# Presentation: 337921

## Technology Tools for Prevention

**Frances M. Murphy, M.D., M.P.H.**
**Deputy Under Secretary for Health**
**For Health Policy Coordination**
**April 16, 2003**

**Technology Tools for Prevention**

- Steps to a HealthierUS: Putting Prevention First

## Quality Problems Persist in U.S. Medical Care

- IOM Quality Chasm Series
- Poor treatment of diabetes – tens of thousands of cases of premature death, amputations, kidney disease and blindness
- Inadequate care after AMI – 18,000 deaths per year
- Less than half of adults >50 years old receive the recommended colorectal screening – common cause of cancer death in the U.S.

## Electronic Health Record System

**A Tool to Improve Care**

- Clinical Reminders for Prevention
- Telemedicine and TeleHome Care:
- Florida’s Community Coordinated Care Service Pilot

## Medical Care

- VHA is the largest, integrated healthcare system in the US:
- 	163 hospitals (19,639 beds, 5.4M BDOC)
- 	135 nursing homes
- 	43 domicilliaries
- 	206 veterans counseling centers
- 	800 clinics (46.5 M outpatient visits)
-       183,000 employees

## VA Patients Receiving Care

- 65 or older: 45%
- Income $25,000 or less: 74%
- No health insurance: 31%

## VA Healthcare Information Technology Infrastructure

- Electronic Health Record System
- Clinical Reminders for Prevention
- Telemedicine and TeleHome Care

## “VA’s integrated health care information system, including its framework for using performance measures, is considered one of the best in the nation”

- Leadership by Example, Institute of Medicine,October 2002

## Electronic Medical Record“VISTA”

- All Sites of Care: Outpatient, Inpatient, and Nursing Homes
- Radiology: Images and Reports
- Diagnostic Testing (Images and Reports) :        Laboratory,  Pathology, Endoscopies, Colonoscopies, Bronchoscopies, EKG, Cardiac Catheterization
- Pharmacy and Physician Order Entry
- Remote View: Records are available at all points of care
- Decision Support: Clinical Guidelines and Clinical Reminders

## VISTA

- Patient Identifiers and Picture
- Medical Problem List
- Current and past medications
- Allergies
- Social History
- Clinic Progress Notes and Consults
- Inpatient Records
- Remote View of EMR from other VA sites
- Advanced Directives
- Diagnostic Test Reports and Images

## Slide 10

## Slide 11

## Quality of Veterans HealthcarePerformance measures

| Indicator | VA (mean) |  | Best Reported |
| --- | --- | --- | --- |
| Beta blocker & AMI | 97% |  | 94%(MMCP) |
| LDL Cholesterol <130 post AMI | 74% |  | 59%(NCQA) |
| Cholesterol screening  | 91% |  | 73%(BRFSS) |
| Cholesterol Screening & AMI | 92% |  | 77%(NCQA) |
| Diabetes:Cholesterol (LDLC) | 94% |  | 87%(MMCP) |
| Diabetes:Cholesterol (LDLC) controlled<130 | 70% |  | 50 %(NCQA) |
| Diabetes:HgbA1c done in 
past  year  | 94% |  | 86%(MMCP) |

## Quality of Veterans HealthcarePerformance measures

| Indicator | VA(mean) | Best Reported |
| --- | --- | --- |
| Breast Ca Screen | 80% | 75%(MMCP) |
| Cervical Ca Screen | 89% | 80%(NCQA) |
| Colorectal Cancer Screen | 64% | 44%(BRFSS) |
| Pneumococcal vaccine :patients>65 yrs | 87% | 60%(BRFSS) |
| Influenza vaccine   :patients >65 yrs | 74%
 | 65%(BRFSS)
 |

## Clinical Reminders for Prevention

- Clinical Care made Effortless
- Prompts the Provider
- Computer Enters the Order
- Documents in Progress Note

## Proportion of patients receiving cancer screening, immunizations, counseling for alcohol abuse and tobacco use have increased 130 to 500 percent.
Vaccinations have been estimated to prevent approximately 4000 deaths.

- %

- Proportion of patients receiving cancer screening, immunizations, counseling for alcohol abuse and tobacco use have increased 130 to 500 percent.
- Vaccinations have been estimated to prevent approximately 4000 deaths.

## Critical Success Factors Electronic Medical Record Systems

- Clinically Relevant and Efficient
- Clinical Decision Support
- Improves Prevention and Care
- Flexible and Customizable
- Integrated and Fully Functional
- Reliable

## VA Healthcare Information Technology Infrastructure

- Electronic Health Record System
- Clinical Reminders for Prevention
- Telemedicine and TeleHome Care

## Community Care Coordination ServiceVA Program in Florida

- Continued the Shift from Hospital to Ambulatory to Home Care for a Complex, Frail Elderly Population
-  Disease Management for 9 conditions including diabetes, hypertension, CHF, CAD, and COPD
- Care Coordination is the key
- Technology is the tool
- Use of Multiple Innovative Technologies to Enhance Care
- Goals: Improved Quality of Life and Reduced Utilization

## Community Care Coordination ServiceProgram Implementation

- Six Florida sites: Urban Tertiary Care Medical Centers and Small Rural Hospitals
- Population: clinically complex patients with multiple chronic conditions
- Multidisciplinary Care Coordination Teams
- Initial In-Home Assessment
- Equipment Installation and Patient Education
- Care Coordination Team Monitors Daily

## Community Care Coordination ServiceTechnology

- Simple, Easy to Use
- Connects to Telephone: 800 Number
-  No Internet Service Necessary
- Secure, Web-based
- Integrated Enrollment, Scheduling, Monitoring Tools
- Care Team and Patients Communicate Quickly
- Flexible to Address Individual Needs

## Community Care Coordination ServicePatients

- Answer Personalized Questions Daily
- Multilingual Service: English or Spanish
- Monitor their Disease Symptoms, Medication Compliance, Disease Knowledge
- Access to Patient Education
- Daily Responses are Categorized and Risk-Prioritized for Most Serious Outcomes

## CCCS Appliance

## CCCS TeleHome Care

## Results of CCCS

- Patient Satisfaction: 96-98%
- Quality of Life (SF-36V):
- Lake City:  50%physical health perception improved
- Miami : no change
- Provider Satisfaction High
- Outcomes:
- Reduction in Hospitalization: Lake City 68%;Miami 46%
- Reduction in BDOC: Lake City 71%; Miami 50%
- Prescriptions: Lake City 66%; Miami 5%
- Daily CCCS Use: Lake City 83%; Miami 64%

## Community Care Coordination ServiceConclusions

- Provides Continuous Care Coordination
- Good Patient Satisfaction
- Reductions in Health Care Utilization
- Stable or Improved Perception of Physical and Mental Health

## Technology Tools for Prevention

- Summary

- 1) The U.S. can no longer afford to practice 20th      century Preventive Medicine
- 2) Health Information Technology is an essential tool to improve health promotion, disease prevention, quality of care, and patient satisfaction
- 3) U.S. health care must become patient-centered, accessible and accountable