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Public Health IT Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture.

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Presentation on theme: "Public Health IT Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture."— Presentation transcript:

1 Public Health IT Public health enabled Electronic Health Records, Decision Support, and Their Role in the Meaningful Use of Healthcare Technology Lecture b This material (Comp13_Unit4b) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000003.

2 EHRs, Decision Support, and Meaningful Use of HIT Learning Objectives 2 Demonstrate knowledge of public health-oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting (Lecture b) Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the "meaningful use" legislation (Lecture b) Identify the essential features of four primary public health IT functions including syndromic surveillance, bi- directional immunization registries, public health alerts, ad-hoc reporting, etc. (Lecture b) Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

3 8 Key Features of ECW 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 4. CDSS Automatically displays preventive service alerts that are suppressed when addressed 3. Automatic Visual Alerts Highlights abnormal vitals 2. Enhanced Registry Identifies patients by structured data (e.g., diagnoses, drugs, labs, demographics) 1. Measure Reports Side-by-side provider comparisons of performance on quality measures

4 8 Key Features of ECW (cont.) 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 8. Medication History With patient consent, displays a medication history of all Rxs filled by the patients 7. CIR and School Health Sends information to City Immunization Registry & generates school health forms 6. Comprehensive Order Sets Displays best practice recommendations (e.g., for meds, labs, patient education) 5. Quick Orders One-click ordering of recommended preventive services

5 The following storyline… 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b Illustrates these Public Health-enabled EHR functions in action Jane Doe, a 48 year-old woman is cared for by her family practitioner, Dr. Sam Willis

6 Measure Reports Using the QUALITY MEASURE REPORTS FUNCTION, Dr. Willis finds that only one-third of his hypertensive patients have achieved good BP control. (Buck, 2010.) 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Dr. Willis wants to find out how he is performing compared to other physicians in his practice in controlling high blood pressure for his patients.

7 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets 7. CIR and School Health8. Medication History Using the ENHANCED REGISTRY FUNCTION, Dr. Willis identifies five patients with high blood pressure who do not have an appointment scheduled, and reaches out to each patient; he generates a letter scheduling a follow-up visit with patient Jane Doe. (Buck, 2010.) 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b Dr. Willis wants to improve his score on BP control and queries the EHR to identify patients with poorly controlled hypertension. Enhanced Registry

8 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Jane Doe receives the letter and makes a f/u appointment During the visit, Dr. Willis’s assistant takes her history and vitals Jane mentions that she has had a few weeks of excessive thirst and fatigue Jane’s blood pressure is elevated (150/90) and highlighted in red by the AUTOMATIC VISUAL ALERT FUNCTION. Dr. Willis can trend her BP over time. (Buck, 2010.) Automatic Visual Alert

9 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Based on Jane’s new diagnosis of diabetes, the CLINICAL DECISION SUPPORT FUNCTION identifies four preventive care services that should be performed. This list of services is automatically populated in the CDSS panel. (Buck, 2010.) 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b Based on Jane’s chief complaint of excessive thirst, Dr. Willis performs a fingerstick test and confirms his suspicion that Jane has diabetes Dr. Willis enters a diagnosis of diabetes into the EHR CDSS

10 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Dr. Willis agrees that these tests are appropriate and should be performed Dr. Willis uses the QUICK ORDER FUNCTION to order an HbA1C test for Jane, as well as a flu vaccine; the alerts disappear from the panel once they are ordered. Dr. Willis may also choose to suppress alerts, if he deems them unnecessary. (Buck, 2010.) Quick Orders

11 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets 7. CIR and School Health8. Medication History Dr. Willis also selects the “LDL control (high risk)” alert, which displays the order set for high LDL levels The 1 st part of the COMPREHENSIVE ORDER SET displays a selected list of recommended medications (brand & generic) for lipid control. (Buck, 2010.) Comprehensive Order Set (Pt I)

12 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Dr. Willis views other order sets for high LDL levels The 2 nd part of the COMPREHENSIVE ORDER SET displays a selection of recommended labs, immunizations, follow-up appointments, referrals as well as printable physician and patient education materials. (Buck, 2010.) Comprehensive Order Set (Pt II)

13 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History While she’s there, Jane asks Dr. Willis for a school health form for her 5 year- old (Tim) who is entering day care. Dr. Willis generates a preloaded NYC School Health form populated with Tim’s information for Jane to take with her. CIR and School Health

14 Citywide Immunization Registry Tim’s information has already been automatically uploaded to the CITYWIDE IMMUNIZATION REGISTRY. The CIR will maintain a complete record of Tim’s immunizations which can be accessed by other providers as needed. (Buck, 2010.) 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

