Health IT Success Stories (Text Version)

Slide presentation from the AHRQ 2010 conference.

On September 29, 2010, Rebecca Roper made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (5.8 MB). Free PowerPoint® Viewer (Plugin Software Help).


Slide 1

Slide 1. Health IT Success Stories

Health IT [Information Technology] Success Stories

AHRQ Conference

September 29, 2010
Rebecca Roper

Slide 2

Slide 2. Success Stories

Success Stories

  • Easy-to-understand summaries of research project and its momentum to go forward:
    • Enable Layman's understanding of who and how health IT implementation was beneficial.
    • Illustrations.
    • Demonstrated, significant improvement in outcome(s).
    • Resiliency, Adaptability, Sustainability, Transferability of intervention, etc.
    • Quotes from different perspectives.
  • Plus, succinct, substantive ~2-page detail discussion.

Slide 3

Slide 3. Two Reports

Two Reports:

Slide 4

Slide 4. Transforming Healthcare Quality through Health IT (THQIT)

Transforming Healthcare Quality through Health IT (THQIT):

  • 118 Individual Projects

Image: An admission ticket with a power cord and plug extending from it is shown.

Slide 5

Slide 5. Transforming Healthcare Quality through Health IT (THQIT): September 2004-January 2010

Transforming Healthcare Quality through Health IT (THQIT): September 2004—January 2010

  • 40 Cooperative Agreements, THQIT Implementation I (HS-04-011)
    • $ 53.6 Million from AHRQ, plus in-kind support
    • 24 No-cost extensions
  • 24 R-01 THQIT Value Grants (HS-04-012)
    • $ 33.0 Million from AHRQ
    • 22 No-cost extensions
  • 38 P-20 THQIT Planning Grants (HS-04-010)
    • $ 7.1 Million from AHRQ
    • 15 No-cost extensions
  • 16 Cooperative Agreements, THQIT Implementation II (HS-05-013)
    • $ 22.5 Million from AHRQ, plus in-kind support
    • 14 No-cost extensions

Slide 6

Slide 6. Quality Improvement

Quality Improvement

Slide 7

Slide 7. THQIT Implementation

THQIT Implementation

  • EMS Responders Use Health IT to Improve Cardiac Care.
  • Nursing home Health IT Reduces Pressure Ulcers and Increases Staff's Job Satisfaction.
  • Project Echo: Extension for community Healthcare Outcomes Through Telemedicine.
  • Network of Rural Hospitals in Iowa Redesign Patient Care Workflow to Use EHR.

Slide 8

Slide 8. EMS Responders Use Health IT to Improve Cardiac Care

EMS Responders Use Health IT to Improve Cardiac Care

The Problem:

  • Many heart attack patients do not receive needed treatment in the recommended timeframe.

The Health IT Contribution:

  • Clinical Decision Support Software:
    • Helped paramedics quickly determine proper treatment.
  • Web-Based Quality Reporting System:
    • Combined data from the pre-hospital and hospital experience.
    • Data was used to tailor quality improvement programs.

Project Director: Dr. Harry Selker Project Location: Massachusetts
AHRQ Grant: UC1 HS015124

Slide 9

Slide 9. EMS Responders Use Health IT to Improve Cardiac Care

EMS Responders Use Health IT to Improve Cardiac Care

Results:

  • 150% increase in the number of patients receiving treatment in less than 90 minutes.
  • Improved quality of care provided by paramedics.

Sustainability/Transferability:

  • Technology was used in new communities and to address other conditions.
  • The system was integrated with other health IT.

Image: Bar graph shows Baseline 27%; With enhanced health IT 67%.

Slide 10

Nursing Home Health IT

Nursing Home Health IT

The Problem:

  • Pressure ulcers are a prevalent and preventable condition for nursing home residents.

The Health IT Contribution:

  • Electronic documentation
    • Part of larger On-Time quality improvement program.
    • Documented residents' behavior, weight, and skin integrity.
    • Produced reports to help identify residents at high-risk of pressure ulcer development.

Project Director: Dr. Susan Horn
Project Location: Multi-state
AHRQ Grant: UC1 HS 015350
http://healthit.ahrq.gov/ahrq-funded-projects/nursing-home-information-technology-it-optimal-medication-and-care-delivery

Slide 11

Slide 11. Nursing Home Health IT

Nursing Home Health IT

Results:

  • Decreased percent of residents with high-risk pressure ulcers.
  • Improved job satisfaction.

