1. Evaluating the Impact of Health IT Interventions in OKPRN Zsolt Nagykaldi, PhD University of Oklahoma Health Sciences Center Department of Family and Preventive Medicine Oklahoma Physicians Resource/Research Network (OKPRN)

2. OKPRN Health IT Portfolio  Strong commitment to develop, test, and disseminate HIT solutions since 2000  Over a dozen solutions have been developed (patient registries, clinical decision support tools, chronic disease management, influenza surveillance system, task management, a patient Wellness Portal, and a third-generation HRA tool)  PBRN leadership includes a PhD faculty programmer & developer  Focus on patient and practice utility, quality improvement, and cost-saving

3. A Current Example: My Wellness Portal  “My Wellness Portal” is a web-based, integrated, and connected patient self-management tool  Personalized (and soon prioritized) preventive service recommendations, tracking of wellness parameters, secure messaging with the PCP’s office, and patient education  Practice is fully in the loop via a clinician portal  Portal is integrated into a novel care delivery approach (via system-level redesign)

4. Wellness Portal RCT - Evaluation of the Impact of Portal Implementations  Goal of the Portal implementation: to improve the quality, safety, and patient-centeredness (patient value) of care  In addition: we improve the delivery system by practice redesign around the new technology (a necessary step)  Although technology is only a tool that empowers patients and practices, its implementation is a good opportunity to help transform practices to truly patient-centered medical homes

5. Health IT – A New Opportunity to Address Old System-Level Problems CCR Wellness Portal CCR HRA: Health Risk Appraisal; EHR: Electronic Health Record; CCR: Continuity of Care Record PSRS: Preventive Services Reminder System Risk Processor (HRA) Prioritizes available interventions from clinical guidelines by outcome and size of effects Prioritized Recommendations Lists Wellness Plan Decision Support Tool Link to Resources Task Manager Registry, reminder, and recall system (PSRS) Lab results, consults and referrals Billing System, EHR Personal attributes, values, goals, preferences, constraints ClinicianPatient Wellness nurse Evidence-based guidelines and population statistics

6. Impact of the Portal Intervention: What do we measure?  Quality & safety of preventive care (or appropriateness of services): “The right and value-added service delivered to the right patient at the right time, efficiently.”  Patient-centeredness of preventive care: “The patient’s personal care experience and its effect on the patient’s health status.”  Improvements in preventive service delivery: “Any care related to the future requires the same essential delivery system elements in primary care practices (e.g. primary, secondary, tertiary prev.)”

7. Impact of the Portal Intervention: How do we measure them?  Quality & safety: compare delivered care with personalized, evidence-based recommendations from an informed and integrated risk engine  Patient-centeredness: CAHPS ® Clinician and Group Survey; Patient Activation Measures (PAM) instrument (patient knowledge, confidence, and self-efficacy); patient focus groups  Improvements in preventive service delivery: Adapted Assessment of Chronic Illness Care (ACIC) tool; clinician semi-structured interviews CAHPS-A: Consumer Assessment of Health Plan Surveys – Ambulatory version

8. Impact of the Portal Intervention: The Nitty-Gritty Details  An important lesson we learned from the Portal implementation: Patients’ computer and Internet literacy must be gauged very carefully at the beginning of their participation. Patient tiers must be identified and assisted in a targeted fashion: Tier I: “I push that button and my e-mail thing comes up…” Tier II: “I have e-mail and often browse the Net for info…” Tier III: “I do online banking and account management…” Tier IV: “I am not stopped by error messages, I know how computers work and I can fix most problems…” Tier I-II intervention: phone & e-mail support (basic) + 15-minute tutorial video CD + interactive online help

9. The Future: “Phase IV” in Health IT Studies?  Longitudinal and state-wide or national evaluations through dissemination projects linked to original R&D initiative  PBRNs are ideal “experimental farms” for Health IT dissemination and “post-release” studies  Dissemination of knowledge, technology, and resources / support, require a national innovation dissemination system which is not available for healthcare (see: Agricultural extension model)  Evaluation of population impact of Health IT could be done through the same dissemination infrastructure via a built-in QI/QA mechanism

10. Summary  The purpose, role, and goal of Health IT must be chosen properly and defined clearly  Health IT must be integrated “organically” into a more effective and efficient (redesigned) care delivery system as a tool for specific purposes (empowerment / support of processes)  The impact of Health IT must be evaluated from multiple angles and with multiple methods (especially in complex primary care settings)  We desperately need a national knowledge and innovation dissemination & QI infrastructure akin to the Agricultural Cooperative Extension Service