collect Data

Evaluate Processes

Evaluate Outcomes

CREATE

EHR Analytic Modules

Where to look for data

Chart reviews

Creating harmony within the existing system and new system

Tracking mechanisms

IMPLEMENT

Clinic infrastructure Network Infrastructure in Rural

Communities Current workflow and staff Lack of patient management systems

Staff concerns Training and installation Single physician clinics Clinician Acceptance / Buy-In

Challenges to EHR Challenges to EHR ImplementationImplementation

Privacy and Security HIPAA Compliance

Limited capability of IT Host Facility Unreliable data center infrastructure Need to build redundance Servers and networking support

Infrastructure support by health care facilities (single physicians, etc.)

Challenges to EHR Challenges to EHR ImplementationImplementation

Loss of Network Service Provider Reliable Health Technology

Equipment Operators at Remote Locations

Key Personnel Changes Changes in Clinic Location

Challenges to EHR Challenges to EHR ImplementationImplementation

Equipment Maintenance in Remote Locations

Availability of Qualified StaffData Acquisition

Provider responsibility for maintenance

Access by DHA and external evaluators

Challenges to EHR Challenges to EHR ImplementationImplementation

COLLECT

Data Collection Methodology Assessment of longitudinal change

Collection time Reporting the data

Data IssuesData Issues

Disparate practice management systems Workflow management Data elements captured

EHR design modifications Required for unique measures

Access to external data Medicaid Evaluating cost / benefit outcomes

Data ChallengesData Challenges

Tracking Outcomes

Provider use of an EHR system will increase

Measure: % of visits where EHR was used

Information captured by the EHRs Measure: Use of quality

measurement reports Information not captured because

Analytics Module was not purchased Overcame barrier by establishing audit trail

Tracking Outcomes

Patient use of EHR will increase Measure: % of patients who

access their personal health information, including medication therapy Cannot capture data because the

Interactive Module was not purchased

Must develop new measure to capture impact on patients

Tracking Outcomes

Adding an EHR system to an existing model will significantly improve medication management.

Measure: Formulary compliance - % of prescriptions complying with formulary

Captured by EHR Analytics Module Measure: Patient Compliance with

medication Determined by EHR - # filled/#prescribed

Tracking Outcomes

Adding an EHR will also improve other process-of-care measures.

Measure: % of patients receiving appropriate care for treatment Captured by EHR Analytics Module Is determined by nationally recognized

medical standards of care – American Diabetes Association

Tracking Outcomes

Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

Measure: Patient Satisfaction improved Determined by primary data collection

Measure: Diabetes outcomes Lipid profiles, BP, A1c, etc. all captured by

EHR as specifically designed for the clinics

LESSONS LEARNED

Network / internet speed and capacity is critical WAN Optimizers

Providers may resist financial commitment of any amount

IT vendor territory issues Local business loyalty in small

communities

Lessons LearnedLessons Learned

Have clinic personnel on your planning and evaluation committees

Be flexible with training staff Design and modify current

systems Have contingency plans

Lessons LearnedLessons Learned

When you have all of this, you When you have all of this, you impact clinic and community impact clinic and community

success!success!

Successful EHR Implementation

+Better Patient Outcomes

=Healthy Community

Logic ModelLogic Model

Activities Outputs Outcomes Impact

Cooperation and collaboration

EHR implementation

System training

Data collection and reporting

Existing medical structure

Traditional clinic system

Traditional hospital structure

Information infrastructure

Networks and Servers

Expanded services and access

Patient and provider satisfaction

Improved workflow

Provider enrollment

Reduced health care costs for providers and patients

Improved chronic disease outcomes

Inputs

28

Patient Health Outcomes

Reduced Cost of Care

Increased medical homes

Increased productivity

Improvement in ratio of clinicians to population

Together.Today. Tomorrow.