Bon Secours Achieves Consistency in Preventive Care Guidelines With AHRQ ePSS
Bon Secours Health System, a health system with facilities in seven States, is using its Epic electronic health record (EHR) system to access the U.S. Preventive Services Task Force (USPSTF) recommendations.
Edward Glynn, MD, is the Medical Director of Ambulatory Informatics at Bon Secours Health System. He explains that Bon Secours participated in AHRQ's electronic Preventive Service Selector (ePSS) Knowledge Transfer project because it wanted to "turn to a single, trusted source such as the USPSTF recommendations for building its health maintenance and best practice alerts" in its EHR system.
The ePSS 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.
Bon Secours has used Epic's EpicCare EHR system in its ambulatory practices since January 2009. In 2010, Bon Secours decided to begin using health maintenance alerts in its EHR. Bon Secours recognized that they had two options for preventive service guidelines. "We could use a single entity such as the USPSTF, or we could form a committee of providers to identify guidelines that would require compromises and maintenance," said Glynn.
The Bon Secours Physician Design Team ultimately decided to go with the USPSTF recommendations because of the advantages of using a single entity for consistency and simplicity. Providers can opt to use recommendations from a specialty society if they prefer. However, according to Glynn, "the USPSTF recommendations give the providers a solid baseline."
During discussions about implementing the health maintenance recommendations, Bon Secours sought the guidance of its EHR vendor. Bon Secours designed the guidelines and reporting functionality to provide three levels of data: patient-centered data focusing on the individual patient encounter; panel-level data for each provider; and population management data across all providers in a Bon Secours market or throughout the health system.
Bon Secours implemented the USPSTF colon cancer screening recommendations in July 2010. Feedback indicated that providers did not know how to use the health maintenance functionality in the EHR system and did not have time to use the recommendations. This information prompted Bon Secours to review their processes and EHR system functionality.
Glynn says, "Physician buy-in was a huge issue. We have now refocused our health maintenance efforts on consistency, efficiency, and workflow to mimic the current patient flow in the practices. We are creating new training materials, including e-learning, and are introducing the three levels of clinical decision support and monitoring in January 2011 with colon, breast, and cervical cancer screening."
Tarsha Darden, MD, Bon Secours physician champion in Hampton Roads, Virginia, adds that "education has been key to improving physician buy-in."
Glynn cited three lessons learned during the initial ePSS implementation process. "First, the electronic health record is a clinically run program and must be championed by a physician. Second, it is important to turn to other organizations that are ahead of you in the process for feedback and learn from their mistakes and build on their success. And, third, it is important to have dedicated resources to the project, including an executive sponsor who 'gets it,'" he explains.
In addition, Glynn says that "patience and persistence are required for implementing the USPSTF recommendations as health maintenance alerts." Health care providers and their information technology support systems balance multiple clinical and technical issues every day that impact implementation of the recommendations. According to Glynn, "providers should persist in implementing ePSS because it is right for the patients and right for the future."
AHRQ provided technical assistance to Bon Secours to incorporate the ePSS tool into its Epic 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 EHRs.
- Assisting providers in implementing ePSS recommendations into their EHRs' clinical decision-support systems.
- Working with EHR vendors to ensure appropriate support during the technical implementation process.
- Providing support in using the USPSTF recommendations.
The 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 PDA and Web versions is available at http://epss.ahrq.gov/PDA/index.jsp.
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