# Presentation: 359750

## Doctor’s Office QualityInformation Technology (DOQ-IT)James Sorace, MD, MS, Clinical AdvisorSusan Fleck, RN, MMHS, GTL Office Systems Survey and Care Management/DOQ-IT U 

- March 20, 2007

## DOQ-IT - Assist Practices in Transforming System Change to Improve Quality of Care

- Started DOQ-IT as a four state Pilot in 7th SOW
**     ****DOQ-IT Designed to** –
- Promote the adoption of clinical information systems
- Promote **effective** implementation of systems and associated workflow changes to achieve efficiencies
- Implement care management and patient self management processes
**     ****Focus of DOQ-IT - **
- Small/medium primary care practices (1-9 physicians) *without pre-existing HIT* – complex workflow and limited resources
- Assist practices with : assessment of practice site readiness/needs workflow redesign,  EHR  selection, vendor issues, e.g.,., essential element of a vendor contract

## What are the DOQ-IT Goals?

- Not limited to installation
**Use and Produce:** Practices must be able to store and retrieve diagnostic codes, labs, and medication.
**Care management:** Ultimate goal is for practices to reorganize their workflows to achieve better care for patients.
- QIOs recruited approximately 4,000  practices
- Progress

## DOQ-IT Special Studies

- DOQ-IT is built around two special studies.
- The Office Systems Survey, and
- The Care Management/DOQ-IT U

## OSS Update

- Masspro is lead contractor/Maine Health Information Center (MHIC) is subcontractor
- Baseline Survey Completed in October 2006
- Only existing extensive national survey to capture information about Health Information Technology (HIT) adoption/use in small-medium physician practices, focusing on primary care practices
- Goal of OSS is to measure the movement of practices along the continuum of EHR adoption and care management processes with QIO intervention, between baseline and re-measurement surveys
- Captures not only what systems the practices have, but what the practices are using their systems for: EHR, e-prescribing, e-registry, e-labs, care management
- Achieved 90% National Response Rate, data represent over 4,000 practices and 12,000 physicians
- Currently in process of validating OSS responses

## OSS Update Continued

- Only the re-measurement survey will be used for QIO evaluation, not the baseline survey
- OSS re-measurement:  scheduled for summer/fall 2007
- OSS can be easily revised to meet future needs to assess higher levels of HIT adoption, and increased/improved levels of care management processes

## Care Management/DOQ-IT U Update

- Masspro is lead contractor
- Two components to special project:
- To provide clinical decision support, evidence-based medicine guidelines for practices that is disease/population targeted
- To provide this information in an interactive web-based adult learning environment, offer CME/CEU credits (DOQ-IT U)
- Using Learning Management System (LMS) – CMS has license from Meridian
- Provide at no charge, to all health care professionals nationally, not just to IPGs

## Technical Advisory Panel (TAP) – ACP, AAFP, and ABIM represented
Defined Care Management: evidence-based, integrated clinical care activities that are patient-specific and ensure that every patient has a coordinated plan of care and services
DOQ-IT U is currently “live”  website: http://elearning.qualitynet.org
National Press Release is in process
Modules (learning sessions) include elements of a care plan, and sample care plans for physician practices 
Current modules are: Office Workflow Redesign around an EHR/Culture Change/Communications, Vendor Contract/Vendor Relations Issues, and Care Management Module #1  
“A Day in the Life of a Practice”

- Defined Care Management: evidence-based, integrated clinical care activities that are patient-specific and ensure that every patient has a coordinated plan of care and services
- DOQ-IT U is currently “live”  **website: **_[http://elearning.qualitynet.org](http://elearning.qualitynet.org/)_
- National Press Release is in process
- Modules (learning sessions) include elements of a care plan, and sample care plans for physician practices
- Current modules are: Office Workflow Redesign around an EHR/Culture Change/Communications, Vendor Contract/Vendor Relations Issues, and Care Management Module #1
- “A Day in the Life of a Practice”

**Care Management/DOQ-IT U Update **
**(Cont)**

## First disease specific module – Diabetes (will include CKD component)
All disease specific modules will have patient self-management component, critical to successfully managing patients with chronic disease
Diabetes Module due for release June 2007
Subsequent disease specific modules will follow

- All disease specific modules will have patient self-management component, critical to successfully managing patients with chronic disease
- Diabetes Module due for release June 2007
- Subsequent disease specific modules will follow

**Care Management/DOQ-IT U Update **
**(Cont)**

## DOQ-IT U Features

- Web-based, interactive, adult learning environment (graphics/mouse hover feature), glossary of terms
- Auto Feedback Button directly to Masspro
- Survey capability
- Utilization tracking capability
- No Charge to Practice
- Open to all practices nationally
**ONE STOP SHOPPING**
**Future Features:  **CME/CEUs, Provider Profile Page

## Developed the only national sustainable product that combines clinical processes (clinical decision support and evidence-based medicine) with metrics (tools, national utilization tracking)
Linked to the OSS
Sustainable to use for additional modules targeted to all health care settings

- Developed the only national sustainable product that combines clinical processes (clinical decision support and evidence-based medicine) with metrics (tools, national utilization tracking)
- Linked to the OSS
- Sustainable to use for additional modules targeted to all health care settings

## Points to Consider

- DOQ-IT is the only national program that combines:
- The ability to educate practices as to how to use EHRs to improve patient care.
- With, the ability to measure the adoption of EHRs by national survey.
- DOQ-IT exists in a complex environment.
- Marked state to state variation in EHR adoption.
- Other Federal programs influence the EHR landscape.
- Effective utilization of EHRs first ***requires*** that they be comprehensively populated with valid data.
- EHRs must “talk to” other primary data producers (Labs, Pharmacies, Imaging Centers etc.).
- Offices must enter structured data (Labs, Mammograms, Diagnostic Codes, Structured Text etc.).

## HIT Strategy

- Encouraging adoption of Certification Commission for Health Information Technology (CCHIT) systems.
- Assure that ***critically***  needed standards (labs, medications etc.) meet CMS requirements and are adopted as soon as appropriate.
- Crucial need for these standards so that EHRs can be meaningfully populated with data, and support patient care.
- Standards must be developed to meet CMS  business/policy needs such as CLIA (Clinical Laboratory Improvement Act) and HIPAA.