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

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).

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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

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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

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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.

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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

• 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

• 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

• 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

• 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.

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Findings: Facilitators and Barriers

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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.

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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?

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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