Sustainability/Transferability:

  • 67 additional facilities have implemented or are starting to implement the technology.
  • On-Time Manual being created.

On-Time emphasizes communication, you know the residents are better cared for; families are happy.
~ Quote from a staff member

[At the beginning of the project] we had to practically beg [health IT] vendors to incorporate the set of On-Time reports into their system. Since then there has been a growing recognition that the value of health IT comes from impacting clinical decision making, not just automating the paper documentation process, and On-Time reports can add value to a vendor's system.
~ Quote from Principal Investigator

Slide 12

Nursing Home Health IT

Slide 13

Slide 13. Telemedicine Connects Rural Residents to Specialty Care

Telemedicine Connects Rural Residents to Specialty Care

The Problem:

  • Rural residents often have problems accessing specialty care for complex conditions.

The Health IT Contribution:

  • Project ECHO: Extension for Community Healthcare Outcomes through Telemedicine:
    • Enabled patients to be treated long-distance.
    • Provided a platform for rural providers to hone their clinical skills.

Project Director: Dr. Arora Sanjeev
Project Location: New Mexico
AHRQ Grant: UC1 HS 015135

http://healthit.ahrq.gov/ahrq-funded-projects/project-echo-extension-community-healthcare-outcomes

Slide 14

Slide 14. Telemedicine Connects Rural Residents to Specialty Care

Telemedicine Connects Rural Residents to Specialty Care

Results:

  • Improved access to care for 4,000 patients with hepatitis C.

Sustainability/Transferability:

  • Expanded program to other conditions.
  • Project selected as winner in search for Disruptive Innovations in Healthcare-New Models.

We're developing our knowledge networks so that every doctor can provide best practice care without being an expert in all chronic diseases.
~ Quote from Principal Investigator.

Slide 15

Slide 15. Telemedicine Connects Rural Residents to Specialty Care

Telemedicine Connects Rural Residents to Specialty Care

Original Focus: Hepatitis C21
Expanded to these Conditions and Facilities
Asthma/Pulmonary16
Child, Adolescent, and Family Psychiatry32
Child, Adolescent Psychology14
Chronic Pain/Headache9
Diabetes/Cardiovascular Risk Reduction19
High-Risk Pregnancy21
HIV/AIDS17
Integrated Addiction/Psychiatry14
Medical Ethics7
Occupational Medicine5
Pediatric Obesity43
Psychotherapy4
Rheumatology11

Notes: Results: The rate at which patients were cured of hepatitis C was the same for those treated through the project as those treated at the hepatitis C clinic at the University of New Mexico.

Sustainability: In June 2007 the project was selected by Changemakers in partnership with RWJF as a winner of their international search for Disruptive Innovations in Healthcare—New Models, and work is underway to bring the model to the University of Washington, University of Chicago, and several universities in India.

Slide 16

Slide 16. Telemedicine Connects Rural Residents to Specialty Care

Telemedicine Connects Rural Residents to Specialty Care

Original Focus: Hepatitis C21
Expanded to these Conditions and Facilities
Asthma/Pulmonary16
Child, Adolescent, and Family Psychiatry32
Child, Adolescent Psychology14
Chronic Pain/Headache9
Diabetes/Cardiovascular Risk Reduction19
High-Risk Pregnancy21
HIV/AIDS17
Integrated Addiction/Psychiatry14
Medical Ethics7
Occupational Medicine5
Pediatric Obesity43
Psychotherapy4
Rheumatology11

Facility Count = 233.

Slide 17

Slide 17. Enhancing Use of EHR Functions to Improve Quality of Care

Enhancing Use of EHR Functions to Improve Quality of Care

The Problem:

  • If EHR functions are not used effectively, preventable quality and safety issues may persist.

The Health IT Contribution:

  • Enhance use of EHR functions, examples:
    • 54 clinical decision support rules were added to the system.
    • Pharmacists from the rural referral center use the EHR to remotely check medication dosing and drug alerts at critical access hospitals.
    • Nursing documentation functionality added.
    • Electronic ordering of tests and medications added.

