Evaluation of a CDSS and EMR-Based Registry to Improve Management of Hypertension in a Community Health Center

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Helene Kopal, MPA, MPH, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (420 KB).

Slide 1

Evaluation of a Clinical Decision Support Systems (CDSS) and Electronic Medical Record (EMR)-Based Registry to Improve Management of Hypertension in a Community Health Center

Helene Kopal, MPA, MPH
Director, Primary Care Development Corporation

Slide 2

Our Team

The colored map shows Westchester County, NY with 4 locations highlighted:

• Primary Care Development Corporation
• Open Door Family Medical Centers
• New York University
• Columbia University: Mailman School of Public Health

Slide 3

Project Design and Timeline

Sep. '07-Dec. '08

• Baseline & Development: Institutional review board (IRB) & Federal Wide Assurance (FWA):
  • Set Objectives
  • Develop Intervention
  • Collect Baseline Data
  • EMR
  • Provider Process
  • Assessment of Chronic Illness Care (ACIC)
  • System Inventory

Nov.-Dec. '08-Mar. '09

• Acceptance:
  • Train Users
  • Implement Intervention
  • Acceptance Period

Mar. '09-Jun. '10

• Intervention:
  • Collect Post-Intervention Data
  • EMR
  • Provider Process

Jun. '10-Sep. '10

• Post-Intervention:
  • Analysis
  • Write-up
  • Dissemination plan

Slide 4

Our Patients

• 72% Hispanic
• 66% Female
• 90% at or below 150% of poverty level

Preliminary Baselines

• 94% screened for hypertension
• 16% reported with hypertension

Slide 5

Our Patients

The pie chart shows blood pressure (BP) control among hypertensives.

• Always: 21%
• Sometimes 50%
• Never: 29%

Slide 6

Our Providers

The bar graph measures the positive attitudes towards guidelines.

• Positive Attitudes Towards Guidelines (N=15):
  • Hypertension (HTN) Care & JNC7: 3.7
  • Clin Prac Guidelines: 3.9

Slide 7

Our Providers

The bar graph measures the satisfaction with eClinicalWorks EMR.

• Satisfaction with eClinicalWorks (ECW) EMR (N=15):
  • Satisfied with ECW: 3.8
  • ECW Made Clin Tasks Easier: 5.4

Slide 8

Developing the Intervention

1. Identify Clinical Objective
2. Identify Objective Class
3. Identify Type & Workflow Step of CDSS
4. Select CDSS Intv'ns
   4½ Create Use-Cases
5. Specify & Validate Each Intv'n

• Note: Osheroff, Jerome A., MD, FACP, FACMI et al. Improving Outcomes with Clinical Decision Support: An Implementer's Guide, Chicago: Healthcare and Information Management Systems Society, 2005.