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Using Meaningful Use to Improve Patient Care
Learning & Action Network Session
Goal – Create an Action Plan
Objectives
1. Define and identify future HIE & HIT enhancements to the healthcare system in Utah
2. Sharing of best practices from providers in the community to increase recognition of EHR value in delivering quality patient care
3. Facilitate development of participant action plans
Schedule
12:00 - 12:05 p.m. Introduction to the Learning and Action Network
12:05 - 12:10 p.m. Post-live Playbook
12:10 - 12:30 p.m. Past, Present, and Future of EHR Functionality
12:30 - 1:10 p.m. Stories from the Front Lines
1:10 - 1:25 p.m. Discussion
1:25 - 1:40 p.m. Care Concepts of Meaningful Use
1:40 - 2:00 p.m. What’s Your Action Plan & Upcoming Events
Post Live Playbook
• Meaningful Use • Health Information Exchange • Quality Improvement • Working with Vendors
Electronic Health Record Past – Present – Future First Part of Breakout
Wyatt Packer Vice President of Operations
Past
• Narrative focused • Data not easily measured • Legal focus (backup in court) • E and M and billing focus (coding) • Less secure
Present
• Data-focused • Ability to generate reports • Reports measure high-priority family care
measures • Ability to do population management • Point of care alerts • Secure
Future
• Engage patients through portals • Interoperability with other physicians • Ability to create and measure many areas of
care • Advanced ability to capture clinically relevant
information • Advanced care coordination functionality
Stories From the Front Lines
Jan Root, PhD – CEU, UHIN
John Berneike, MD – Utah Healthcare Institute
Mary Tipton, MD – Copperview Medical Center
Jan Root, Ph.D.
The value of the cHIE
Why the cHIE is more important to you than ever!
cHIE History: The cHIE is growing
Successes: HB 46 ~350,000 consent decisions Long- Term Care, 100%
Challenges Consent More Data! More Value!
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cHIE Secure Patient Directory
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9,000,000Clinical Cumulative Messages by Type
Laboratory Transcription Radiology
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LTC Adoption
Actual Projected
Complete Oct-12
Things have Changed! Healthcare Transformation Road Map
DRIVERS OF CHANGE Changes in Delivery
Metrics
Payment Model
Individual Providers using EHRs and HIE
Patient Outcomes measurements
Measurable Outcomes improvements across populations
Population based and health status measurements
Providers at risk Fee for Service
Integrated and Improved Care, Patient Population, Costs
Care teams
Pay for Outcomes, Shared Savings
Technology: ENABLERS OF CHANGE Analytics
Transactional Requirements
Infrastructure Requirements
Provider centric reporting
Certified EHR, Meaningful Use Wellness Management Tools embedded in workflow, longitudinal record, remote care
Ubiquitous access to health and wellness transformation
Enterprise HIE interfaced to regional HIE
Predictive modeling and forecasting
Outcome Reporting Population-based Reporting
Improved data access, standards, and interoperability
Do Utah Patients use more than one healthcare system?
3,825,635 Total cHIE Identities Range: 34%-81% are shared
42%
54%
Shared Identities in cHIE Between Healthcare Systems
Shared Unshared
Specific Use Case
DATA MARTS More effective mgt of diabetics
Case Manager Cohort of
diabetics
cHIE Information about only the
people on the list
•Specific cohorts: uncontrolled diabetics
•Specific Information: HcA1C results
•Specific Times: daily, weekly
Specific Data
ALERTS Helping Clinicians Manage Patients
Step 1: Doctor tells cHIE which patients are in “cohort” & what data they want to receive for that cohort
Example: Cohort: cardiac failure Data: ED/Hospital Admissions
Cohort List
Step 2: cHIE monitors data on that cohort for ED/
Hospital Admissions
Step 3: If there is a match, cHIE sends an alert: ED or
Hospital Admit of Patient X at hospital/ED Y
Alert
Camden Coalition for Patient Centered Care Patient Case Presentation #1
52 yo female, Spanish speaking COPD/Trach/Vend dependent Admitted for resp distress 12-Month hospital utilization:
– 8 readmits – 1 ED – Ave time b/t hosp = 29days
Identified through HIE daily hospitalization report Used Alerts to manage care
1 year pre-enrollment Charges: $745,018; Receipts: $95,358
Inpatient days: 55, ED visits: 1
Post-enrollment Charges: $0, Receipts: $0
Inpatient days: 0. ED visits: 0
The result!
ANALYTICS: Partnering with HealthInsight ACO/PCMH Quality of Care Reports
Info
Info Info
Complete Quality Report
PCMH
cHIE Direct: Available Now
Secure Email National Standard:
– Eventually can exchange email with anyone across the country, providers, payers, hospitals, patients, etc.
