The Primary Care Information Project

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On September 15, 2009, Sarah Shih, MPH made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (2 MB).

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Slide 1

The Primary Care Information Project

Sarah Shih, MPH
Exec. Dir. Healthcare Quality Information
New York City
Department of Health and Mental Hygiene
sshih@health.nyc.gov
www.nyc.gov/pcip

 

Slide 2

NYC's Health Agenda
Take Care New York

1. Have a Regular Doctor or Other Health Care Provider
2. Be Tobacco-Free
3. Keep Your Heart Healthy
4. Know Your HIV Status
5. Get Help for Depression
6. Live Free of Dependence on Alcohol and Drugs
7. Get Checked for Cancer
8. Get the Immunizations You Need
9. Make Your Home Safe and Healthy
10. Have a Healthy Baby

 

Slide 3

Health Care that Maximizes Health

• Health Information Systems that are oriented toward prevention
• Redesigned Practice Workflows Patient Engagement that highlights prevention
• Payment that rewards disease prevention and the effective management of chronic disease

 

Slide 4

Focused on Medically Underserved Patients in NYC

We have secured signed commitments from 2,100 providers in 379 practices and at 480 sites

~ 1 new provider goes live on the EHR every day

Practices	Live	In Progress	Practice IS ratio
Small Practices	247	96	86:1
Health Centers	18	13*	15:1
Hospital OPDs	3	2*	4:1
Sub-total	268	111

*Practice with sites both live and in implementation
 

 

Slide 5

BRINGING THE RESOURCES OF LARGE NETWORKS TO INDEPENDENT SMALL PRACTICES - A "VIRTUAL NETWORK"

Kaiser Permanente > NYC PCIP

 

Slide 6

PCIP, eCW & Practice team structure

PCIP	ECW	Practices
		Small	Large
Implementation specialists	Project Managers, Business Analysts, SAMS	Providers, Office Managers	Project Management Team
Infrastructure team	Technical Specialists	IT Consultant	IT Department
Interface Coordinator (PM, labs and CIR)	Lab Interface team	Providers, Office Managers	IT Department, Ref/In-house lab
Quality Assurance	Developement team	Providers, Office Managers	Site Administrators
Quality Improvement consultants, Supers Users, Billing consultants	Trainers, Billing Specialists, Business Analysts	Providers, Office Managers, Biller	Quality Improvement Unit, Financial Dept.
Privacy and Security consultants	Development team	Providers, Office managers	IT Department, Legal
Development team	Development team	Providers, Office Managers	Super Users

 

 

Slide 7

8 Key Features of the TCNY Build

1. Measure Reports
   Side-byb-side provider comparisons of performance on quality measures
2. Enhanced Registry
   Identifies patients by structured data (e.g., diagnoses, drugs, labs, demographics)
3. Automatic Visual Alerts
   Highlights abnormal vitals
4. CDSS
   Automatically displays preventive service alerts that are suppressed when addressed
5. Quick Orders
   One-click ordering of recommended preventive services
6. Comprehensive Order Sets
   Displays best practice recommendations (e.g., for meds, labs, patient education)
7. eMedNY
   With patient consent, displays 90-day history of all Rxs filled by Medicaid patients
8. CIR School and Health
   Sends information to City Immunization Registry and generates school health forms

 

Slide 8

Small Practice Consulting Approach

Client-Facing Teams are phased in, as appropriate
 

 

Slide 9

Following Medical Home and Chronic Care Models

Useful framework for organizing QI work

• Actionable curriculum consisting of a collection of discrete activities and achievable goals
• Focus on "whole-practice" redesign (e.g. teamlet care - C. Sinsky)
• Provide actionable and meaningful feedback
• View EHR-derived quality measure data on a routine basis
• Provides incremental recognition

"BOOTS ON THE GROUND"

• Assist practices through the process and lower the "activation energy"
  
  • Software, QI, EMR consulting, Pay for Performance, relationships
    
  • Partnership with NCQA- multi-site survey
    
• Keep practices focused on care & and reduce administrative burdens
  
  • Average physician spends $68,274 per year interacting with insurance plans*
    
• Focus practices on areas to have the highest impact for health
• Provide share resources to practices (care coordinators, nurses, panel managers)
• Conduct patient outreach using the data from EHR

*J. A. Sakowski, J. G. Kahn, R. G. Kronick et al., "Peering into the Black Box: Billing and Insurance Activities in a Medical Group," Health Affairs Web Exclusive, May 14, 2009, w544-w554
 

Slide 10

How do we know whether providers are meaningfully using the EHR?

• PCIP staff
  • Scheduled on-site visits
  • Demo of registry query functions
• Data Transmissions from EHR
  • Encounter information from PM
  • Utilization of EHR metrics
  • Quality Measures (EoC)

 

Slide 11

Average Encounters Per Month by Practice Size*

Bar graph depicting average encounters per month up to three providers.

