# Presentation: 264505

## Health Information Technology in OKPRN

**Health Information Technology in OKPRN**

- Zsolt Nagykaldi, PhD
- University of Oklahoma HSC,
- Department of Family & Preventive Medicine
- Oklahoma City, OK

- High-speed AV
- group collaboration

- Registry Prompt/Reminder

- Biosurveillance

- Decision Support

- Patient Tracking

- Data Repositories

## OKPRN  HIT  Portfolio (since 2001)

**OKPRN  HIT  Portfolio (since 2001)**

_**Patient Registry / Tracking / Eval & Clinical Decision Support**_:
- Preventive Services Reminder System (PSRS) - Java Struts on Tomcat and PostgreSQL
- Diabetes Patient Tracker® - networked registry on PC and PDA clients and MS-SQL
- LogProcedure - secure Java web application & database for resident competency evaluation
- Smoke Free Families - PDA tracking and clinical decision support tool for smoking cessation
- OU Home Visits - networked home health care patient management solution
_**PBRN / Clinician Web Resources**_:
- OKPRN web site and clinician web resources (www.okprn.org)
- Other web resources (surveys, GIS-maps, membership databases, listservs, blogs, etc)
_**Infectious Disease Surveillance & Rapid Messaging**_:
- OKAlert® - ILI System - Internet-based dual-use biosurveillance & rapid messaging system
- Office Hermes - secure physician office messaging tool with PC clients on an SQL database
_**Prescription / Lab Management & Scheduling**_:
- yScribe Rx - comprehensive prescription management solution for mobile devices
- LabMan - laboratory test results tracking and management system for PDAs
- DocSchedule - PC-based physician & resident scheduling application
_**Health Screening / Point-of-Care Patient Evaluation**_:
- DartScreen Teen Health Screener - PDA/PC -based clinical screening & decision support tool
- DartScreen Child Health Screener - PDA/PC -based clinical screening & decision support tool
_**“**__**Pure” Research Data Collection Tools**_:
- Palm Sleep Study - clinical data collection tool for mobile devices on Pendragon Forms

## The HIT ‘Research Pipeline’ in OKPRN

**The HIT ‘Research Pipeline’ in OKPRN**

- 1) Impetus for development
- 2) Conceptual framework
- 3) Design / development of applications and resources
- 4) Alpha and beta- testing in PBRN practices (PDSA cycles)
- 5) Implementation through systems-redesign / reengineering
- 6) Study of utility, effectiveness, and cost in clinical trials
- 7) Continuous quality improvement – “phase IV trial”
- 8) Dissemination of proven technology within & outside of PBRN

## Impetus for HIT Development & Adoption

**Impetus for HIT Development & Adoption**

- _“__Wrong” impetus for PBRNs_:
-  Making money on software
-  Put some IT in the proposals to get funded – ‘buzzword’ HIT
-  P4P peer pressure – must ‘go electronic’ quickly, no matter what
- _“__Right” impetus for PBRNs_:
-  Our clinicians have a specific problem and HIT is the best answer
-  The focus is on improving care, not on technology
-  HIT is ‘ancilla medicinae’ (servant maid of medicine) to reach the goal
-  Improve quality and safety of care _AND_ do research at the same time
-  Make practices more efficient in an economical manner

## Conceptual Framework – An Example

**Conceptual Framework – An Example**

- PSRS
- in the context of the delivery system

## Design & Development of HIT Resources

**Design & Development of HIT Resources**

- The HIT Team:
- A faculty in our research division who is also an HIT specialist and a programmer (one of his research areas is HIT adoption in primary care)
- Two outside ‘open-source minded’ programmers (2002-2005)
- A lead faculty physician investigator with strong IT background
- Support and endorsement of our Department and Campus IT
- Support of our University medical community through the CTSA program
- Strong and enthusiastic support and participation of our PBRN clinicians

## Testing – Improvement Via Planned Iteration

**Testing – Improvement Via Planned Iteration**

- Standard c-QI methodology (PDSA):
- 1) Start small and simple (one practice or 1 doc in a practice)
- 2) Work out the problems, issues, and bugs in ‘light mode’ (e.g. using application only with 5 patients and day)
- 3) Iterate, until app is useful and efficient on small scale
- 4) Scale up (include all patients or all clinicians in the practice, extend use to multiple practices)
- 5) Go through PDSA cycles again and refine implementation
- 6) Disseminate and constantly monitor use and feedback

## Implementation Through Practice Redesign

**Implementation Through Practice Redesign**

- Labs, consults,
- and referrals between visits

**Waiting Room**
- Risk factors, wellness history

- Nurse empowerment

**Nurse Station**
- Regular care

**Patient**
- Community and practice resources,
- patient education

- “Prevention” Workflow

- Existing Workflow

-  Feasible (sufficient resources & time)
-  Achieves practice goal (e.g. QI)
-  Fits ‘organically’ into new processes
-  Cost neutral or +ROI

## Study of Utility, Effectiveness, and Cost

**Study of Utility, Effectiveness, and Cost**

- Utility Survey - What characteristics of the
- system do you value the most?

- PSRS Time-Motion Study

| 2-3 year olds & adult diabetics | HEPB#3 | DTaP#4 | MMR#1 | PCV#3 | Smoking Status | Smoking Counseling | Adult Pneumococcal |
| --- | --- | --- | --- | --- | --- | --- | --- |
| INTERV. (PRE) | 78% | 68% | 86% | 30% | 66% | 23% | 39% |
| INTERV. (POST) | 93% | 86% | 93% | 38% | 93% | 78% | 78% |
| p(intervention; n=3) | 0.0005 | 0.001 | 0.0005 | NS | 0.02 | 0.0004 | 0.0003 |
|  |  |  |  |  |  |  |  |
| CONTROL (PRE) | 64% | 57% | 64% | 29% | 75% | 6% | 33% |
| CONTROL (POST) | 61% | 53% | 61% | 27% | 70% | 13% | 33% |
| p(control; n=3) | NS | NS | NS | NS | NS | NS | NS |

- PSRS Effectiveness Trial

- Practice Financial Analysis

## C-QI In HIT Implementation

**C-QI In HIT Implementation**

- Electronic OKPRN network database on 250+ clinicians (contains PRINS I-II dataset)
- Electronic Practice Record with Practice Facilitator (PEA) field notes
- Routine patient encounter data in a preventive services database (PSRS) and several diabetes patient registries
- PSRS has over 160,000 patient charts and data on 8000 patient encounters
- Diabetes registries store routine care data on 5000+ diabetics in Oklahoma
- Databases are regularly mined for practice-based research, quality improvement, and direct feedback to clinicians

## Dissemination of Proven Technology

**Dissemination of Proven Technology**

- Conference presentations in-state and nationally
- Publications in peer-reviewed literature
- OKPRN website, listserv, convocations, newsletters
- Demonstration projects and practice-based research studies through state agencies (health department, Medicaid) and national health care organizations (e.g. RWJF)
- Dissemination through national funding sources (e.g. NIH, AHRQ)
- Partnerships with other networks and Universities
- Planned: Audio-visual media (CD, DVD, streaming video/audio)