# Presentation: 417368

## 

 Session Overview
&
Workgroup Background

QUERI National Meeting
December 12, 2008

** ****Session Overview**
**&**
**Workgroup Background**
**QUERI National Meeting**
**December 12, 2008**

## Roles of Facilitators
Moderator: 	 Denise Hynes, PhD, MPH, RN
Case Study 1: Katharine Bradley, MD, MPH 
	Presenters	 Carol Achtmeyer, MN, ARNP 
				 Daniel Kivlahan, PhD 
Case Study 2: Mary Goldstein, MD
	Presenters	 Ruth Cronkite, PhD
Panelists:   	 Kathleen Lysell, Psy.D
				 James Breeling, MD
				 Jim Demetriades

- Moderator: 	 Denise Hynes, PhD, MPH, RN
- Case Study 1: Katharine Bradley, MD, MPH
- 	Presenters	 Carol Achtmeyer, MN, ARNP
- 				 Daniel Kivlahan, PhD
- Case Study 2: Mary Goldstein, MD
- 	Presenters	 Ruth Cronkite, PhD
- Panelists:   	 Kathleen Lysell, Psy.D
- 				 James Breeling, MD
- 				 Jim Demetriades

## 

Purpose
Describe and discuss approaches for developing sustainable HIT innovations through the identification of useful resources, collaborations, and strategies.

**Purpose**
- Describe and discuss approaches for developing sustainable HIT innovations through the identification of useful resources, collaborations, and strategies.

## Session Overview
Case Study 1
Case Study 2
Panel Response and Group Discussion
Facilitated Group Consensus Building 
Recap for Working Group Presentations

- Case Study 1
- Case Study 2
- Panel Response and Group Discussion
- Facilitated Group Consensus Building
- Recap for Working Group Presentations

**Notes:**
Mixed Group discussion and Q & A throughout both case studies in addition to the panelist response

## Previous VA Meetings and Projects Addressing Health Information Technology
QUERI National Meeting “Informatics Strategies to Support Healthcare Quality Improvement,”                      December 2003
Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” 
	November 2004
State-of-the-Art Conference on “Implementing the Evidence: Transforming Practices, Systems, and Organizations,”
	December 2004
State-of-the-Art Conference on “ Managing Complexity in Chronic Care,” Informatics for Complex Chronic Care Workgroup,    
   September 2006
VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects 2005-2006”

- QUERI National Meeting “Informatics Strategies to Support Healthcare Quality Improvement,”                      December 2003
- Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,”
- 	November 2004
- State-of-the-Art Conference on “Implementing the Evidence: Transforming Practices, Systems, and Organizations,”
- 	December 2004
- State-of-the-Art Conference on “ Managing Complexity in Chronic Care,” Informatics for Complex Chronic Care Workgroup,
-    September 2006
- VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects 2005-2006”

## QUERI National Meeting “Informatics Strategies to Support Healthcare Quality Improvement,” December 2003
Discussion of lessons learned from three QUERI informatics projects
Decision support for chronic hypertension management
Collaborative care for chronic schizophrenia management
Tele-care for chronic diabetes management
Discussion of barriers and facilitators in clinical reminder use in the VA
Presentation on future plans for VistA

- Discussion of lessons learned from three QUERI informatics projects
- Decision support for chronic hypertension management
- Collaborative care for chronic schizophrenia management
- Tele-care for chronic diabetes management
- Discussion of barriers and facilitators in clinical reminder use in the VA
- Presentation on future plans for VistA

## Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” November 2004
Local Innovation and National Standardization
Identified 3 goals for best possible business case for rolling out local innovations
Workflow efficiency from the provider’s perspective
Improved decision-making and better outcomes from the patient’s perspective
Optimal health from the target population’s perspective

- Local Innovation and National Standardization
- Identified 3 goals for best possible business case for rolling out local innovations
- Workflow efficiency from the provider’s perspective
- Improved decision-making and better outcomes from the patient’s perspective
- Optimal health from the target population’s perspective

## Patient Care Services Retreat “Implementation Research and VHA’s Clinical IT Strategy,” November 2004
Need for Systematic Evaluation of Processes and Outcomes of Implementation
Criteria
How well applications meet needs of users
How well applications impact outcomes
How well applications improve the health of patients
Recommendations
Improved communication and collaboration among OI, PCS, and HSR&D
Center for informatics implementation? 

- Need for Systematic Evaluation of Processes and Outcomes of Implementation
- Criteria
- How well applications meet needs of users
- How well applications impact outcomes
- How well applications improve the health of patients
- Recommendations
- Improved communication and collaboration among OI, PCS, and HSR&D
- Center for informatics implementation?

**Notes:**
Collaborations between researchers and computing specialist within existing HSRD Centers of Excellence (including QUERI Centers) and OI Field Offices to address high priority areas for clinical care

## State-of-the-Art Conference on “Implementing the Evidence: Transforming Practices, Systems, and Organizations” December 2004
Identified attributes of an ideal health information system

- Identified attributes of an ideal health information system

- Supports knowledge-based decisions
- Evaluation/reporting capability
- Evolves with health care system
- Accurate**/**correct content
- Standardized/compatible
- Defined accountability: organization vs. provider
- Equitable: “No service/facility left behind”

- Sustainable
- Secure
- Usable
- integrated
- all electronic
- flexible
- transparent to users
- non-intrusive
- easily up-datable

## State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006
Key Issues Discussed
How can information systems be used:
To improve care for complex chronic illness during patient visits? Between visits? 
To promote communication and information sharing among clinicians treating patients with complex chronic illness?
To improve patient self-management?
To encourage patients with complex chronic illness to share information with their providers between visits?
What type of aggregate information should be captured to help improve quality of care at the provider and system levels? 
What are the evidence-based practices in informatics that systems should begin to implement?

