Using your EHR to Facilitate Effective Patient Population Management Real World Strategies Jen Brull, MD Family Physician Plainville, KS
Objectives Utilize both population health and patient-specific tools in the electronic health record (EHR) to identify appropriate patients for colorectal cancer screening. Develop work flows for both outreach and point-of-care reminders to increase colorectal cancer screening rates around identified patients. Institute a colorectal cancer screening quality improvement project at the practice site. Translate lessons learned in colorectal cancer screening to other areas of focus (e.g., blood pressure control in patients with hypertension).
1: the WHY
ACO Triple Aim Improving the patient experience of care (including quality and satisfaction) Improving the health of populations Reducing the per capita cost of health care
QI: Why Not? Time (not budgeted, not consistent) Inclination (lack of motivated champion, no staff buy-in) Poor communication EHR challenges (implementation, adoption) Money (insufficient for project, cash flow) Rewards not great enough to motivate change
QI: Why? Improve patient health. Reduce adverse events/improve safety. Appropriately screen/use preventive health services. Consistently manage chronic disease/use evidence-based guidelines. Make doing the right thing easy. Improve processes and work flow. Put information in easy-to-reach locations. Communicate seamlessly/asynchronously. Eliminate duplicate work/data entry. If you measure it, you will improve it!
2: the WHAT
QI (Quality Improvement) BMJ 2007: combined and unceasing efforts of everyone healthcare professionals, patients and their families, researchers, payers, planners and educators to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning) Healthcare will not realize its full potential unless change making becomes an intrinsic part of everyone s job, every day, in all parts of the system. (Batalden and Davidoff) Although all improvement involves change, not all changes are improvement.
Successful QI Paradigm Shift: process mapping from current process to future vision FULL staff participation Continual Learning: frequent revisions based on shared successes Informal PDSA cycles learn on the fly Structured time for meetings learn from each other
3: the HOW
Team Composition Champion/Lead physician/provider administrator Important Staff nurse/ma scheduler receptionist biller Administrator/Secretary Patients!
Population Health QI Tools Clinical Quality Measure (CQM) Reports EHR based reporting; required for Meaningful Use (MU) and Physician Quality Reporting System (PQRS) Availability may be limited depending on EHR vendor Registries (internal or external) Clinical data repository designed for tracking both preventive and chronic disease measures Frequently used for reporting purposes
Population Health QI Tools Generate lists of patients missing chronic or preventive services Outreach via portal, phone, mailing Goal is eliminating gaps in care
Patient-Specific QI Tools EHR-based point of care reminders Occur during clinical encounters May increase alert fatigue External Registry point of care tools Coalesce data across multiple chart locations Increase cost of care/system
QI Work Flow Incremental change: try one idea at a time Diverse input: ask everyone involved Don t fear: toss out ideas that didn t work Build on success: think about next steps
4: the WHY again
5: the WHAT S NEXT
Taking it home Start small. All it takes is one person in a leadership role with desire to start the process. Pick something easy. Don t try to change the world, just look at one measure that you have access to the data and are interested in changing. Be consistent. Make a commitment you can keep to doing QI in your setting. Keep going! Even if your efforts don t seem to be making a difference initially, pick another small change and keep moving forward.
Jen Brull, MD mrsbrull@gmail.com www.facebook.com/mrsbrull www.twitter.com/mrsbrull www.linkedin.com/in/mrsbrull Prairie Star Family Practice 1210 N Washington, Suite B Plainville, KS 67663