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Indian Health Service Using Decision Support Effectively: Lessons from the Field Lisa Dolan-Branton, RN Indian Health Service Office of Information Technology/Chronic.

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Presentation on theme: "Indian Health Service Using Decision Support Effectively: Lessons from the Field Lisa Dolan-Branton, RN Indian Health Service Office of Information Technology/Chronic."— Presentation transcript:

1 Indian Health Service Using Decision Support Effectively: Lessons from the Field Lisa Dolan-Branton, RN Indian Health Service Office of Information Technology/Chronic Care Initiative AHRQ 2007 Annual Meeting Lisa Dolan-Branton, RN Indian Health Service Office of Information Technology/Chronic Care Initiative AHRQ 2007 Annual Meeting

2 Presentation Overview Indian Health System SettingIndian Health System Setting IHS Resource and Patient Management SystemIHS Resource and Patient Management System Clinical Decision Support in RPMSClinical Decision Support in RPMS Key Elements of a responsive HISKey Elements of a responsive HIS (so clinicians use it with every patient)

3 Mission and Goal Mission: to raise the physical, mental, social, and spiritual health of American Indians and Alaska natives to the highest level. Goal: to assure that comprehensive, culturally acceptable personal and public health services are available and accessible to American Indian and Alaska Native people.

4 The Indian Health System IHS 33 Hospitals 49 Health Centers 46 Health Stations Tribal 15 Hospitals 198 Health Centers 121 Health Stations 180 Alaska Village Clinics 34 Urban health care services and resource centers 1.8 million users (Federally Recognized Tribes) 56% AIAN rely primarily on IHS funded care (2000 census) $3.1 billion from FY 2006 Appropriations $628 million from Third-Party collections (2004)

5 IHS APPROPRIATIONS PER CAPITA COMPARED TO OTHER FEDERAL HEALTH EXPENDITURE BENCHMARKS IHS Forecast to Year of Last Published Data 2,101 3,753 3,965 3,832 5,184 5,454 6, Medical Care Non- medical

6 AI/AN Population by State, ,00 to 333,400 50,000 to 99,999 10,000 to 49,999 1,713 to 9,999 WA OR CA NV ID MT WY UT CO AZ NM TX OK ND KS NE SD AR MO IA MN GA TN MS AL LA MI OH INIL WI FL PA VA ME NY WV NC KY SC AK NH VT NJ DE MD HI American Indian and Alaska Native Population By State * Census 2000, One race (AI/AN) alone

7 COMMUNITY ORIENTED PRIMARY CARE Cultural & Spiritual Behavioral & Social Medical Care Public Health Water & Sanitation The Indian health care system is built on a broad spectrum approach to health. It starts with a base of fundamental public health and sanitation infrastructure. It provides inpatient and ambulatory medical services. It also integrates community-oriented programs promoting healthy behaviors and lifestyles.

8 COMMUNITY ORIENTED PRIMARY CARE HAS REDUCED AI/AN MORTALITY % % Decrease in Mortality Rates since 1973 American Indians & Alaska Natives US All Races US White Infant Mortality Rates 1973 – 2002 (25.0 to 8.5/1,000) 66% Reduction

9 Resource Patient Management System (RPMS)

10 Indian Health System Spectrum of CIS Use No RPMS No RPMS RPMS PCC with paper charts and centralized data entry RPMS PCC with paper charts and centralized data entry PCC+ with centralized data entry PCC+ with centralized data entry Partial use of EHR or other Electronic Medical Records Partial use of EHR or other Electronic Medical Records Fully implemented EHR Fully implemented EHR

11 Decision Support in EHR Order ChecksOrder Checks Med orders are checked for drug-drug interactions and allergiesMed orders are checked for drug-drug interactions and allergies All orders are checked for duplicate ordersAll orders are checked for duplicate orders Prescribing Restrictions / GuidancePrescribing Restrictions / Guidance Prescribing guidelines in pharmacy package accessible to prescribers (see screenshot)Prescribing guidelines in pharmacy package accessible to prescribers (see screenshot)

12 Oral Contraceptive Help

13 Decision Support in EHR (contd) Info ButtonInfo Button Customizable links to web pages from POV (diagnosis) and Patient Ed componentsCustomizable links to web pages from POV (diagnosis) and Patient Ed components Can be configured to insert selected text into web sites search functionCan be configured to insert selected text into web sites search function RemindersReminders National or locally createdNational or locally created Health maintenance or condition-drivenHealth maintenance or condition-driven Reminder Dialogs enable simultaneous resolution of reminders (orders, education, etc.) and documentationReminder Dialogs enable simultaneous resolution of reminders (orders, education, etc.) and documentation

14 EHR v1.1 Supports Web Link Information button on POV and Education components

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18 Patient Wellness Handout Immunizations due Weight, Height, BMI Blood pressure Allergies Current medications

19 Patient Wellness Handout

20 EHR Physician Study Setting 26 IHS health centers implementing EHR between June 2003 and December % federally operated, 31% tribal health centers Mountain – 58% Pacific – 19% West south central – 12% South atlantic – 8% West north central – 4% Median number of physicians per clinic: 5.0 (IQR 2-19) Median number of NP/PA per clinic: 2.0 (IQR 1-6)

21 Impact of EHR on Quality Agreed (%)* EHR helps to improve quality of care EHR helps to improve patient safety EHR decreases quality of physician-patient interaction EHR creates less time to talk with patients in the office * At least 4 on a 5 point Likert scale

22 Use of Key EHR Functionality

23 iCare: Population Management GUI

24 iCare - Pre-Planning

25 iCare - Patient Panels

26 iCare - Flags

27 iCare - Panel Outcomes

28 RPMS Behavioral Health Applications Functions Documentation of individual and group encountersDocumentation of individual and group encounters DSM IV-TR Axis I – V Diagnostic CodingDSM IV-TR Axis I – V Diagnostic Coding Treatment PlansTreatment Plans Case Management InformationCase Management Information Suicide data collectionSuicide data collection Ability to document non-direct patient care activities such as community education, Performance Improvement, clinical supervision, training, etc.Ability to document non-direct patient care activities such as community education, Performance Improvement, clinical supervision, training, etc. Robust reports module: workload, case management, condition-specificRobust reports module: workload, case management, condition-specific

29 Future Clinical Decision Support

30 Key Elements of Responsive CDS HIT solution can drive improvement at each patient visit HIT solution can drive improvement at each patient visit Vision of a HIT system that provides you with the ability to manage patients, communities and populations within your mission context Vision of a HIT system that provides you with the ability to manage patients, communities and populations within your mission context Value of requirements development with Clinicians Value of requirements development with Clinicians Clear and specific requirements that put the clinical and public health needs at the center of the specification and programming process Clear and specific requirements that put the clinical and public health needs at the center of the specification and programming process Rapid cycle development Rapid cycle development Like a good community organizerbecomes background noise Like a good community organizerbecomes background noise Its not about IT Its not about IT

31 Lisa Dolan-Branton, RN QUESTIONS? QUESTIONS? QUESTIONS?


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