*Limited to small practices that have been on the EHR for 6 months or more.
Data available on ~116 small practices
 

 

Slide 12

PCIP Contractual Expectations with Providers
Selected Measures for Demonstrating Use of EHR

1. Visits where office visit CPT codes were entered into the progress note.
2. Visits where an order set was used as part of the progress note.
3. Visits where a smart form was used as part of the progress note.
4. Visits where blood pressure was entered into the progress note.
5. Visits where allergy data was entered in a structured format
6. Insurance claims created over total number of insurances for patients that month
7. Visits where medications were prescribed through the EHR
8. Prescriptions entered into the EHR that were sent via fax or electronic interface
9. Labs reviewed over labs ordered
10. Current medications were entered or verified in the EHR
11. Months in a 6 month period when required data files were transmitted to the DOHMH
12. Months in a 6 month period when all core utilization measures were reported to the DOHMH

 

Slide 13

Proposed Meaningful Use Measures Overlapping with Data Transmitted to PCIP

Line	2011 Measures (Draft from HITECH)	Level
9,10	% of permissible RX's transmitted electronically	Provider
21,22	% lab results incorporated into EHR in coded format [OP,IP]	Practice Provider
26	% of encounters for which clinical summaries were provided [OP, IP]	Provider
28	% of encounters where med reconciliation was performed [OP, IP]	Practice
30	Report up-to-date status for childhood immunizations [OP]	Practice
31	% reportable lab results submitted electronically [IP]	Practice

 

Slide 14

EHR Utilization Transmitted to PCIP

• Snapshot of monthly activities
• Number of practices with EHR use data
  • 133 practices in July and August 2009
  • 85 have been using EHR for 8 months or longer

EHR use transmissions	Total Jul*	Total Aug*
Lab results transmitted	48,072	52,183
Lab results reviewed	56,731	63,882
Use of Medicaid State Rx Claims	2,422	2,560
Active patients	508,079	516,283

*limited to practices on the EHR for 8 months or longer

 

Slide 15

Proposed Meaningful Use Measures Currently within PCIP Quality Measures

Line	142011 Measures (Draft from HITECH)
1	% diabetics with A1c under control [OP]
2	% of hypertensive patients with BP under control [OP]
3	% of patients with LDL under control [OP]
4	% of smokers offered smoking cessation counseling [OP, IP]
5.6	% of patients with recorded BMI [OP]
14	% of patients over 50 with annual colorectal cancer screenings [OP]
15	% of females over 50 receiving annual mammogram [OP]
16	% of patients at high-risk for cardiac events on aspirin prophylaxis [OP]
17	% of patients with current pneumovax [OP]
19	% eligible patients who received flu vaccine [OP]

Note: Quality Measures are collected at the provider level and stratified by insurance type. For some practices, stratified by race/ethnicity, though few providers are completing the field for race/ethnicity
 

 

Slide 16

Preliminary Data - Quality Measures

	Mar08 to Feb09			Aug08 to Jul09
Measure Name	N	Mean (std)	Sum*	N	Mean (std)	Sum*
A1C control (< 7%)	12	53.7 (16.6)	492	44	47.2 (17.0)	2,498
Antithrombic Treatment	58	47.5 (21.2)	8,617	89	49.6 (21.3)	13,686
Asthma control (5-11 yrs)	3	87.8 (18.4)	49	4	89.0 (12.4)	104
Asthma control (12-17 yrs)	2	74.1 (16.4)	22	3	90.6 (8.4)	54
Asthma control (18-56 yrs)	2	45.7 (36.4)	12	11	61.9 (27.5)	105
Body Mass Index	86	61.6 (29.8)	83,029	110	70.4 (26.9)	126,842
BP Control ≤130/80 DM	56	23.9 (13.5)	4,922	78	30.7 (17.3)	7,358
BP control ≤140/90 HTN	63	48.6 (16.4)	12,305	85	51.9 (16.0)	18,480
BP Control ≤140/90 IVD	32	67.4 (16.3)	650	46	69.7 (20.1)	868
Cholesterol Control <100 gen pop	14	63.4 (22.5)	573	48	52.2 (21.3)	3,145
Cholesterol Control <100 IVD,DM	15	65.3 (18.5)	874	37	62.4 (15.7)	1,879
Breast cancer screening	16	4.5 (5.8)	6,346	51	5.2 (7.9)	22,034
Colorectal cancer screening	8	1.9 (1.3)	4,126	46	3.9 (6.2)	22,008
Influenza vaccine (over 50)	48	22.6 (18.4)	25,550	70	15.6 (15.2)	38,431
Pneumococcal vaccine	66	9.8 (13.0)	27,352	98	9.8 (13.5)	45,641
Smoking cessation intervention	45	19.0 (14.5)	4,798	79	29.7 (23.6)	8,253

*A population estimate was derived by summing across practice denominators per measure

 

Slide 17

Questions?

Contact: sshih@health.nyc.gov

Visit: www.nyc.gov/pcip