Creating a Shared Quality Improvement Reporting System (Text Version)

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, Lisa Schilling, M.D., M.S.P.H., made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (1.7 MB).

Slide 1

Creating a Shared Quality Improvement Reporting System

Colorado Associated Community Health Information Exchange (CACHIE)

Lisa Schilling, MD, MSPH
AHRQ Annual Conference
September 8, 2008

Slide 2

CACHIE Participants

• 14 Colorado federally qualified community health centers.
• Colorado Community Managed Care Network.
• Colorado Community Health Network.
• Others.

Slide 3

Presentation Objectives

• Illustrate the use of business process analysis to inform user requirements.

Slide 4

CACHIE Goals

• To promote the use of information technology to support quality reporting and improvement across the community health centers (CHC) networks:
  • To design, build, & implement a shared system for quality reporting among 6 CHCs with 4 disparate Electronic Medical Record (EMR)/Payment Management System (PMS).
  • To assist CHC with EMR template implementation to improve care provision, documentation & measurement.

Slide 5

Data ←→ Information

Screen shot of a diagram which presents a centered, red cross ("Template") with arrows pointing to three ovals ("Provide Care," "Document Care," and "Measure Care"), and three large, blue arrows placed between the three ovals, pointing in a clockwise formation.

Slide 6

What is a business process?

Business process:
A "business process" describes a set of activities and tasks that logically group together to accomplish a goal or produce something of value for the benefit of the organization, stakeholder, or customer.

Slide 7

Why Use Business Process Analysis?

• Everything is not as it appears to be:
  • Unintended internal and external consequences.
  • It's not just a "flip of the switch".
  • Technology must complement workflow.
• Expectancy:
  • Exceeding capacities.
• Fashion:
  • Unnecessary complexity.
  • Remaining current.
• Stakeholder interest:
  • Varying levels over time.
  • Developing consensus.

Slide 8

Method

Business Process Analysis (BPA)

• Think: How do we do our work now?
  • Define goals and objectives.
  • Model context of work.
  • Identify business rules.
  • Describe tasks and workflows.
  • Identify common task sets.

Business Process Redesign

• Rethink: How should we do our work?
  • Examine tasks and workflows.
  • Identify inefficiencies.
  • Identify efficiencies with repeatable processes.
  • Refine business processes and rules.
  • Remodel the context of work.
  • Restructure the tasks and workflow.

Requirements Definition

• Describe: How an information system can support our work?
  • Define tasks to be performed for optimized business processes.
  • Describe the implementation of business rules.
  • Describe in words and graphics how an information system is to be structured.
  • Determine scope of next phase of activities.

Slide 9

BPA Example #1

Outcome: Provide a "fast food" customer with their order efficiently and receive payment.

Slide 10

Restaurant Order Fulfillment Process Context Diagram

Screen shot of a diagram showing the process of fulfilling a restaurant order.

• Customer
  • Order detail
  • Payment
• Order taker
  • Burger order
  • Fry order
  • Drink order
• Burger Station, Fry Station, Drink Station
  • Food and beverage inventory
  • Supplies: wrappers, oil, straws, cups
• Order taker
  • Burger
  • Fries
  • Drink
  • Reports, receipts
• Customer
  • Greeting
  • Amount Due
  • Change
  • Order

Legend:
Transaction: Thin black arrows
Outcome: Thick red arrows
Output: Orange font
Input: Blue font

Slide 11

CACHIE BPA Purpose

• Align the Information system (IS) with the organization's mission:
  • Need a clear model of the desired outcomes and the business processes that result in those outcomes.
• IS should support and enhance business processes.
• Creating a shared system required that we understand CHC business process similarities and differences.

Slide 12

CACHIE BPA Goals

• Develop a common definition of quality improvement reporting system.
• Describe and visually document how quality improvement efforts are accomplished.
• Describe how the quality improvement efforts will function with the quality IS.
• Develop a list of functional requirements to drive information system design and implementation.

