Rheumatoid Arthritis Learning Collaborative. Transforming data into Insight

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1 1 Add your company logo here Rheumatoid Arthritis Learning Collaborative Sponsored by AMGF and AbbVie August 13 15, 2014 Virginia Mason Medical Center Transforming data into Insight

2 2 Go to view/master/slide Master and Insert your company logo here Medical Group Profile Virginia Mason is a nonprofit organization, which started in 1920 (rheumatology clinic began in 1964) offering a system of integrated health services including the following: A large multispecialty group practice of 460 physicians, offering both primary and specialty care An acute care hospital licensed for 336 beds Benaroya Research Institute at Virginia Mason A network of medical centers throughout the region Bailey Boushay House, a nursing residence and chronic care management center for people living with AIDS and other chronic or terminal illnesses How many sites does our rheumatology practice serve? 5 clinic locations How many providers are in your practice? 7 rheumatologists, 1 Allied Health professional (6 FTEs) VM offers 16 specialties Our outpatient visits per year totals 14,924 (2013) Our electronic health record is: Cerner We are a tertiary hospital which treats patients from around the region including AK, NV, MT and ID

3 3 Team Composition 8 Providers total 1:1 Medical Assistant (MA) supports one Provider MA enters the MDHAQ data into Cerner 3 4 Providers in clinic each day (8 exam rooms) 3 Clinic Service Representatives (CSRs) answer ~80 calls per day, resolve ~25 50 patient questions per day complete ~10 20 prior authorization requests per day. 1 Manager 1RN 2 Research Associates as needed

4 4 RA Goals & Objectives Our mission aligns with our organization s which is to transform healthcare. Our goal is to increase quality and provide a cost effective treatment for rheumatoid arthritis. We aim to utilize existing technology and information to produce outcomes measures and improve quality and patient safety.

5 5 RA Intervention & Population Baseline All RA patients; new and established Over 18 years of age, male and female Dx codes In 2013 we implemented use of a PowerForm in Cerner to capture the MDHAQ scores in the electronic health record at every visit. We have a registry of RA patients already created through our partners at the Benaroya Research Institute but didn t set one up for this purpose. Basic flow: patient is given MDHAQ form at front desk, they complete it and hand it to medical assistant who calculates the score and enters it into Cerner We started this intervention in 2/14/13 so we have over a years worth of HAQ scores captured in Cerner. Additionally, we had a doctoral student of nursing practice data mine ~300 RA patient records looking for % of patients whose Rapid 3 score improved at 3 and 6 months post start of a DMARD. She will report her findings to the group on 9/5/14.

6 Improvement Interventions 6

7 7 Measures Used We used the MDHAQ on ACR website and as presented to us by Dr. Ted Pincus in fall of We worked with our IT to pull data points from Cerner There were 1666 RA patients from June 2013 and June /1666 or 99% of these patients had provided information used to calculate a HAQ Function Score and Rapid 3 score (PQRS # 178, PQRS # 177). We are working on pulling the % RA patients on DMARDs

8 8 Challenges or Obstacles VM Policy requires that new technology must be hosted on VM domain IT has had conflicting demands in the past Vendors can be expensive We would like to collect the disease activity scores (DAS) but there is no way to complete the tender/swollen joint count using Cerner. We are exploring dynamic documentation systems.

9 9 Outcomes and Successes We are proud to have been collecting the HAQ scores in our EHR for over a year because this data serves as our foundation for outcomes reporting. Use of VMPS/change management tools to increase the urgency and make change stick are reasons why entering the HAQ scores became routine. Our IT team & organization are aligned with the rheumatology section and have been supportive of our goals.

10 10 Future Steps Continue to meet weekly with IT team Mine the data and obtain the # of patients on DMARDs and Biologics by provider by end of September Mine the data and build dashboard that correlates HAQ scores with medication use by end of October IT will meet with vendors on 9/3 to determine whether or not we can gather HAQ scores via kiosk or electronic portal (although we are concerned that compliance rates may drop if patients are reporting on their own). Share data with providers/team and staff and determine gaps Learn from analytics team how to transform clinical data into insights Use VMPS to spread change and integrate tools into daily clinic flow

11 11 Lessons Learned Timing is everything Persistence is rewarded Steal shamelessly

12 12 Questions 1. Are any other rheumatology practices here considered a Center of Excellence 2. How do you plan to use outcomes data and will you involve your patients in future plans to gather or share data?