The BLUES Project (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Karen C. Fox, Ph.D., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (550 KB).

Slide 1

The BLUES Project

Karen C. Fox, Ph.D.
Chief Executive Officer

Slide 2

BLUES Overview

• Better Life Utilizing Electronic Systems.
• Purpose.
• Demonstrate the effects of diabetes management practices.
• Ambulatory clinics in rural and urban settings.
• Utilizing well-designed, comprehensive health information technology.

Slide 3

The bar chart shows by respondent categories, the percent of respondents identifying a particular issue as being a major factor driving the need for an Electronic Health Record (EHR).

Slide 4

The Current State of EHR Implementation in the U.S.

• Significant increase over last year:
  • In solo and small practices motivated to implement EHRs.
• Increase in the use of almost all data capture methods:
  • Especially structured data entry.
• High level of implementation plans for e-prescribing, remote access to EHRs, and order entry placed by nurses or staff.
• http://www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

Slide 5

The BLUES Target Service Area

The drawn map shows the counties of Mississippi with a number of the western counties highlighted in blue and yellow.

Slide 6

BLUES Overview

Research Aims:

• Successfully implement EHRs in diabetes management clinics, focusing on integration of the EHR into clinician workflows.
• Evaluate the impact of the EHR system on clinical processes of care and patient outcomes.
• Produce and distribute a generalizable, replicable model of care for implementing an integrated health IT system for diabetes management care throughout the U.S.

Slide 7

BLUES Overview (continued)

Hypotheses:

• Provider use of an EHR system will increase.
• Patient use of EHR will increase.
• Adding an EHR system to an existing model will significantly improve medication management.
• Adding an EHR will also improve other process-of-care measures.
• Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

Slide 8

Understanding Data: Road Maps to Successful Outcomes

The slide shows an image of a winding road.

Slide 9

BLUES Overview (continued)

• Create Systems:
  • Collect Baseline.
  • Track Outcomes.
• Implement Systems.
• Collect Data:
  • Evaluate Processes.
  • Evaluate Outcomes.

Slide 10

CREATE

• EHR Analytic Modules.
• Where to look for data.
• Chart reviews.
• Creating harmony within the existing system and new system.
• Tracking mechanisms.

Slide 11

Implement

Slide 12

Challenges to EHR Implementation

Clinic infrastructure:

• Network Infrastructure in Rural Communities.
• Current workflow and staff.
• Lack of patient management systems.

Staff concerns:

• Training and installation.
• Single physician clinics.
• Clinician Acceptance/Buy-In.

Slide 13

EHR: Electronic Healthcare Record

• Privacy and Security:
  • Health Insurance Portability and Accountability Act (HIPAA) Compliance.
• Limited capability of IT Host Facility:
  • Unreliable data center infrastructure.
  • Need to build redundance.
  • Servers and networking support.
• Infrastructure support by health care facilities (single physicians, etc.).

Slide 14

Challenges to EHR Implementation (continued)

• Loss of Network Service Provider.
• Reliable Health Technology Equipment Operators at Remote Locations.
• Key Personnel Changes.
• Changes in Clinic Location.

Slide 15

Challenges to EHR Implementation (continued)

• Equipment Maintenance in Remote Locations.
• Availability of Qualified Staff.
• Data Acquisition:
  • Provider responsibility for maintenance.
  • Access by DHA and external evaluators.

Slide 16

Collect

Slide 17

Data Issues

• Data Collection Methodology:
  • Assessment of longitudinal change.
  • Collection time.
• Reporting the data.

Slide 18

Data Challenges

• Disparate practice management systems:
  • Workflow management.
  • Data elements captured.
• EHR design modifications:
  • Required for unique measures.
• Access to external data:
  • Medicaid.
  • Evaluating cost/benefit outcomes.

Slide 19

Tracking Outcomes

Provider use of an EHR system will increase.

• Measure: % of visits where EHR was used:
  • Information captured by the EHRs.
• Measure: Use of quality measurement reports:
  • Information not captured because Analytics Module was not purchased:
    • Overcame barrier by establishing audit trail.

Slide 20

Tracking Outcomes (continued)

Patient use of EHR will increase.

• Measure: % of patients who access their personal health information, including medication therapy:
  • Cannot capture data because the Interactive Module was not purchased.
  • Must develop new measure to capture impact on patients.

Slide 21

Tracking Outcomes (continued)

Adding an EHR system to an existing model will significantly improve medication management.

• Measure: Formulary compliance—% of prescriptions complying with formulary:
  • Captured by EHR Analytics Module.
• Measure: Patient Compliance with medication:
  • Determined by EHR—# filled/#prescribed.

Slide 22

Tracking Outcomes (continued)

Adding an EHR will also improve other process-of-care measures.

• Measure: % of patients receiving appropriate care for treatment:
  • Captured by EHR Analytics Module.
  • Is determined by nationally recognized medical standards of care—American Diabetes Association.

Slide 23

Tracking Outcomes (continued)

Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

• Measure: Patient Satisfaction improved.
  • Determined by primary data collection.
• Measure: Diabetes outcomes.
  • Lipid profiles, blood pressure (BP), A1c, etc. all captured by EHR as specifically designed for the clinics.

Slide 24

Lessons Learned

Slide 25

Lessons Learned

• Network/Internet speed and capacity is critical.
  • WAN Optimizers.
• Providers may resist financial commitment of any amount.
• IT vendor territory issues.
• Local business loyalty in small communities.

Slide 26

Lessons Learned (continued)

• Have clinic personnel on your planning and evaluation committees.
• Be flexible with training staff.
• Design and modify current systems.
• Have contingency plans.

Slide 27

• When you have all of this, you impact clinic and community success!
• Successful EHR Implementation Plus Better Patient Outcomes Equals Healthy Community.

Slide 28

Logic Model

• Inputs:
  • Existing medical structure.
  • Traditional clinic system.
  • Traditional hospital structure.
  • Information infrastructure.
  • Networks and Servers.
• Activities:
  • Cooperation and collaboration.
  • EHR implementation.
  • System training.
  • Data collection and reporting.
• Outputs:
  • Expanded services and access.
  • Patient and provider satisfaction.
  • Improved workflow.
  • Provider enrollment.
• Outcomes:
  • Patient Health Outcomes.
  • Reduced Cost of Care.
  • Increased medical homes.
  • Increased productivity.
  • Improvement in ratio of clinicians to population.
• Impact:
  • Reduced health care costs for providers and patients
  • Improved chronic disease outcomes.

Slide 29

Delta Health Alliance Icon and Motto: Today. Tomorrow. Together