Project Director: Dr. Donald Crandall
Project Location: Iowa
AHRQ Grant: UC1 HS 015196 

http://healthit.ahrq.gov/ahrq-funded-projects/rural-iowa-redesign-care-delivery-ehr-functions

Slide 18

Slide 18. Enhancing Use of EHR Functions to Improve Quality of Care

Enhancing Use of EHR Functions to Improve Quality of Care

Results:

  • Improved the timeliness of indwelling catheter removal.

Sustainability/Transferability:

  • Implemented additional clinical decision support rules.
  • Enhanced EHR function use in other system hospitals.

Image: Bar chart showing results. The baseline was 40% and follow-up 26%.

Slide 19

Slide 19. Planning and Implementation THQIT Grants

Planning and Implementation THQIT Grants

  • Public-Private Partnership Creates Web-Based System to Improve Rural Children's Access to Health Care Through a Medical Home.
  • Replication of Health Information Exchange Framework Across Oklahoma.

Slide 20

Slide 20. Public-Private Partnership: Web-based System Improves Childrens' Access

Public-Private Partnership: Web-based System Improves Childrens' Access

The Problem:

  • Rural, lower income children lack access to appropriate healthcare.

The Health IT Contribution:

  • iReach Web-based system:
    • Tracks patients enrolled in a program that helps children obtain insurance and links children to providers (Access El Dorado).

Project Director: Dr. Gregory Bergner Project Location: California
AHRQ Grants: P20 HS 014908 (planning) UC1 HS 016129 (implementation)
http://healthit.ahrq.gov/sites/default/files/docs/page/THQITStoriesBergner2010.pdf

Slide 21

Slide 21. Public-Private Partnership: Web-based System Improves Childrens' Access

Public-Private Partnership: Web-based System Improves Childrens' Access

Results:

  • iReach reduced errors by Access El Dorado staff.
  • 23% reduction in time to manage a single case.

Sustainability/Transferability:

  • Health care providers are funding ongoing operating costs for program.

I feel that iREACH has been extremely efficient. I just know from before, it's a much less tedious process, more streamlined.... The paper process was bogging us down.
~ Quote from a user

A great success [of the AHRQ-funded planning process] was creating a community of trust and commitment among the partners, so that they perceived those being served as "our" patients rather than "yours" or "mine."
~ Quote from ACCEL program director

Slide 22

Slide 22. HIE Spreads Across Oklahoma

HIE Spreads Across Oklahoma

The Problem:

  • Patients often see multiple providers and their care becomes fragmented.

The Health IT Contribution:

  • Health Information Exchange (HIE):
    • Local groups of providers use an established framework to develop an HIE.
    • Local HIEs are connected to create a "network of networks."

Project Director: Mark Jones Project Location: Oklahoma
AHRQ Grant: P20 HS 015365 (planning) UC1 HS 016131 (implementation)
http://healthit.ahrq.gov/ahrq-funded-projects/implementation-health-improvement-collaboration-cherokee-county-ok

Slide 23

Slide 23. HIE Spreads Across Oklahoma

HIE Spreads Across Oklahoma

Results:

  • HIE has 49 member organizations and data on 3 million patients.

Sustainability/Transferability:

  • In 2011, HIE is expected to cover 70% of Oklahoma.
  • Central Florida providers use "network of networks" model.

This started as 1 network with 4 health facilities and 400,000 records, and it grew to 5 networks across Oklahoma with 49 health facilities and 37 million records in 2.5 years.
~ Quote from Principal Investigator

Slide 24

Slide 24. HIE Spreads Across Oklahoma

HIE Spreads Across Oklahoma

Image: A map of Oklahoma showing SMARTNET Facilities by County.

Notes: A county-differentiated map of the state of Oklahoma identifies the three counties with County Health Departments which participated in SMARTNET (Mayes, Cherokee, Adair); the 16) counties with planned SMRTNET members (Alfalfa, Comanche, Garwin, Haskell, Hughes, Jackson, Johnston, McCurtain, Oklahoma, Osage, Pittsburg, Pushatalha, Seminole, Stephens, Tulsa, Wagoner); and the 17 counties which have SMRTNET members ( Adair, Canadian,  Cherokee, Cleveland, Custer, Delaware,  Jackson, Kay, Marshall, Mayes, Muskogee, Nowata, Oklahoma, Pottawatomie, Seminole, Sequoyah); 48 counties are eligible incubator sites (Atoka, Beaver, Beckham, Blaine, Bryan, Caddo, Carter, Choctaw, Cimarron, Coal,Cotton,Craig, Creek, Dewey, Ellis, Garfield, Grady, Grant, Greer, Harmon, Harper, Jefferson, Kingfisher, Kiowa, Latimor, LeFlore, Lincoln, Logan, Love, Macintosh, Major, McCain, Murray, Noble, Okfuskee, Okmulgee, Ottawa, Pawnee,  Payne, Pontotoc, Roger Mills, Rogers, Texas, Tillman, Washington,  Washita, Woods, Woodward).