Slide 13

On The Road

Screen shot of a map of Colorado which highlights Clinica, Sunrise, Mountain Family, Peak Vista, High Plains, and Valley Wide.

Slide 14

Screen shot of a sample flow chart showing the relationship between the clinic and CACHIE services.

Slide 15

BPA Example #2

Outcome: Improve the provision and documentation of guideline concordant care in primary care clinic.

Slide 16

Provide & Document Diabetes Mellitus (DM) Eye Care

• Goal: Provide DM pts guideline concordant care.
• Objective: Ensure DM pts receive eye exams.
• Business rules: Electronic referrals are not possible, referrals to both internal and external providers.
• Trigger: DM pt presents for care (other?).
• Task Set: Care for any acute needs, refer for DM care.
• Outcome: Provide & document DM eye care.

Slide 17

Providing and Documenting Guideline Concordant Care

Screen shot of a diagram showing the process of providing and documenting care.

• Diabetic Patient
• Provider
  • Document care
  • Enter eye referral
• EMR-Codified, text, scan
  • Referral to
• Internal Ophthalmologist, External Ophthalmologist
  • Ophth note
• Medical records
• EMR-Codified, text, scan
  • Retinal exam documented
  • Scan
  • Quality reports
• Provider
• Diabetic Patient

Legend:
Transaction: Thin black arrows
Outcome: Thick red arrows
Output: Orange font
Input: Blue font

Slide 18

BPA—other topics

• Lab ordering & results handling.
• Documentation of foot exams & self-management goals.
• Incorporation of new or modified guidelines into their patient care processes, into their EMR templates, into their quality reporting.
• Current methods of creating & using quality reports from EMR data, challenges and successes.

Slide 19

Screen shot of a complex diagram showing how to improve the process of care and documentation of guideline concordant diabetes care through quality improvement and feedback to provider in real-time (point of care).

Slide 20

What We Learned

Templates:

• Not uniformly available.
• Require costly professional support to develop/modify.
• Require lots of CHC staff time.
• When available, not always used.
• Not automatically linked with "forms" leading to double data entry.
• Desire for more & improved.

Slide 21

What We Learned (continued)

Quality Reporting

• Great variability among CHC capacity.
• Requires professional support ($$) to develop reports.
• Reporting limited by $$$.
• Reporting limited by system.
• Desire for data (re-)use.

Slide 22

What We Learned (continued)

Quality Reporting-2

• Analyze at provider, pod, clinic site, CHC level.
• Analyze discrete specified time periods.
• Track trends for individual patients.
• Provide pre-built reports (UDS, etc).
• Easily create reports for individual CHC needs.
• Save & share built reports.
• Run "huddle" reports based on scheduled patients.

Slide 23

Screen shot of a sample flow chart showing the relationship between the clinic and CACHIE services.

Slide 24

It Takes a Village...

CACHIE Steering Committee

• Ross Brooks, Director
• Molly Brown, Manager
• Art Davidson, Co-Medical Director
• Jason Greer, HIT Director
• Molly O'Fallon, Clinical Quality Director
• Lisa Schilling, Co-Medical Director
• Dan Tuteur, CCMCN Ex. Director

Health Information Technology (HIT) Committee

• David Adamson, Mountain Family HC
• Kitty Bailey, CCHN
• Andrew Bienstock, Salud Family HC
• David Fleurquin, Pueblo Community HC
• Pete Gutierrez, Denver Health, Committee Chair
• Annette Kowal, CCHN
• Pete Leibig, Clinica Family Health Services
• Konnie Martin, Valley-Wide Health Systems, Inc.
• Pam McManus, Peak Vista Community HC
• Mitzi Moran, Sunrise Community Health
• Paul Olson, Peak Vista Community HC
• John Santistevan, Salud Family HC
• Pat Tellez, Metro Community Provider Network

AHRQ

• Marybeth Farquhar

Slide 25

Contacts

CACHIE Project Manager
Ross Brooks ross@cchn.org

CACHIE Medical Directors
Lisa Schilling lisa.schilling@ucdenver.edu
Arthur Davidson art.davidson@dhha.org