Ability to exchange messages and attachments securely – Implementing now
Attachments E-Forms (authorizations) Referrals POLST
Mary Tipton, MD
Copperview Medical Center
Primary Care office in South Jordan 11 providers serving all ages and stages
Mix of private and government plans & uninsured Internal Medicine / Pediatrics, Family Medicine, FNP, PA
Electronic Prescribing
Success How we did it
• 99% electronically generated prescriptions
• Actual medication reconciliation • Medication history function saves
time and prevents duplicate prescriptions
• Formulary access at the time of prescribing
• Drug-drug interactions checked • Drug-allergy interactions checked
Persevered through that first year • had to “match” drugs to standardized
database • had to “match” allergies to standardized
list • Detected error in EMR interface 4
months in • Taught and re-taught MA’s to reconcile
medications • Taught and re-taught providers how to
reconcile medications • Complete workflow change for every
person in office
Positive Outcomes
• Patients are relieved we have pharmacy data • More likely we can identify “that little blue pill” • Decreased calls from pharmacies (formulary, refills) • Providers are relieved to avoid prescribing costly
medications if alternative exists • We have access to compliance data (fill dates) • High level of satisfaction for acute care visits, less so
for chronic care • Much easier to send rx to mail order companies
Our next steps for improvement (wish list)
• Controlled substance E-rx is essential
• Integrated EMR/E-rx solution with 2 way interface
• Usage/fill variations reflected accurately for chronic
medications
• More accurate formulary information
• Eliminate duplicate refill requests
• Immediate prior authorization notification (denial)
Secrets to future success?
Keep our sense of humor!
St. Mark’s Family Medicine (Utah Healthcare Institute)
St. Mark’s Family Medicine
Count of HgbA1c & Average HgbA1c by Quarter since EMR implementation
Population-centric Care
Registry (Meridios) – Practice-wide dashboards – Patient lists
Dashboard
Registry
John Berneike, MD St. Mark’s Family Medicine Residency
Utah HealthCare Institute 1250 E 3900 S #260
SLC, UT 84124 801-265-2000
[email protected] www.utahhealthcare.org
Discussion
How can you implement these ideas and concepts into your own clinic?
Basic Meaningful Use Concepts Second Part of Breakout
Basic Meaningful Use Care Concepts
• Lists • Reminders • Quality Measures • Clinical Decision Support • Health Information Exchange
Example
Diabetes a1c example: – List – diabetes patients with no a1c in last year. – Reminder-send postcard to list (record reminder
for credit in EHR) – Quality Measure – NQF0575 – Clinical Decision Support – Alert for patients at
point of care who have not had a1c in last year. – Use HIE to see if a1c has been taken at another
clinic or institution, see value of number.
Electronic Health Record Past – Present – Future Heidi Smith, MHA PMP
BEACON Project Manager
Sample Plan – Heidi Smith
Example of an Improvement Plan: What are we trying to accomplish, our action step: Improve HgA1c control from 74% to 84% by March 31, 2013 How will we know that we have made an improvement? We will run a report every month looking at our average HgA1c values for all of our patients with diabetics. Tasks Needed: List the tasks needed to set up this action (who, what, where, when): At each visit, MA asks patient if they are diabetic while taking vitals. If yes,
check chart for last HgA1c result. If >6.5% and >3 months--- MA orders a HgA1c screen and updates the chart. Provider decides if pt. needs to be referred to case management, diabetes
class, scheduled back for DM follow-up. Document plan in EHR.
Sample Plan Continued
What Change can we test by next Tuesday? Review process with team in one week to determine how well it is working.
Abandon it or continue. AND Then in the next 90 days? We will run a report every month looking at our average HgA1c values for
all of our patients with diabetics. Within 90 days we should see a definite trend in improvement of screening outcome measures.
What are your greatest barriers to achieving success with your team’s action step? • Will MA’s remember to ask patients if they are diabetic and have
enough time to check the chart before the provider comes into the exam room?
• MAs need a standing physician order to be able to order HgA1c. • Patients may not follow through with the lab work.
Create Action Plan
• Clinic • Nursing Home and Home Health – What’s
your clinical question? – Flu Shot
• Other
What is Your Plan of Action? What is your Plan of Action?
Step One: Based on what you heard today, pick an action that you can implement to improve patient-centered care.
Here are some ideas to get you started:
Patient Centered Ideas for Action:
• Assess current patient engagement practices for gaps
• Improve cultural competency • Assess health literacy barriers • Provide care plans/visit summaries
in non-medical language • Implement Personal Health records • Implement an electronic patient
portal • Train patients to plan their visits • Use “teach back” or “AskMe3” • Train staff in motivational
interviewing • Train staff in coaching • Develop a panel of patient experts
to advise you
Measurement Ideas: • Patient satisfaction scores • # of times a tool is used each day • # of staff trained in ___ _____ • # of meetings with a patient story
shared • # of meetings with a patient
participant • # of new templates with self-
management assessment developed and used
Ideas I heard today that I like: __________________________________________________________________________________________________________________________________________
People I met today I want to contact:
______________________________________________________________________________________________________________
• Consider the ideas on page 13.
• Fill out your plan for action on page 14.
• Share with your table what your plan is.
• Go to action!
Tell us about your experience today
There are two evaluations: 1. White Evaluation – confidential
– This page is completed without listing your name. – Please rate the morning plenary presentations and the
afternoon presentation you attended. 2. Blue evaluation – Please fill in your name and contact information
– To request CME credit and follow up technical assistance as needed.
When you have completed both pages of the evaluation, please turn them in separately as you leave. Thank you for your participation and feedback!