Slide 25

Slide 25. Value Grants

Value Grants

  • Electronic Prescribing: Lowering Patients' Prescription Drug Costs
  • Integrated Telemedicine System Demonstrates Reduction in Children's Emergency Department Visits

Slide 26

Slide 26. Electronic-Prescribing Lowers Drug Costs

Electronic-Prescribing Lowers Drug Costs

The Problem:

  • Prescription drug costs can put much-needed medication beyond the reach of low-income patients and those with chronic conditions.

The Health IT Contribution:

  • Electronic-Prescribing:
    • Color-coded drug list indicating the relative cost of drugs.

Project Director: Dr. Joel Weissman
Project Location: Massachusetts
AHRQ contract: R01 S015175

http://healthit.ahrq.gov/ahrq-funded-projects/e-prescribing-impact-patient-safety-use-and-cost

Slide 27

Slide 27. Electronic-Prescribing Lowers Drug Costs

Electronic-Prescribing Lowers Drug Costs

Results:

  • $3.26 saved per electronic prescription.

Sustainability/Transferability:

  • Health plans offered the system free of charge to more providers.

[The study findings indicate that] doctors want to do the right thing, but they don't always have the right information available.
~ Quote from Principal Investigator

Slide 28

Slide 28. Telemedicine Reduces Children's ED Visits

Telemedicine Reduces Children's ED Visits

The Problem:

  • Children often exhibit symptoms of illness and school staff are unable to decide which students need to be sent home.
  • Wages lost when parents care for children who could be at school can be detrimental for low income families.
  • Low income parents, needing to quickly return to work, often seek attention from costly EDs.

The Health IT Contribution:

  • Telemedicine:
    • Schools and child care centers have access to telemedicine equipment.
    • PCPs provide remote consultations.

Project Director: Dr. Kenneth McConnochie
Project Location: New York
AHRQ Contract: R01 HS 015165
http://healthit.ahrq.gov/ahrq-funded-projects/valuation-primary-care-integrated-telehealth/activity/2008

Slide 29

Slide 29. Telemedicine Reduces Children's ED Visits

Telemedicine Reduces Children's ED Visits

Results:

  • 83% of providers were equally confident in their telemedicine diagnoses and in-office diagnoses.
  • Children with access to telemedicine sites had 24% fewer ED visits.

Sustainability/Transferability:

  • Payers started reimbursing telemedicine visits.
  • Telemedicine program is expanding to other settings.

It's both convenience—health care when and where you need it—and continuity—by people you trust. Who couldn't use more of that from health care?
~ Quote from Principal Investigator

Slide 30

Slide 30. Telemedicine Reduces Children's ED Visits

Telemedicine Reduces Children's ED Visits

Duplicate of Slide 29.

Slide 31

Slide 31. Telemedicine Reduces Children's ED Visits

Telemedicine Reduces Children's ED Visits

  • Visits for Illness:
    • Total: 22.9 % increase
    • Emergency Department: 23.6 % decrease
    • Costs of illness visits: 3.0 % decrease

Slide 32

Slide 32. Telemedicine Reduces Children's ED Visits

Telemedicine Reduces Children's ED Visits

Number and Cost of Medical Care Visits, by Type of Visit, for Children Enrolled in Health-E-Access vs. Comparison Children

Images: Two bar charts show visits per 100 children per year and cost of visits per 100 children for Health-E-Access and Comparison.

Notes: Results: The total number of visits for children with access to telemedicine sites was higher than for other children because of the additional telemedicine visits. But, they were 24% less likely to visit the emergency department and since ED visits are 7 times more expensive than office visits, the program was cost effective.

Sustainability: All local payers except FFS Medicaid are reimbursing telemedicine visits as a result of demonstrated savings.

Program is expanding to other settings including assisted living environments and senior day care centers.