15 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b 1. Measure Reports2. Enhanced Registry3. Automatic Visual Alerts4. CDSS 5. Quick Orders6. Comprehensive Order Sets7. CIR and School Health8. Medication History Dr. Willis wonders if he should change Jane’s medication regimen to better control her lipids and wants know what medications have been filled by her Jane has signed a consent form to give the provider access to her medication history Dr. Willis can use the Medication History function to view her 90-day medication history. He notices that Jane has not filled her lipid medication (simvastatin) for the past three months; she admits that she has stopped taking them because she wondered if her tiredness might have been due to these pills. (Buck, 2010.) Medication History Function

16 Public Health Meaningful Use Functions 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b Syndromic Surveillance Immunization Registries Public Health Alerts & Ad- hoc Reporting

17 Syndromic Surveillance Syndromic surveillance is a Meaningful Use function 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

18 Syndromic Surveillance System The syndromic surveillance system was designed and built in Sept/Oct 2008 by PCIP and deployed in November 2008 Syndromic definitions for Influenza-like Illness (ILI), Fever, and Gastrointestinal Illness are encoded using MySQL database queries Executed in a nightly batch job, with results reported securely through SFTP to PCIP 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

19 System Screenshot (Buck, 2010.) 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

20 Syndromic Data 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b Only “Count Data” is collected Table 1.1 Measure IDMeasure NameReport Date TimeAge GroupPatient NumeratorPatient Denominator 9000ILISyndromic1/23/2010 22:50b_2to4years02 9000ILISyndromic1/24/2010 22:50d_12to16years03 9000ILISyndromic1/25/2010 22:50e_17to44years02 9000ILISyndromic1/26/2010 22:50h_AllAges19 9001FeverSyndromic1/27/2010 22:50a_0to1years12 9001FeverSyndromic1/28/2010 22:50b_2to4years02 9001FeverSyndromic1/29/2010 22:50d_12to16years03 9001FeverSyndromic1/30/2010 22:50e_17to44years02 9001FeverSyndromic1/31/2010 22:50h_AllAges19 9002InfluenzalCD9ONly2/1/2010 22:50a_0to1years02 9002InfluenzalCD9ONly2/2/2010 22:50b_2to4years02 9002InfluenzalCD9ONly2/3/2010 22:50d_12to16years03 9002InfluenzalCD9ONly2/4/2010 22:50e_17to44years02 9002InfluenzalCD9ONly2/5/2010 22:50h_AllAges09 9100GISyndromic2/6/2010 22:50a_0to1years02 9100GISyndromic2/7/2010 22:50b_2to4years12 9100GISyndromic2/8/2010 22:50d_12to16years03 9100GISyndromic2/9/2010 22:50e_17to44years02 9100GISyndromic2/10/2010 22:50h_AllAges19

21 7 Day Average % of ILI Visits by Age Group (Buck, 2010.) 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

22 All Ages % of Visits Related to ILI (Buck, 2010.) 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

23 EHRs, Decision Support, and Meaningful Use of HIT Summary – Lecture b This lecture has shown that a combination of measure reports, registry tool, visual alerts, clinical decision support, order sets, CIR, and medication history all enable a clinical provider to practice good preventative follow- up care in-line with public health priorities. It has also shown how EHR data could be used to detect the H1N1 flu outbreak in New York City. 23 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

24 EHRs, Decision Support, and Meaningful Use of HIT References – Lecture b References 1.Plagianos M, Buck MD, et al. Syndromic Surveillance during Pandemic (H1N1) 2009 Outbreak. Emerging Infectious Diseases. 2011 Sept;17(9).1724-6. 2.Amirfar S, Taverna J, Anane S, Singer J. Developing Public Health Clinical Decision Support Systems (CDSS) for the Outpatient Community in New York City: Our Experience. BMC Public Health. (Accepted for publication) Images Slide 6-14 & 18: Buck, M. (2010). Example images of eclinicalworks: personal desktop. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 20: Buck, M. (2010). 7 Day average percent of ILI visits by age group. New York Department of Health and Mental Hygiene, Primary Care Information Center. Slide 21: Buck, M. (2010). All ages percent of visits related to ILI. New York Department of Health and Mental Hygiene, Primary Care Information Center. Charts, Tables, Figures 1.1 Table: Buck, M. (2010). Syndromic data. New York Department of Health and Mental Hygiene, Primary Care Information Center. 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Public Health IT EHRs, Decision Support, and Meaningful Use of HIT Lecture b

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