Creating a Shared Quality Improvement Reporting System (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

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On September 8, 2008, Lisa Schilling, M.D., M.S.P.H., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.7 MB).

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Slide 1

Creating a Shared Quality Improvement Reporting System

Colorado Associated Community Health Information Exchange (CACHIE)

Lisa Schilling, MD, MSPH
AHRQ Annual Conference
September 8, 2008

Slide 2

CACHIE Participants

• 14 Colorado federally qualified community health centers.
• Colorado Community Managed Care Network.
• Colorado Community Health Network.
• Others.

Slide 3

Presentation Objectives

• Illustrate the use of business process analysis to inform user requirements.

Slide 4

CACHIE Goals

• To promote the use of information technology to support quality reporting and improvement across the community health centers (CHC) networks:
  • To design, build, & implement a shared system for quality reporting among 6 CHCs with 4 disparate Electronic Medical Record (EMR)/Payment Management System (PMS).
  • To assist CHC with EMR template implementation to improve care provision, documentation & measurement.

Slide 5

Data ←→ Information

Screen shot of a diagram which presents a centered, red cross ("Template") with arrows pointing to three ovals ("Provide Care," "Document Care," and "Measure Care"), and three large, blue arrows placed between the three ovals, pointing in a clockwise formation.

Slide 6

What is a business process?

Business process:
A "business process" describes a set of activities and tasks that logically group together to accomplish a goal or produce something of value for the benefit of the organization, stakeholder, or customer.

Slide 7

Why Use Business Process Analysis?

• Everything is not as it appears to be:
  • Unintended internal and external consequences.
  • It's not just a "flip of the switch".
  • Technology must complement workflow.
• Expectancy:
  • Exceeding capacities.
• Fashion:
  • Unnecessary complexity.
  • Remaining current.
• Stakeholder interest:
  • Varying levels over time.
  • Developing consensus.

Slide 8

Method

Business Process Analysis (BPA)

• Think: How do we do our work now?
  • Define goals and objectives.
  • Model context of work.
  • Identify business rules.
  • Describe tasks and workflows.
  • Identify common task sets.

Business Process Redesign

• Rethink: How should we do our work?
  • Examine tasks and workflows.
  • Identify inefficiencies.
  • Identify efficiencies with repeatable processes.
  • Refine business processes and rules.
  • Remodel the context of work.
  • Restructure the tasks and workflow.

Requirements Definition

• Describe: How an information system can support our work?
  • Define tasks to be performed for optimized business processes.
  • Describe the implementation of business rules.
  • Describe in words and graphics how an information system is to be structured.
  • Determine scope of next phase of activities.

Slide 9

BPA Example #1

Outcome: Provide a "fast food" customer with their order efficiently and receive payment.

Slide 10

Restaurant Order Fulfillment Process Context Diagram

Screen shot of a diagram showing the process of fulfilling a restaurant order.

• Customer
  • Order detail
  • Payment
• Order taker
  • Burger order
  • Fry order
  • Drink order
• Burger Station, Fry Station, Drink Station
  • Food and beverage inventory
  • Supplies: wrappers, oil, straws, cups
• Order taker
  • Burger
  • Fries
  • Drink
  • Reports, receipts
• Customer
  • Greeting
  • Amount Due
  • Change
  • Order

Legend:
Transaction: Thin black arrows
Outcome: Thick red arrows
Output: Orange font
Input: Blue font

Slide 11

CACHIE BPA Purpose

• Align the Information system (IS) with the organization's mission:
  • Need a clear model of the desired outcomes and the business processes that result in those outcomes.
• IS should support and enhance business processes.
• Creating a shared system required that we understand CHC business process similarities and differences.

Slide 12

CACHIE BPA Goals

• Develop a common definition of quality improvement reporting system.
• Describe and visually document how quality improvement efforts are accomplished.
• Describe how the quality improvement efforts will function with the quality IS.
• Develop a list of functional requirements to drive information system design and implementation.

Slide 13

On The Road

Screen shot of a map of Colorado which highlights Clinica, Sunrise, Mountain Family, Peak Vista, High Plains, and Valley Wide.