Slide 33

Slide 33. THQIT Synthesis

THQIT Synthesis

  • Grantee Surveys (early 2011)
  • Group of Follow-up Grantee interviews:
    • Depth, Clarification
  • Tool/Guideline:
    • Use of EHR and HIE in rural hospitals

Slide 34

Slide 34. AHRQ's Interest

AHRQ's Interest

Image: An hour glass illustrates that there is no expiration date on AHRQ's interest.

Slide 35

Slide 35. Questions?

Questions?

Slide 36

Slide 36. Success Stories from the AHRQ-Funded Health IT Portfolio (CY 2009)

Success Stories from the AHRQ-Funded Health IT Portfolio (CY 2009)

Slide 37

Slide 37. Research Grants

Research Grants

  • Larry Garber: SAFEHEalth, A Health Information Exchange Improving Health Care Delivery in Central Massachusetts.
  • Pascale Carayon: Using Human Factor Research to Increase the Success of a Health Information Technology Implementation.
  • Denni McColm: Measuring Quality in Physicians' Practices in Southwestern Missouri Using and Electronic Health Record.

Slide 38

Slide 38. SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts

SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts

  • Regional HIE that securely transfers patient health information in "real time" between providers.
  • Dr. Lawrence Garber, AHRQ grant (UC1 HS015220)

Slide 39

Slide 39. SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts

SAFEHealth: A Health Information Exchange Improving Health Care Delivery in Central Massachusetts

  • Goal: Improve patient safety, quality of care, and health care efficiency, while protecting patient privacy.
  • Data exchange includes medication lists, allergies, vital signs, lab results.

Slide 40

Slide 40. SAFEHealth: Steady Increase in Number of Documents Exchanged

SAFEHealth: Steady Increase in Number of Documents Exchanged

No more huge piles of paper. I can set up a follow-up with a Fallon Clinic specialist based on the ER note... Essentially, we have cut out the middle man—talk about GREEN and LEAN!
~ Quote from primary care physician at Fallon Clinic

Images: Two line graphs show the number of documents rising steadily in two clinics during the weeks since SAFEHealth went live.

Notes: Since June 2009, SAFEHealth has provided timely exchange of medical information across health care facilities for one million patients. The number of documents transferred between Fallon Clinic and HealthAlliance has steadily increased in SAFEHealth's first year. Patient data, such as medication lists, allergies, vital signs, and laboratory results, appear in the participating facilities' EHR.

Physicians feel that SAFEHealth allows them to provide higher quality, more effective medical care to their patients. Patients feel that the benefits of SAFEHealth outweigh the risks of privacy and security concerns.

Slide 41

Slide 41. SAFEHealth Key Decisions/Success Factors

SAFEHealth Key Decisions/Success Factors

  • Available through different EHRs.
  • Single Opt in, automated at patient registration, revoke at any time/any or all organizations.
  • Developed internally, costs shared by partners.

Image: A classical facade labeled "Three Pillars of HIE Success." The three pillars are "Establish trust among stakeholders," "Provide value to all stakeholders," and "Fit efficiently into health care workflows."

Slide 42

Slide 42. SAFEHealth: Continuing as a Successful HIE

SAFEHealth: Continuing as a Successful HIE

  • Still continues as an active HIE.
  • Key is to instill trust and value to stakeholders.
  • Must integrate into workflows of patients, registration staff and providers.
  • Patients will see greater value as more organizations participate.
  • Providers are most satisfied when data is easy to find, so data should be sorted by sections into EHR.

Slide 43

Slide 43. Using Human Factor Research to Increase the Success of a Health IT Implementation

Using Human Factor Research to Increase the Success of a Health IT Implementation

  • CPOE can reduce medication errors.
  • Success is tied to how well CPOE is designed and integrated into workflow.
  • Examined impact of implementation in ICUs on quality of care and safety, staff tasks and perceptions, and financial value.
  • Conducted human factors research to evaluate and identify issues with interface and workflow.
  • Dr. Pascale Carayon, AHRQ grant R01 HS 015274

Slide 44

Slide 44. Impact

Impact

  • Decrease in some errors while increase in others.
  • Increase timeliness of antibiotic medication administration.
  • Short term negative staff perception, disappeared after 12 months.
  • Staff tasks changed.
  • No impact on financial value, no difference in ICU costs or physician productivity.

