# Presentation: 710093

## Using HIT to Bring National Quality and Safety Initiatives to the Local Level 

- Fred Rachman, MD

## The “Team”

**Thomas N. Ricciardi, PhD**
- Manager, Clinical Data SerEvices
- GE Healthcare
**Karen Kmetik, PhD**
- Director, Clinical Performance Evaluation
- American Medical Association
**Erin T. O'Brien, MPH**
- Policy Analyst, Clinical Quality Improvement
- American Medical Association
**Andrew Hamilton**
- Nurse Informaticist
- Alliance of Chicago Community Health Services, LLC

## Alliance Overview

- Network of 4 Health Centers located on the Near North Side of Chicago
- Founded based upon long standing history of collaboration and close relationship among Medical Directors
- Health Centers target Latino, African American, Gay and Lesbian, and Immigrant and Homeless  populations
- Services encompass comprehensive Primary Care, Dental, Mental Health and Social Services, Health Education, and Research

## Combined Health Center Service Delivery System

- 22 service delivery sites *
- Users - >79,526; Encounters ->338,899
- Annual Budgets ->$50 million
- 580 total FTE across the network:
- 44 Physicians and Dentists
- 24 Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants
- Primary Care: Pediatrics, Internal Medicine, Family Practice, OB/Gyn   Psychiatry, Dentistry
- Specialists: Infectious Disease and Perinatology, Ophthalmology, Podiatry
- 109 FTE Medical Personnel Nursing, lab, etc.
- Of the 22 Alliance sites, 11 are medical, three are dental, one is medical and dental, four are mental health, two are nutritional, and one is social service.

## The Status Quo

- Overwhelmed practitioners seeing high volumes of patients with limited support
- Lack of coordination/communication among medical providers and between supportive services and disciplines
- Limited time for interactions
- Difficulty accessing information in timely/organized fashion either
- Labor intensity limiting population based data to inform system change

## Clinical Benefits of IT

- Increased access to information
- Facilitation of multidisciplinary care model
- Increased efficiency – reduction in duplication of efforts and resources
- Redirection of human effort from clerical to direct patient service activities
- Application of evidence based practice
- Access to more sophisticated data at individual and population basis

## Promise of Technology

*... **a growing recognition that a stronger information technology (IT) infrastructure is integral to addressing such national concerns as the need to improve the safety and quality of health care, rising health care costs, and matters of homeland security related to the health sector. The efforts of all parties—purchasers, regulators, providers, and vendors—to advance the deployment of EHR systems, would benefit from a common set of expectations about EHR capabilities.*

## Primary and Secondary Uses of an Electronic Health Record System

**Primary Uses**
- Patient Care Delivery
- Patient Care    Management
- Patient Care Support         Processes
- Financial and Other Administrative Processes
- Patient Self-Management

**Secondary Uses**
- Education
- Regulation
- Research
- Public Health and       Homeland Security
- Policy Support

## Capabilities of Electronic Record Systems - basic

- Entails more efficient use of space and personnel in storage and retrieval
- Improves quality of data – legible, consistent
- Facilitates compliance with privacy and security  legislation
- Provides more immediate access to information
- Promotes communication of information by providing more ready  access to information by multiple members of care team
- Reduces duplication of effort in recording or provision of information
- Makes patient medical information and educational materials more accessible.

## Quality impact of basic EHRS function on care

- Reduced duplication of tests due to availability of results
- More timely patient response due to more immediate access to information
- Care coordination improved by more immediate access by various disciplines to relevant information
- Staff time for direct patient care increased due to facilitation of paperwork (e.g.forms/requisitions/prescriptions)

## Capabilities of Electronic Record Systems - advanced

- Provides care “decision support”
- Promotes use of effective/evidence based interventions
-  improves safety /reduces medication errors
- Facilitates more organized and timely delivery of care by flagging needed interventions at time of patient contact.
-  Provides longitudinal and aggregate data for:
-  evaluation of interventions and outcomes
- Supporting quality improvement efforts
- Identify priorities
- Monitor results
- Provide feedback to health care staff
- Collects population level data to identify disparities/trends in health status for research and advocacy
- Potential for increased patient access/involvement

## Capabilities of Electronic Record Systems - advanced

- Provides care “decision support”
- Promotes use of effective/evidence based interventions
-  improves safety /reduces medication errors
- Facilitates more organized and timely delivery of care by flagging needed interventions at time of patient contact.
-  Provides longitudinal and aggregate data for:
-  evaluation of interventions and outcomes
- Supporting quality improvement efforts
- Identify priorities
- Monitor results
- Provide feedback to health care staff
- Collects population level data to identify disparities/trends in health status for research and advocacy
- Potential for increased patient access/involvement

## Decision support

- passive (ability for practitioners to consult references if and when they desire)
- active (prompts, decision trees or required entries/actions driving clinician behavior at key points in care linked to order entry)
- most proprietary ambulatory EMR systems are more passive in the decision support they provide, and many implementations do not include computerization of order entry

## Requirements for Active Decision Support

- Adoption of evidence based protocols
- Ability to capture and process relevant data
- Relevant care elements are captured as structured information
- Implies that “order entry” is computerized
- Data is “clean” and consistent

## EQUIP Partnership

- American Medical Association
- Health Information Management Systems Society
- GE Healthcare Clinical Data Services
- First Consulting Group

## EQUIP project goals

- 1**.  **Implement EHRS in a network of Community Health Centers in a manner that ensures consistency and accuracy of health information across all practitioners, sites and populations.
- 2. Develop a data warehouse that will monitor, aggregate, and provide data to be used for clinical and system quality improvement.
- 3. Utilize the EHRS/data warehouse to facilitate and encourage the use of evidence-based practice measures at the point of care.

## EQUIP project goals

- 4. Utilize the EHRS/data warehouse to facilitate continuous improvement of health care quality and safety and develop its function as a patient registry.
- 5. Promote and support the realization of the full potential of EHRS use in ambulatory care settings, particularly among safety net providers, to improve health care quality and safety**.**