1. Health Information Technology to Support the Patient-Centered Primary Care Medical Home: UNC Experience Sam Weir, MD UNC Family Medicine Center Director

2. Objectives Illustrate our current use of HIT to support PCMH »EMR »Email portal »Chronic disease registry Discuss our hopes for future use of HIT to support PCMH »Patient portal (for results, messages, scheduling appointments) »Expanded registry function »Patient entered histories Summarize with lessons learned

3. UNC Webcis: Patient Record

4. UNC Webcis: Problem List Tab

5. UNC Webcis: Allergy Tab

6. UNC Webcis: Patient Record

7. UNC Webcis: Activity List Function

8. UNC FMC Email Portal

9. UNC FMC Chronic Disease Registry Diabetes, CHF »Based on freeware from Washington State »DEMS, CVDEMS, CDEMS Home :: Improving Chronic Illness Care cdems.com: Chronic Disease Electronic Management System information & user discussioncdems.com: Chronic Disease Electronic Management System information & user discussion Key functions: »Point of service decision support for care team Pre-visit planning Standing orders »Outreach (ex: mailing to encourage flu shots) »Quality reporting and targeted outreach Phone calls to those with A1c>9.0

10. CHF Registry Encounter Form Decision Support Trends of weight, bp, bnp, ejection fraction Lab download from EMR Clinical Data from Chart Audit

11. Quality reports from CVDEMS, Excel

12. Plans for further development: Patient Portal/Referring MD Portal Patient Portal Plans Access for patients to portions of their own records »Lab Results »Radiology Results Improved email portal Improved ability to schedule appointments Referring MD Portal Access for outside referring MD’s to initiate referrals, review their patient’s charts Barrier: Resources

13. Plans for further development: Expanded Registry Function Migrate from CVDEMS to CDEMS »Improved ability to do tailored patient action plans in support of self management »Improved ability to tailor registry encounter forms Switch from weekly downloads from Webcis to feed from UNC’s data warehouse »Expanded ability to pull data into the registry »Expand registry to include preventive services »Barrier: institutional reluctance to share data

14. Plans for further development: Patient entered histories An expanded patient portal »Instant Medical History - Patient Interviewing Software and EMR Productivity ToolInstant Medical History - Patient Interviewing Software and EMR Productivity Tool Barriers »Interfaces with Webcis

15. Lessons Learned Progress is slow (two steps forward, one back) »Example: Who is the patient’s doctor? Persistence is a virtue Solutions can come from a variety of sources »Institutional »Departmental »Freeware from foundations »Vendors