- Key Issues Discussed
- How can information systems be used:
- To improve care for complex chronic illness during patient visits? Between visits?
- To promote communication and information sharing among clinicians treating patients with complex chronic illness?
- To improve patient self-management?
- To encourage patients with complex chronic illness to share information with their providers between visits?
- What type of aggregate information should be captured to help improve quality of care at the provider and system levels?
- What are the evidence-based practices in informatics that systems should begin to implement?

## State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006
Opportunities
Relationships with the Office of Information
QUERI provides a way to bring OI and research together
Collaboration
Need more strategic-level dialogue between operations and research about informatics
Who should develop informatics?
VA’s comprehensive, longitudinal EMR provides starting place for future innovations:
MyHealthevet patient portal
CPRS interface

- Opportunities
- Relationships with the Office of Information
- QUERI provides a way to bring OI and research together
- Collaboration
- Need more strategic-level dialogue between operations and research about informatics
- Who should develop informatics?
- VA’s comprehensive, longitudinal EMR provides starting place for future innovations:
- MyHealth*e*vet patient portal
- CPRS interface

## State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006
Barriers
Relationship with Office of Information: reorganization poses challenges
Need for a new model to fund operations and implementation development, informatics development .
Legal/privacy issues with communication/medical records sharing
Variability in provider comfort with informatics- training opportunity
Need more resources to support clinicians- time and staffing
Academic vs. operational timeline- technology moves faster than research
Lack of data on care outside VA

- Barriers
- Relationship with Office of Information: reorganization poses challenges
- Need for a new model to fund operations and implementation development, informatics development .
- Legal/privacy issues with communication/medical records sharing
- Variability in provider comfort with informatics- training opportunity
- Need more resources to support clinicians- time and staffing
- Academic vs. operational timeline- technology moves faster than research
- Lack of data on care outside VA

## State-of-the-Art Conference on “ Managing Complexity in Chronic Care” Informatics for Complex Chronic Care Workgroup, September 2006
Recommendations
Identify where the intellectual capital is in informatics: 
OI
Researchers 
Patient care
Outside VA
Centralize work on informatics
Resource center on clinical informatics?
Informatics QUERI?

- Recommendations
- Identify where the intellectual capital is in informatics:
- OI
- Researchers
- Patient care
- Outside VA
- Centralize work on informatics
- Resource center on clinical informatics?
- Informatics QUERI?

## VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects 2005-2006”

- *32 projects out of 86

## VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects 2005-2006”
Synthesis of findings
Databases and information technology developed through QUERI implementation research aids VA research in general 
Databases and information technology developed through QUERI implementation research aids VA healthcare quality improvement
QUERI centers have continuing problems maintaining relationships with OI
QUERI centers lack overall strategy for data and information technology development and improvements 

- Synthesis of findings
- Databases and information technology developed through QUERI implementation research aids VA research in general
- Databases and information technology developed through QUERI implementation research aids VA healthcare quality improvement
- QUERI centers have continuing problems maintaining relationships with OI
- QUERI centers lack overall strategy for data and information technology development and improvements

## VIReC’s “Evaluation of Data and Information Technology Approaches in QUERI Implementation Projects 2005-2006”
Recommendations
Improve the processes and support for moving data and information systems from proof of concept to national implementation
Provide constancy of purpose for QUERI database and systems development by coordinating QUERI and VHA national leadership priorities, identifying funding sources, and including informatics strategies in QUERI annual strategic plans
Promote the demonstration of economic value in QUERI projects
Develop a nucleus of information on the use of clinical decision support in implementation research

- Recommendations
- Improve the processes and support for moving data and information systems from proof of concept to national implementation
- Provide constancy of purpose for QUERI database and systems development by coordinating QUERI and VHA national leadership priorities, identifying funding sources, and including informatics strategies in QUERI annual strategic plans
- Promote the demonstration of economic value in QUERI projects
- Develop a nucleus of information on the use of clinical decision support in implementation research

## Health Information Technology Development Strategies Working Group

- Funding
- HIT Development
- within VistA/CPRS
- outside of VistA/CPRS
- Clinical Buy-in
- Institutional Buy-in
- Technical Buy-in
- Usability Testing

- Bring a “QUERI voice” to OI, OQP, ONS and PCS regarding EHR implementation, iterative system evaluation and re-design
- Improve ways for new and experienced investigators to find each other i.e. communities of science
- Expand opportunities to connect
- Continued/expand collaboration between research and OI , OQP, ONS and PCS
- IDMC—QUERI/HSR&D
- Engage ESMs in QUERI/R&D
- Need to create a shared vision for EHR development
- Needs input from many stakeholders, including R&D
- Incorporate evaluation analytics in the evolution of CPRS/VISTA
- R&D working together with OI could offer methods/resources to do so
- R&D participation  in enterprise architecture development
- Expand opportunities for development of communities of science across services/institutions/organizations
- Open/clinical WIKI to enhance communication among specific communities; explore use of sharepoint
- Eg. CPRS redesign input
- Needs ways for developers to get feedback from users and vice versa
- Expand and promote training opportunities