Slide 45

Slide 45. Human Factors Research: Leading to More Effective Technology

Human Factors Research: Leading to More Effective Technology

  • Identified potential problems with the system.
  • Addressed issues by changes in workflow or design interface.
  • Identified potential negative impact on patients & providers before the system went live in the ICUs.

"I thought this was a very useful process with different perspectives generating good discussion of potential issues"
~ Geisinger Employee

Slide 46

Slide 46. Measuring Quality in Physicians' Practices in Southwestern Missouri Using an HER

Measuring Quality in Physicians' Practices in Southwestern Missouri Using an EHR

  • EHRs have potential to provide reliable, valued clinical data for quality measurement.
  • Challenge lies in having unstructured documentation, often in many places within EHR:
    • Complicates search algorithms & makes for confusing results.
  • Aim: To use pre-existing EHR technology to facilitate quality measurement.

Denni McColm, AHRQ grant (HS017094)

Slide 47

Slide 47. Ambulatory EHR System Used in Quality Measurement for PQRI Reporting

Ambulatory EHR System Used in Quality Measurement for PQRI Reporting

  • Participants included 15 practices within Citizens Memorial Healthcare (CMH).
  • Toolkit was developed to help w/ implementing quality measures into CMH's EHR.
  • EHR data elements were standardized.
  • Automated data extraction was developed.
  • Efficiency/accuracy of automated vs. manual data extraction was evaluated.

Image: Sample section of a form for clinical information.

Notes: The EHR was standardized to capture data elements needed to measure the quality of clinical care for the PQRI (PQRI = Physician Quality Reporting Initiative), a Pay for Performance program that provides incentive payments to providers who measure and report on the quality of care and services provided to Medicare patients.

Slide 48

Slide 48. Accurate quality measurement for PQRI reporting through an ambulatory EHR system

Accurate quality measurement for PQRI reporting through an ambulatory EHR system

  • Compared manual to automatic for 3 diabetes measures.
  • Coding completeness 20% for manual coding compared to 100% for automated data extraction.
  • Automated data extraction also more accurate in reporting results.

Slide 49

Slide 49. Outcomes and Lessons

Outcomes and Lessons

  • Without accurate documentation; quality of care may not be accurately reflected:
    • 62 quality measures built into documentation and workflow.
  • Automated data extraction relied heavily on the use of custom documentation queries:
    • Toolkit was expanded and refined to include custom queries.
  • Various strategies can improve physicians' documentation within the EHR system:
    • Web-based report on aggregate organizational performance (developed through this project).
    • Additional training on quality measures and effective use of the EHR (as was done in this project).

Slide 50

Slide 50. Research Contracts

Research Contracts

  • Dr. Lynne Nemeth: Electronic Standing Order in Primary Care Physician Offices Boosts the Delivery of Adult Vaccinations and Other Health Maintenance Services.
  • Dr. Doug Bell: Electronic Referrals Show Promise for Improving Quality Care in Outpatient Settings.

Slide 51

Slide 51. E-Standing Orders

E-Standing Orders

  • Dr. Lynn Nemeth:
    • 10 am
    • Salon E

Slide 52

Slide 52. Electronic Standing Orders in Primary Care

Electronic Standing Orders in Primary Care

  • Services (screening tests, adult immunizations, diabetes care) often overlooked.
  • Implemented and and examined effectiveness of electronic standing orders (SO).
  • SOs triggered by a patient visit and authorize appropriate medical staff to carry out services.

Dr. Nemeth, AHRQ Contract (HHSA290200710015)

Slide 53

Slide 53. EHR Integration of SO

EHR Integration of SO

  • Customized EMR page to integrate SOs and display health maintenance (HM) items
  • HM table indicates a patient's need for a preventive service.
  • Overdue items are highlighted in red for easy viewing, serving as electronic reminders.

Image: A chart showing screening recommendations.

Notes: Screening recommendations of the U.S. Preventive Services Task Force, adult immunization recommendations from the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, and disease monitoring recommendations for persons with diabetes from the American Diabetes Association were used as the basis for the creation of the electronic standing orders and the electronic SO quality of care measures.

Slide 54

Slide 54. Improvement of Practice Performance

Improvement of Practice Performance

Participating practices report:

  • 8-17% increase in adult immunizations
  • 6-10% increase in preventive care screenings
  • Up to 18% increase in diabetes care measures

Image: Line graph shows immunization performances measures rising over a 21-month period.

