Transcript Erie Family Health Center All Staff Meeting July 5, 2000

Opportunities to facilitate community based
research through Community Health Center
of Chicago Community Health Services, LLC
Tim Long, MD
Andrew Hamilton, RN, BSN, MS
NCRR Meeting May 15, 2007
5/3/2007
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What are our goals
1. Promote community based/translational
research
2. Develop an information network that
can promote research and facilitate
translation of evidence based
interventions into practice.
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Potential of HIT enabled translational
research
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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
Challenges to Research in Clinical
Settings
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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
Challenges in the Healthcare Setting
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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
Capabilities of Electronic Record
Systems
Basic
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a storage and retrieval system
VS
Advanced
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a sophisticated interactive database
Considerations in implementing
higher level functionality
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Acceptance of common vision of quality
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Ability to capture and process relevant data
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Adoption of evidence based standards against
which to judge care quality
Agreement to conform to standardized ways of
recording data
Relevant care elements are captured as
structured information
Implies that “order entry” is computerized
Data is “clean” and consistent
What is the Alliance?
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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
Community Health Centers
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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.
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principal services include: primary and preventive
health care, behavioral health care, outreach, and
dental care
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ancillary services include: laboratory tests, X-ray,
environmental health, and pharmacy services
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related services such as health education,
transportation, translation, and legal services
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currently more than 900 nationally with
presidential initiative to increase number
Who CHCs Serve
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2/9/2007
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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
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CHC Profile
o 952 Community-Based Organization
o 1356 Sites of Care across US
o 14.2 Million Patients Served
o 90,000 MDs/NPs, RNs, & Dentists
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2/9/2007
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2/9/2007
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2/9/2007
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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.
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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.
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HIT Partnership
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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
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Clinical consensus
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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.
Considerations for EHRS development
and implementation
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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)
Structured Data Entry
Consideration for Report Development
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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
Measure Example
Diabetes Measurement Set (foot exam)
o 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
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Technical Specifications
Numerator
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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.
Technical Specifications
Denominator
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All patients with diabetes 18-75 years of
age
Codes to identify patients with diabetes
include:
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Prescriptions to identify patients with
diabetes include:
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ICD-9-CM Codes: 250, 357.2, 362.0, 366.41,
648.0) (DRGs) 294, 205
Insulin prescriptions (drug list is available) and
Oral hypoglycemics/ antihyperglycemics
prescriptions (drug list is available)
Technical Specifications
Exclusions
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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-9CM Code 648.8) or steroid-induced diabetes (ICD9-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
Considerations of Technical
Architecture
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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
Potential of EHRS & Research
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Decision Support
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Performance Measurement
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Communication between study sites
Off site intervention
Data warehouse/reporting
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Data collection
Study protocols
Remote hosting
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Client recruitment
Study protocols
De-identification of data
Aggregation and analysis of data
Status of System use
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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 nonAlliance sites
System Use Measures
Adult
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Use of diabetes disease
management form
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Use of cardiovascular disease
management form
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Use of HIV disease management
form
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Use of Asthma disease management
form
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Mammogram BIRAD score
documented
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PAP Results documented
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Colonoscopy Screening documented
Adolescents
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Sexual Activity documented at office
visit
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Violence risk documented at office
visit
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Pediatrics
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Developmental assessment
documented
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Weigh percentile documented
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Height percentile documented
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Head circumference percentile
documented
OB/GYN
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Prenatal visit with documented EDC
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Prenatal visit with FHR documented
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Prenatal visit with genetic history
documented
Mental Health
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Established treatment plan date
documented
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Treatment plan revision date
documented
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Signed metal health assessment
documented
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Substance abuse screening
documented
System Use Measures
Alliance Total
Other System Use Measures
100%
DM used dx 250;
Sexual activity used
obs term sexual
activ, age 12-19;
Prenatal w/doc EDC
used obs term EDC
(any entry), v22.0,
v22.1
% of Total Visits
82%
75%
Good
46%
50%
31%
30%
25%
0%
DM forms used of Sexual activity
eligible (N=733) doc at office visit
(N=747)
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Prenatal visit
w/doc EDC
(N=179)
EMA advisor used
(N=10567)
Use of Diabetes Disease
Management Forms
DM Forms Used Among Eligible
(dx 250)
100%
75%
49%
50%
41%
25%
13%
12%
0%
EFHC-WT (N=331)
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HBHC-SR (N=30)
HCHC-LA (N=117)
NNHS-KH (N=255)
Performance Measures
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AMA/HDC Diabetes
AMA/HDC CVD
HIV/HIVQUAL
AMA/HDC Asthma
AMA/HDC Preventive Care
Pre/Post EHRS Go Live
Diabetes Data
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Data Warehouse
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Login screen
Alliance Reports Folder
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AMA and HDC reports developed
HDC Diabetes Report
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HDC Diabetes measures along left side
Can Export Report to Excel
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File will download locally
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Can Export Report to Excel cont.
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Minimal re-formatting, then submit to HDC
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Can Also Drill Down to Patient Detail
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Note patient ID is encrypted in Portal Reports
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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
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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
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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
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