The Primary Care Information Project

On September 15, 2009, Sarah Shih, MPH made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (2 MB) (Plugin Software Help).

Slide 1

The Primary Care Information Project

Sarah Shih, MPH
Exec. Dir. Healthcare Quality Information
New York City
Department of Health and Mental Hygiene
sshih@health.nyc.gov
www.nyc.gov/pcip

Slide 2

NYC's Health Agenda
Take Care New York

1. Have a Regular Doctor or Other Health Care Provider
2. Be Tobacco-Free
3. Keep Your Heart Healthy
4. Know Your HIV Status
5. Get Help for Depression
6. Live Free of Dependence on Alcohol and Drugs
7. Get Checked for Cancer
8. Get the Immunizations You Need
9. Make Your Home Safe and Healthy
10. Have a Healthy Baby

Slide 3

Health Care that Maximizes Health

• Health Information Systems that are oriented toward prevention
• Redesigned Practice Workflows Patient Engagement that highlights prevention
• Payment that rewards disease prevention and the effective management of chronic disease

Slide 4

Focused on Medically Underserved Patients in NYC

We have secured signed commitments from 2,100 providers in 379 practices and at 480 sites

~ 1 new provider goes live on the EHR every day

*Practice with sites both live and in implementation
 

Slide 5

BRINGING THE RESOURCES OF LARGE NETWORKS TO INDEPENDENT SMALL PRACTICES - A "VIRTUAL NETWORK"

Kaiser Permanente > NYC PCIP

Slide 6

PCIP, eCW & Practice team structure

Slide 7

8 Key Features of the TCNY Build

1. Measure Reports
   Side-byb-side provider comparisons of performance on quality measures
2. Enhanced Registry
   Identifies patients by structured data (e.g., diagnoses, drugs, labs, demographics)
3. Automatic Visual Alerts
   Highlights abnormal vitals
4. CDSS
   Automatically displays preventive service alerts that are suppressed when addressed
5. Quick Orders
   One-click ordering of recommended preventive services
6. Comprehensive Order Sets
   Displays best practice recommendations (e.g., for meds, labs, patient education)
7. eMedNY
   With patient consent, displays 90-day history of all Rxs filled by Medicaid patients
8. CIR School and Health
   Sends information to City Immunization Registry and generates school health forms

Slide 8

Small Practice Consulting Approach

Client-Facing Teams are phased in, as appropriate
 

Slide 9

Following Medical Home and Chronic Care Models

Useful framework for organizing QI work

• Actionable curriculum consisting of a collection of discrete activities and achievable goals
• Focus on "whole-practice" redesign (e.g. teamlet care - C. Sinsky)
• Provide actionable and meaningful feedback
• View EHR-derived quality measure data on a routine basis
• Provides incremental recognition

"BOOTS ON THE GROUND"

• Assist practices through the process and lower the "activation energy"
  
  • Software, QI, EMR consulting, Pay for Performance, relationships
    
  • Partnership with NCQA- multi-site survey
    
• Keep practices focused on care & and reduce administrative burdens
  
  • Average physician spends $68,274 per year interacting with insurance plans*
    
• Focus practices on areas to have the highest impact for health
• Provide share resources to practices (care coordinators, nurses, panel managers)
• Conduct patient outreach using the data from EHR

*J. A. Sakowski, J. G. Kahn, R. G. Kronick et al., "Peering into the Black Box: Billing and Insurance Activities in a Medical Group," Health Affairs Web Exclusive, May 14, 2009, w544-w554
 

Slide 10

How do we know whether providers are meaningfully using the EHR?

• PCIP staff
  • Scheduled on-site visits
  • Demo of registry query functions
• Data Transmissions from EHR
  • Encounter information from PM
  • Utilization of EHR metrics
  • Quality Measures (EoC)

Slide 11

Average Encounters Per Month by Practice Size*

Bar graph depicting average encounters per month up to three providers.

*Limited to small practices that have been on the EHR for 6 months or more.
Data available on ~116 small practices
 

Slide 12

PCIP Contractual Expectations with Providers
Selected Measures for Demonstrating Use of EHR

1. Visits where office visit CPT codes were entered into the progress note.
2. Visits where an order set was used as part of the progress note.
3. Visits where a smart form was used as part of the progress note.
4. Visits where blood pressure was entered into the progress note.
5. Visits where allergy data was entered in a structured format
6. Insurance claims created over total number of insurances for patients that month
7. Visits where medications were prescribed through the EHR
8. Prescriptions entered into the EHR that were sent via fax or electronic interface
9. Labs reviewed over labs ordered
10. Current medications were entered or verified in the EHR
11. Months in a 6 month period when required data files were transmitted to the DOHMH
12. Months in a 6 month period when all core utilization measures were reported to the DOHMH

Slide 13

Proposed Meaningful Use Measures Overlapping with Data Transmitted to PCIP

Slide 14

EHR Utilization Transmitted to PCIP

• Snapshot of monthly activities
• Number of practices with EHR use data
  • 133 practices in July and August 2009
  • 85 have been using EHR for 8 months or longer

*limited to practices on the EHR for 8 months or longer

Slide 15

Proposed Meaningful Use Measures Currently within PCIP Quality Measures

Note: Quality Measures are collected at the provider level and stratified by insurance type. For some practices, stratified by race/ethnicity, though few providers are completing the field for race/ethnicity
 

Slide 16

Preliminary Data - Quality Measures

*A population estimate was derived by summing across practice denominators per measure

Slide 17

Questions?

Contact: sshih@health.nyc.gov

Visit: www.nyc.gov/pcip