Atlanta Health System Uses AHRQ ePSS to Provide Real-Time Decision Support for Clinicians
Piedmont Healthcare, a large integrated health system in the Atlanta, Georgia, area, is using its NextGen electronic health record (EHR) system to access U.S. Preventive Services Task Force (USPSTF) recommendations.
James C. Sams, the physician lead at Piedmont, is pleased with the decision to participate in AHRQ's electronic Preventive Services Selector (ePSS) Knowledge Transfer project because it gave Piedmont a "chance to benchmark internal processes with external standards and improve quality of care."
NextGen embedded ePSS as part of the health maintenance module, allowing the USPSTF recommendations to be "right there in front of us every time a patient comes in for a visit," Sams says. The health record in the EHR shows providers the date a patient had a procedure/test, the results, and, if applicable, past medical history.
The ePSS tool is designed to provide real-time decision support for clinicians regarding appropriate screening, counseling, and preventive services for their patients. It is based on the recommendations of the USPSTF and can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors.
Piedmont has been active in quality improvement efforts for more than 20 years and has a technologically savvy Physicians User Group composed of five physicians who meet on a regular basis. When new clinical systems are deployed, these physicians serve as a clinical test group. Along with senior clinical leaders, they recognized the importance of the USPSTF recommendations and ePSS and made the decision to work with AHRQ to integrate the tool into its EHR, according to Sams.
Facilitated by its participation in the ePSS project, Piedmont identified three health maintenance items that must be completed for every patient for whom the screenings are appropriate, based on age, sex, and risk factors: screenings for diabetes, colorectal cancer, and tobacco use. It is mandatory that information for these three screenings be completed before the chart can be closed and billed.
According to Sams, Piedmont has "improved quality by making it possible for office staff to accurately capture all patient conditions via a comprehensive checklist included in the health maintenance module of the patient's electronic record." Staff members working directly with patients are trained to access the patient's EHR at the beginning of the visit and complete a summary of the patient's health profile. Providers are then informed if the patient needs a referral for a test such as colorectal screening or a mammogram, or whether they need to provide counseling.
AHRQ provided technical assistance to Piedmont to incorporate the ePSS tool into its NextGen EHR product. AHRQ has also worked with more than a dozen primary care provider groups across the United States in the following ways:
- Assisting providers in implementing the ePSS widget into their EHR.
- Assisting providers in implementing ePSS recommendations into their EHR's clinical decision support system.
- Working with EHR vendors to ensure appropriate support during the technical implementation process.
- Providing support in the use of the USPSTF recommendations.
AHRQ's ePSS, which is updated as new recommendations are released, can be downloaded to a PDA, accessed on the Web, or installed on any Web site as a widget. More information on both the print and Web versions of the recommendations is available at http://www.uspreventiveservicestaskforce.org/.
U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2010-2011. Rockville, MD: Agency for Healthcare Research and Quality; September 2010. http://www.ahrq.gov/clinic/pocketgd.htm
Electronic Preventive Services Selector. Rockville, MD: Agency for Healthcare Research and Quality. http://epss.ahrq.gov/PDA/index.jsp