The BLUES Project (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

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On September 8, 2008, Karen C. Fox, Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (550 KB).

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Slide 1

The BLUES Project

Karen C. Fox, Ph.D.
Chief Executive Officer

Slide 2

BLUES Overview

• Better Life Utilizing Electronic Systems.
• Purpose.
• Demonstrate the effects of diabetes management practices.
• Ambulatory clinics in rural and urban settings.
• Utilizing well-designed, comprehensive health information technology.

Slide 3

The bar chart shows by respondent categories, the percent of respondents identifying a particular issue as being a major factor driving the need for an Electronic Health Record (EHR).

Slide 4

The Current State of EHR Implementation in the U.S.

• Significant increase over last year:
  • In solo and small practices motivated to implement EHRs.
• Increase in the use of almost all data capture methods:
  • Especially structured data entry.
• High level of implementation plans for e-prescribing, remote access to EHRs, and order entry placed by nurses or staff.
• http://www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

Slide 5

The BLUES Target Service Area

The drawn map shows the counties of Mississippi with a number of the western counties highlighted in blue and yellow.

Slide 6

BLUES Overview

Research Aims:

• Successfully implement EHRs in diabetes management clinics, focusing on integration of the EHR into clinician workflows.
• Evaluate the impact of the EHR system on clinical processes of care and patient outcomes.
• Produce and distribute a generalizable, replicable model of care for implementing an integrated health IT system for diabetes management care throughout the U.S.

Slide 7

BLUES Overview (continued)

Hypotheses:

• Provider use of an EHR system will increase.
• Patient use of EHR will increase.
• Adding an EHR system to an existing model will significantly improve medication management.
• Adding an EHR will also improve other process-of-care measures.
• Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

Slide 8

Understanding Data: Road Maps to Successful Outcomes

The slide shows an image of a winding road.

Slide 9

BLUES Overview (continued)

• Create Systems:
  • Collect Baseline.
  • Track Outcomes.
• Implement Systems.
• Collect Data:
  • Evaluate Processes.
  • Evaluate Outcomes.

Slide 10

CREATE

• EHR Analytic Modules.
• Where to look for data.
• Chart reviews.
• Creating harmony within the existing system and new system.
• Tracking mechanisms.

Slide 11

Implement

Slide 12

Challenges to EHR Implementation

Clinic infrastructure:

• Network Infrastructure in Rural Communities.
• Current workflow and staff.
• Lack of patient management systems.

Staff concerns:

• Training and installation.
• Single physician clinics.
• Clinician Acceptance/Buy-In.

Slide 13

EHR: Electronic Healthcare Record

• Privacy and Security:
  • Health Insurance Portability and Accountability Act (HIPAA) Compliance.
• Limited capability of IT Host Facility:
  • Unreliable data center infrastructure.
  • Need to build redundance.
  • Servers and networking support.
• Infrastructure support by health care facilities (single physicians, etc.).

Slide 14

Challenges to EHR Implementation (continued)

• Loss of Network Service Provider.
• Reliable Health Technology Equipment Operators at Remote Locations.
• Key Personnel Changes.
• Changes in Clinic Location.

Slide 15

Challenges to EHR Implementation (continued)

• Equipment Maintenance in Remote Locations.
• Availability of Qualified Staff.
• Data Acquisition:
  • Provider responsibility for maintenance.
  • Access by DHA and external evaluators.

Slide 16

Collect

Slide 17

Data Issues

• Data Collection Methodology:
  • Assessment of longitudinal change.
  • Collection time.
• Reporting the data.

Slide 18

Data Challenges

• Disparate practice management systems:
  • Workflow management.
  • Data elements captured.
• EHR design modifications:
  • Required for unique measures.
• Access to external data:
  • Medicaid.
  • Evaluating cost/benefit outcomes.

Slide 19

Tracking Outcomes

Provider use of an EHR system will increase.

• Measure: % of visits where EHR was used:
  • Information captured by the EHRs.
• Measure: Use of quality measurement reports:
  • Information not captured because Analytics Module was not purchased:
    • Overcame barrier by establishing audit trail.

Slide 20

Tracking Outcomes (continued)

Patient use of EHR will increase.

• Measure: % of patients who access their personal health information, including medication therapy:
  • Cannot capture data because the Interactive Module was not purchased.
  • Must develop new measure to capture impact on patients.

Slide 21

Tracking Outcomes (continued)

Adding an EHR system to an existing model will significantly improve medication management.

• Measure: Formulary compliance—% of prescriptions complying with formulary:
  • Captured by EHR Analytics Module.
• Measure: Patient Compliance with medication:
  • Determined by EHR—# filled/#prescribed.

Slide 22

Tracking Outcomes (continued)

Adding an EHR will also improve other process-of-care measures.

• Measure: % of patients receiving appropriate care for treatment:
  • Captured by EHR Analytics Module.
  • Is determined by nationally recognized medical standards of care—American Diabetes Association.

Slide 23

Tracking Outcomes (continued)

Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

• Measure: Patient Satisfaction improved.
  • Determined by primary data collection.
• Measure: Diabetes outcomes.
  • Lipid profiles, blood pressure (BP), A1c, etc. all captured by EHR as specifically designed for the clinics.

Slide 24

Lessons Learned

Slide 25

Lessons Learned

• Network/Internet speed and capacity is critical.
  • WAN Optimizers.
• Providers may resist financial commitment of any amount.
• IT vendor territory issues.
• Local business loyalty in small communities.

Slide 26

Lessons Learned (continued)

• Have clinic personnel on your planning and evaluation committees.
• Be flexible with training staff.
• Design and modify current systems.
• Have contingency plans.

Slide 27

• When you have all of this, you impact clinic and community success!
• Successful EHR Implementation Plus Better Patient Outcomes Equals Healthy Community.

Slide 28

Logic Model

• Inputs:
  • Existing medical structure.
  • Traditional clinic system.
  • Traditional hospital structure.
  • Information infrastructure.
  • Networks and Servers.
• Activities:
  • Cooperation and collaboration.
  • EHR implementation.
  • System training.
  • Data collection and reporting.
• Outputs:
  • Expanded services and access.
  • Patient and provider satisfaction.
  • Improved workflow.
  • Provider enrollment.
• Outcomes:
  • Patient Health Outcomes.
  • Reduced Cost of Care.
  • Increased medical homes.
  • Increased productivity.
  • Improvement in ratio of clinicians to population.
• Impact:
  • Reduced health care costs for providers and patients
  • Improved chronic disease outcomes.

Slide 29

Delta Health Alliance Icon and Motto: Today. Tomorrow. Together

Current as of January 2009

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Internet Citation:

The BLUES Project. Slide Presentation from the AHRQ 2008 Annual Conference (Text Version). January 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualmtg08/090808slides/Fox.htm

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