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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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9,000,000Clinical Cumulative Messages by Type

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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

jberneike@utahhealthcare.org 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!