together.today.tomorrow. the blues project karen c. fox, phd chief executive officer
TRANSCRIPT
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
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
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
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
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