Slide 14

Screen shot of a sample flow chart showing the relationship between the clinic and CACHIE services.

Slide 15

BPA Example #2

Outcome: Improve the provision and documentation of guideline concordant care in primary care clinic.

Slide 16

Provide & Document Diabetes Mellitus (DM) Eye Care

• Goal: Provide DM pts guideline concordant care.
• Objective: Ensure DM pts receive eye exams.
• Business rules: Electronic referrals are not possible, referrals to both internal and external providers.
• Trigger: DM pt presents for care (other?).
• Task Set: Care for any acute needs, refer for DM care.
• Outcome: Provide & document DM eye care.

Slide 17

Providing and Documenting Guideline Concordant Care

Screen shot of a diagram showing the process of providing and documenting care.

• Diabetic Patient
• Provider
  • Document care
  • Enter eye referral
• EMR-Codified, text, scan
  • Referral to
• Internal Ophthalmologist, External Ophthalmologist
  • Ophth note
• Medical records
• EMR-Codified, text, scan
  • Retinal exam documented
  • Scan
  • Quality reports
• Provider
• Diabetic Patient

Legend:
Transaction: Thin black arrows
Outcome: Thick red arrows
Output: Orange font
Input: Blue font

Slide 18

BPA—other topics

• Lab ordering & results handling.
• Documentation of foot exams & self-management goals.
• Incorporation of new or modified guidelines into their patient care processes, into their EMR templates, into their quality reporting.
• Current methods of creating & using quality reports from EMR data, challenges and successes.

Slide 19

Screen shot of a complex diagram showing how to improve the process of care and documentation of guideline concordant diabetes care through quality improvement and feedback to provider in real-time (point of care).

Slide 20

What We Learned

Templates:

• Not uniformly available.
• Require costly professional support to develop/modify.
• Require lots of CHC staff time.
• When available, not always used.
• Not automatically linked with "forms" leading to double data entry.
• Desire for more & improved.

Slide 21

What We Learned (continued)

Quality Reporting

• Great variability among CHC capacity.
• Requires professional support ($$) to develop reports.
• Reporting limited by $$$.
• Reporting limited by system.
• Desire for data (re-)use.

Slide 22

What We Learned (continued)

Quality Reporting-2

• Analyze at provider, pod, clinic site, CHC level.
• Analyze discrete specified time periods.
• Track trends for individual patients.
• Provide pre-built reports (UDS, etc).
• Easily create reports for individual CHC needs.
• Save & share built reports.
• Run "huddle" reports based on scheduled patients.

Slide 23

Screen shot of a sample flow chart showing the relationship between the clinic and CACHIE services.

Slide 24

It Takes a Village...

CACHIE Steering Committee

• Ross Brooks, Director
• Molly Brown, Manager
• Art Davidson, Co-Medical Director
• Jason Greer, HIT Director
• Molly O'Fallon, Clinical Quality Director
• Lisa Schilling, Co-Medical Director
• Dan Tuteur, CCMCN Ex. Director

Health Information Technology (HIT) Committee

• David Adamson, Mountain Family HC
• Kitty Bailey, CCHN
• Andrew Bienstock, Salud Family HC
• David Fleurquin, Pueblo Community HC
• Pete Gutierrez, Denver Health, Committee Chair
• Annette Kowal, CCHN
• Pete Leibig, Clinica Family Health Services
• Konnie Martin, Valley-Wide Health Systems, Inc.
• Pam McManus, Peak Vista Community HC
• Mitzi Moran, Sunrise Community Health
• Paul Olson, Peak Vista Community HC
• John Santistevan, Salud Family HC
• Pat Tellez, Metro Community Provider Network

AHRQ

• Marybeth Farquhar

Slide 25

Contacts

CACHIE Project Manager
Ross Brooks ross@cchn.org

CACHIE Medical Directors
Lisa Schilling lisa.schilling@ucdenver.edu
Arthur Davidson art.davidson@dhha.org

Current as of January 2009

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Internet Citation:

Creating a Shared Quality Improvement Reporting System. 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/Schilling.htm

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