Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs?

Slide presentation from the AHRQ 2010 conference.

On September 28, 2010, Marilyn Moon made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (206 KB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs?

Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs?

AHRQ Annual Conference
September 28, 2010

Marilyn Moon
American Institutes for Research

Slide 2

Acknowledgement of team members and funders

Acknowledgement of team members & funders

  • Project team:
    • AIR: Kristin Carman (Project Director), Marilyn Moon (Senior Advisor), Callan Blough, Lauren Smeeding
    • Urban Institute: Kelly Devers
    • Geisinger Health System: Walter Stewart, Eric Newman, Virginia Lerch
  • Michael Harrison, Project Officer, AHRQ
  • Funding: Agency for Healthcare Research and Quality, ACTION Network, #290200600019, Task Order #2 Contract

Slide 3

Project Overview

Project overview

  • Timeline: August 2007—October 2010
  • Objectives:
    • Aim 1: Develop, refine, and implement PACER-Rheum.
    • Aim 2: Evaluate whether PACER-Rheum improves efficiency, productivity, quality and safety, adherence, and patient-centeredness.
    • Aim 3: Determine which elements explain the observed effects.
    • Aim 4: Disseminate findings.

Slide 4

What is PACER-Rheum?

What is PACER-Rheum?

  • PACER-Rheum is an HIT tool that...
    • Begins with a touch screen questionnaire to collect patient reported data.
    • Pulls data from EHR.
    • Presents trend data in tabular dashboard format.
    • Includes an After Visit Summary.
    • Redesign of office workflow.
    • Was designed by outside firm in conjunction with GHS research staff.
    • Web application that exists outside of EHR.

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Methods: data collection

Methods: data collection

  • Quantitative data to assess outcomes at the physician, encounter, and patient level:
    • From EHR, patient surveys, and workflow collected manually.
  • Qualitative data to describe and monitor implementation in real time at the system and practice level:
    • Assess factors and conditions necessary for successful implementation in different settings.
    • Detailed guidelines for implementation and decision-making.
    • Digital diaries, telephone interviews, site visits.

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Efficiency and Quality Issues

Efficiency and Quality Issues

  • Information Collection:
    • EHR vs. Patient Reported and EHR
  • Information Assembly:
    • Mental dashboard vs. screen dashboard
  • Information review:
    • Sorting through papers vs. trends over time
  • Provider documentation

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Findings: Early implementation

Findings: Early Implementation

  • GHS culture encourages and fosters clinical innovation.
  • Many revisions and updates necessary.
  • Clinic staff expected increase in quality of care and efficiency, but impact unclear.
  • Patients had mixed reactions to PACER-Rheum.
  • Physicians noted need to change documentation note in PACER-Rheum.

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Findings: Post-implementation

Findings: Post-Implementation

  • Staff are more comfortable with use of PACER-Rheum, but efficiency burdens are shifting.
  • Conversations with patients are changing.
  • Patients still have mixed reactions to PACER-Rheum.
  • Documentation still needs to be improved.
  • Long learning curve.

Slide 9

Findings: Facilitators and Barriers

Findings: Facilitators and Barriers

FacilitatorsBarriers
Supportive culture / environmentConservative IT environment
Resources to support innovation and technologyPhysical layout
Physician championPatient resistance to technology
Alignment of incentives 
Familiarity with EPIC 

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Findings: Lessons Learned

Findings: Lessons Learned

  • IT/IS culture and priorities can be a major hindrance to innovation and research.
  • Getting clinicians and office staff on board is major task.
  • Key features of PACER-Rheum are database interaction and combining data into one screen.
  • PACER-Rheum may not be applicable for all patients.
  • Questions about transferability of PACER-Rheum to external organizations.

Slide 11

Discussion Questions

Discussion questions

  • Has enough time passed to realize all benefits?
  • Are there tradeoffs between efficiency and quality?
  • What are the implications from burden shifts?
    • On patients?
    • On support staff and nurses?
    • Away from physicians?
  • What are the policy implications for use of EHRs?

Slide 12

Resources

Resources

Key contacts:

Kristin L. Carman, PhD
Managing Director, Health Policy & Research
American Institutes for Research
1000 Thomas Jefferson St., NW
Washington, DC 20007
Phone: 202-403-5090
E-mail: kcarman@air.org

Marilyn Moon, PhD
Vice President, Health Program
American Institutes for Research
10720 Columbia Pike
Silver Spring, MD 20901
Phone: 301-592-2101
E-mail: mmoon@air.org
www.air.org

Current as of December 2010
Internet Citation: Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs?. December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/moon/index.html