Providence Medical Group Uses USPSTF Recommendations in Five-State EHR System

Providence Medical Group (PMG), a physician organization owned and operated by the nonprofit health care delivery system Providence Health & Services of Renton, Washington, has incorporated several U.S. Preventive Services Task Force (USPSTF) recommendations into its homegrown software application, CareManager™, and its electronic health record (EHR) system. As a result, the majority of PMG's 3,000 physicians, located in five western States, are able to apply Task Force recommendations that are tailored to the needs of specific patients at the point of care.

More than 400,000 patients in Alaska, California, Montana, Oregon, and Washington benefit from their primary care physicians and certain specialists having instant access to USPSTF recommendations. Rather than taking its clinicians to the USPSTF Web site, PMG has incorporated Task Force recommendations into its EHR tools and disease registry application. As a result, PMG's system automatically applies USPSTF recommendations to individual patients. Based on age, sex, diagnosis, and other information in a patient's electronic medical record, PMG providers are automatically prompted by the EHR to recommend screening, counseling, or preventive medications based on a Task Force recommendation.

"The clinical decision support tools use EHR data to drive population dashboards and point-of-care tools that integrate with existing EHR workflows," says Ginger Pape, PharmD, BCPS, Quality Improvement Clinical Project Manager at PMG. "Driven by evidence-based guidelines, the tools prompt providers and staff with key decision support information for managing patients. The tools enable physicians and support staff to focus their efforts on meaningful patient care, rather than researching guidelines. It makes the office visit more efficient and helps providers be able to spend more time in shared decisionmaking with their patients."

In 2006, PMG first integrated USPSTF recommendations into its electronic disease management software program for Oregon providers and patients. "A decision was made by the design team to utilize the USPSTF recommendations as the foundation for building current and future preventive care topics," says Pape.

PMG's cancer screening module was initially designed and piloted with evidence-based recommendations from the USPSTF on screening for cervical and breast cancer. Pilot data from one PMG provider with a panel of approximately 1,000 female patients revealed an improvement in the cervical cancer screening rate, from 26% to 46% between 2006 and 2008. The osteoporosis module was designed and piloted in 2010 and colon cancer screening in 2013. Other Task Force recommendations have been added, including those concerning tobacco use and heart failure.

In 2011, Providence Health & Services made a strategic decision to purchase and transition to the Epic EMR, outfitting it to work across all five States that PMG operates in. Today, CareManager operates in conjunction with Epic EMR and is accessible by all PMG providers. The program is also capable of reporting performance percentages, population outreach, and point-of-service prompts for treatment opportunities.

"The CareManager registry and native EMR tools now work hand-in-hand to identify the relevant population, prompt the appropriate test at the appropriate interval, allow for automated population outreach, provide feedback to clinicians, and support reporting requirements, such as the Physician Quality Reporting System and Meaningful Use," says Pape.

PMG anticipates that additional USPSTF recommendations will be integrated into its EHR system by January 2014.

Pape concludes, "PMG's population health work requires having a firm foundation in the clinical evidence. And while evidence is often controversial, a recommendation must be made based on the currently available information. The USPSTF, with administrative and scientific support from AHRQ, has been a tremendous resource for this information by providing clear and concise scientific evidence reviews and recommendations."

To learn more about the USPSTF, visit http://www.uspreventiveservicestaskforce.org/index.html.