The project made us more aware that our patients were missing regular health maintenance....we did not realize that we missed this. We are now keeping up with their health maintenance issues, and patients realize that they are cared about.
~ Participating Physician

Slide 55

Slide 55. Electronic Referrals Show Promise for Improving Quality of Care in Outpatient Settings

Electronic Referrals Show Promise for Improving Quality of Care in Outpatient Settings

  • Lack of communication between referring providers & specialists causes fragmented patient care
  • EReferral is a Web-based service that streamlines and facilitates communication between clinics and thereby has the potential to increase efficiencies and improve clinical outcomes.
  • Assessment of how electronic referral systems can best be used to support improvements in health care processes and outcomes.
  • Dr. Bell, AHRQ Contract (HHSA290200600017)

Slide 56

Slide 56. eReferral Process

eReferral Process

Image: A flowchart of the eReferral Process is shown. The PCP [primary care phsyician] submits the electronic referral, which is consult reviewed by a specialist. If an appropriate speciality referral is necessary and the pre-referral work-up is complete, the case is determined to be urgent or non-urgent and scheduled accordinginly. If the PCP can manage with guidance or the pre-referral work-up is incomplete, the case is not scheduled or more information is requested; the case is then scheduled, never scheduled, or the PCP re-submits the referral.

Notes: In January 2007, �The University of California San Francisco (UCSF) at San Francisco General Hospital (SFGH) launched an electronic referral portal that incorporated subspecialist triage, iterative communication with referring providers, and existing electronic health record data to improve access to subspecialty care.

Goals of the eReferral system:

  • Enable physicians to submit requests via a Web-based system vs. paper-based form (sent via fax) or phone request.
  • Create opportunities for increased clinical review and communication.
  • Help identify and expedite urgent cases, reduce premature referrals, and eliminate inappropriate referrals.

Slide 57

Slide 57. Improving Quality of Care in Outpatient Settings

Improving Quality of Care in Outpatient Settings

  • "It just keeps everything organized.It really helps me track everything a lot more easily than what we used to have. It's an electronic trail that is very logically set up."—Specialty Reviewer
  • "I think the patient's visit is more productive because the specialists have already done some of the initial diagnostic work.—Referring Physician

Image: Bar chart shows a PCP Assessment of eReferral Compared with Paper-Based Referrals.

Notes: There were favorable attitudes about eReferral despite some challenges, such as increased workload for referring physicians, having some difficulty in notifying patients about appointments in specialty care, system design issues, and poor connectivity in some clinics.

Slide 58

Slide 58. Future Considerations

Future Considerations

  • Generalizability to other settings will depend on EMR infrastructure and financial incentives.
  • Successful implementation requires careful consideration of end user workflow.
  • User education is critical to support realistic expectations and long-term adoptability.
  • Learning curve impacts use of new technology and its outcomes.

Slide 59

Slide 59. Contracts

Contracts

  • Anne Peterson: Building Bridges Workshop: Healthcare Consumer Needs and the Design of Health Information Technology
  • Jeffrey Kerwin: Healthcare Consumers' Perspectives on the Design and Use of Health Information Technology
  • Cheryl McDonnell: Strategies for Integrating Usability in Electronic Health Records

Slide 60

Slide 60. Building Bridges Workshop: Consumer Needs and the Design of Health IT

Building Bridges Workshop: Consumer Needs and the Design of Health IT

  • Consumer-based health care has been identified as a critical strategy to improve health outcomes.
  • Empowering healthcare consumers is critically dependent on the ability to collect, store, and manage "personal health information" (PHI).
  • A 2-day workshop (July, 2009) was held to bring together a multi-disciplinary group of experts to address and promote the design of consumer health IT systems based on a solid understanding of consumers' PHIM practices.
  • Anne Peterson, AHRQ Contract (#HHSA290200710072T )

Image: A bridge is shown.

Slide 61

Slide 61. 3 Themes Emerged

3 Themes Emerged

Defining PHIM—Systems needs to be flexible and accessible to different types of users, across different settings.

Design Issues—Systems need to take into account the particular needs of the consumer, rather than the needs of the physician, insurance company, or some other entity with a stake in the patient's health care.

Steps for the Advancement of Consumer Health IT— Additional research on consumers' PHIM practices and increased sharing of info within the technology field is needed to lead to better, more efficient designs.

