Transcript DRAFT presentation

Paperless Records and HIV Clinical Care
With a Laptop:
Electronic Health Record Health
Maintenance Alerts and HIV Registry
Mark Sannes, MD, MS, AAHIVS
Chair, Infectious Disease
Park Nicollet Clinic/HealthPartners Care Group
St. Louis Park, MN
Learning Objectives
• Recognize the evolution of HIV/AIDS into a
chronic disease model, and the need for longterm clinical quality goals in this population.
• Implement basic HRSA/HAB benchmarks into HIV
clinical practice via electronic health record
maintenance alerts.
• Review how to further achieve HIV population
health goals through a basic HIV registry.
Disclosures
• Speakers Bureau for Gilead, Janssen,
Merck
• There will be no off-label/investigational
uses discussed in this presentation.
What % of your HIV-positive patients are
≥ 50 years of age?
a.
b.
c.
d.
< 10%
11-25%
26-50%
51-75%
BACKGROUND
• HIV/AIDS has evolved to a chronic disease model; we are
providing BOTH HIV-specific care and primary care to our
patient population; 50% of which will be > 50 years of age
by 2020.
• Park Nicollet Clinic is provider for ~750 HIV+ patients, or
10% of those living with HIV in MN; ¾ of those as primary
care provider.
• Validated quality of HIV care measures exist at the federal
level through HRSA/HAB for funding purposes.
• Desire to ascertain how well we achieve these quality
measures in our practice >> PN Advanced Training Program
General Mission Statement:
• Caring for patients with HIV has evolved from
acute episodic care to a chronic disease model.
Health maintenance in this population needs to
evolve as well, with an eye toward achieving
disease-specific best practices that are
incorporated real-time into clinic flow by virtue of
electronic reminders and standing nursing orders
at every visit.
TRIPLE AIM
Assess quality of care. Desire to ascertain how
well we achieve these quality measures in our
practice > HIV Registry
 Assess affordability of care. Once quality
benchmarks achieved, could delivery be more
efficient and less costly?
(CD4 counts annually instead of four times/year;
$250 X 3 X 750 patients = $562,500)
 Improve patient experience by making our results
transparent to patients; overall better satisfaction

CLINIC IMPACT – NEAR TERM
• Improve quality of HIV care
– Patients satisfied with more comprehensive care
– More reliable design of care delivery
• Increase clinician and staff satisfaction
– Reduce time spent on health maintenance during a visit
(improve clinician satisfaction)
– Allow nursing staff to own health maintenance
• Reduce cost associated with unnecessary routine care (e.g.
decrease variation in lab ordering)
• Utilize advanced practice providers with primary care
experience – right people doing right job.
CHANGE HYPOTHESES
• By providing a checklist prior to clinic visits with standing
orders for vaccinations, we will improve our overall
vaccination rates.
• By removing the physician order step at the clinic visit, we
hope to avoid “missed opportunities” when that order
doesn’t get placed.
• By showing real-time improvement, we will keep provider
and nursing staff engaged in this process.
• With remaining health maintenance measures included on
the health maintenance alert, we hope to establish the
baseline and start continuous improvement in non-vaccine
areas immediately.
ATTRIBUTION
Patient Attribution
18
100%
42
75
90%
80%
70%
103
130
41
60%
Blank
50%
635
30%
Current ID provider
557
40%
425
20%
10%
0%
1 (5/10)
2 (6/13)
Other PNC
3 (6/20)
SUMMARY
• Many HIV providers also provide primary care for their
patients. A chronic disease model increasingly fits our
patient population.
• Need for attention to quality benchmarks is now for this
patient population. Our health maintenance alert in the
EMR addresses that immediate need, respecting valuable
care team time by utilizing standing orders and improving
clinic flow.
• Population level data in our HIV Registry allows for data
collection around public health measures, targeted
interventions, and continuous improvement at level of
provider or clinic.
FUTURE DIRECTIONS
• HMA/HIV Registry targets:
– Vaccinations expanded to include influenza,
pneumococcal, Hepatitis A/B, HPV, VZV, others?
– “Registry within registry” work around D5 and optimal
vascular care; possibly depression, drugs/alcohol
– Cancer prevention (% with updated cervical/anal Pap
smear, colonoscopy, mammography more refined)
– Metabolic screening (DEXA in men > 50, renal function)
– Expanded STD screening (GC/Chlamydia, syphilis,
Hepatitis C, others)
– Total cost of care analyses (attention to decreased
variation in care, lab/pharmacy savings)
QUESTIONS?
• Thank you:
– AAHIVM/Institute for Technology in Healthcare HIV
Practice Award
– Park Nicollet Clinic team members:
•
•
•
•
•
•
•
David Homans, MD and Kate Klugherz, MHA (Admin Sponsors)
Amber Larson, MHA (Quality Improvement)
Apryl Starcznski, RN (Clinic Manager)
Molly Lundberg, RN (Nursing Supervisor)
Theresa Gilseth (Analytics, Epic reporting)
Tatiana Ryvlin (Epic health maintenance alerts)
Great ID colleagues and nursing staff
How might a health maintenance alert (HMA)
help you in your day-to-day clinic practice?
a. More accurately complete HIV-specific health
maintenance
b. Decrease clinician and nursing time spent
completing HIV and routine health maintenance
c. Improve patient satisfaction through
transparency of health maintenance
d. Decrease unnecessary variation in care
e. All of these
How can a HIV registry improve the health of
your population of HIV-positive patients?
a. Align best practices in HIV care with your own
clinic practice
b. Deliver provider-specific summary data,
individualizing opportunities for improvement
c. Identify public health opportunities for
intervention (syphilis/STD screening, etc.)
d. Identify sub-groups that require more attention
based on medication exposure, age, etc.
e. All of these