Slide 62

Slide 62. Future Opportunities

Future Opportunities

  • Field of PHIM still in its infancy: no existing systems, models, or classifications.
  • Time is ideal to incorporate consumers' needs into the PHIM framework:
    • "Who & what are we designing for?"
  • User-centered PHIM tools can:
    • Empower patients as partner in their own health care.
    • Improve patient-doctor communication.
    • Make tools and systems more widely available to all consumers.

One of the most underused resources in health care in America is the consumer.
~ Carolyn Clancy, Director, AHRQ

Slide 63

Slide 63. Health Care Consumers' Perspectives on the Design and Use of Health IT

Health Care Consumers' Perspectives on the Design and Use of Health IT

  • Surveys suggest the public could be better informed regarding health IT capabilities and how physicians use EHRs.
  • 20 focus groups offered patient perspectives on health IT:
    • Awareness, beliefs, perceptions, fears of health IT.
    • At what point patients want to be engaged in development of health IT.
  • Dr. Jeffrey Kerwin, PhD, Contract PSC TO TO#07R000131, IAA Number 06-443R-06

Slide 64

Slide 64. Consumer Perspectives

Consumer Perspectives

  • Almost complete agreement that patients should have a say in how data is shared/used.
  • General Agreement that health IT would improve efficiency, reduce errors.
  • Little agreement about the role of patients in the design/ use of health IT.

"...my doctor comes in ... she has, like, a big, thick [file] because I've been going to her for years ... But, if she had a laptop or something, she'd be able to go back to that date and time and just pull that up and it would pop right up. It would be easier for her, as far as being organized and being systematic."
~ Focus Group Participant

Slide 65

Slide 65. Fears/Concerns

Fears/Concerns

"That's your personal information. You should have every right to say how it's used."

"Everything else has been hacked. Government files have been hacked; banks have been hacked. My credit cards have been stolen. What else is left?"

  • Consumers feel that patient health info belongs to the patients.
  • Concerns raised over privacy, security, interpersonal impact.
  • Doubts in cost savings—fear of rising costs.
  • Uncertainty re: how health IT can enhance health care decisions.

Slide 66

Slide 66. Suggestions for Engaging Consumers in Health IT Design and Use

Suggestions for Engaging Consumers in Health IT Design & Use

  • Engage consumers early in process.
  • More surveys and focus groups on consumer opinions or perspectives.
  • Involvement of patient advocacy orgs.
  • Consumers involved in advisory committees.
  • More public education on health IT, its impact on patients, and security/privacy issues.

Slide 67

Slide 67. Strategies to Integrate Usability in EHRs

Strategies to Integrate Usability in EHRs

  • EHRs revolutionize medicine, however lack of usability data to inform design and practice.
  • A panel of multidisciplinary EHR experts & vendors was convened to participate in informal interviews.
  • This is AHRQ's first initiative to guide EHR innovations in usability.
  • Dr. Cheryl McDonnell, AHRQ Contract (HHSA2900710073T)

Slide 68

Slide 68. Reports Document Expert Recommendations

Reports Document Expert Recommendations

  • Three documents were developed to focus on key areas of interest to policymakers, researchers, and EHR developers:
    • Framework Evaluation
    • Interface Design
    • Vendor Practices and Perspectives

"There is strong evidence (outside health care) that usability testing in the design and development phase is more effective and less expensive than after market release."
~ Expert Panel Member

Slide 69

Slide 69. Findings

Findings

  • Framework Evaluation: definition of categories for usability and evaluation.
  • Interface Design: incorporation of recommendations for evidence-based lessons from other fields.
  • Vender Practices and Perspectives: description of usability engineering processes and engagement of end users throughout the product life cycle.

Slide 70

Slide 70. Dissemination of Findings

Dissemination of Findings

Chart 1. EHR Usability Publication Coverage by Media Type

Image: Pie chart shows the following:

  • News Web sites, 23% (18)
  • Online Version, 38% (30)
  • Blogs, 39% (32)

Notes: An aggressive dissemination strategy was initiated, the results of which are represented in Chart 1. 

While the download of online versions of the reports was the second most frequent dissemination method, blogs and news Web sites have considerably larger viewer bases and facilitated wider exposure of the reports to the target audiences.

Current as of December 2010
Internet Citation: Health IT Success Stories (Text Version). December 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/conference/2010/roper/index.html