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Meeting Quality Standards with the Next Generation of EHRs 4th National HIT Summit March 30, 2007 Michael S. Barr, MD, MBA, FACP Vice President, Practice.

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Presentation on theme: "Meeting Quality Standards with the Next Generation of EHRs 4th National HIT Summit March 30, 2007 Michael S. Barr, MD, MBA, FACP Vice President, Practice."— Presentation transcript:

1 Meeting Quality Standards with the Next Generation of EHRs 4th National HIT Summit March 30, 2007 Michael S. Barr, MD, MBA, FACP Vice President, Practice Advocacy & Improvement Division of Governmental Affairs & Public Policy American College of Physicians Email: Phone: 202-261-4531

2 What Is the Definition of Quality? Doing it right when no one is looking. Henry Ford

3 What Should EHRs Facilitate? zClinical care yClinical decision support zDocumentation/Coding zData reporting yRetrievable yReportable across conditions yIdentify groups and subgroups zImprovement

4 Barriers to Health Information Technology Adoption for Quality zCost zLack of financial incentives* zComplexity of systems (lack of standards) zPrivacy, confidentiality and security zLegal issues (e.g., Stark laws; medical liability) *Most important factor Bates, D: The quality case for information technology in healthcare BMC Medical Informatics & Decision Making 2002, 2:7

5 The Local Environment: Redesign Challenges in the Office zPractice environment yFinancial (cost) yPersonnel/Staffing yTechnology limitations zKnowledge/Awareness zSkills zMotivation

6 Asymmetric Information Leads to Caution…But Opportunities to Narrow the Knowledge Gap* Research Demos CCHIT HITSP AHIC EHR VENDORS Research Demos CCHIT HITSP AHIC Gap Knowledge/Information Time *Not drawn to scale...

7 7

8 Operations Issues zCommunication (dis)connections yInternal and external xDifficulty obtaining information from specialists and hospitals zMedical records risks zPractices generally do not use two identifiers on all patient-related materials (paper charts) zSample medication storage is variable and logs for sample distribution are rarely used

9 HIT Issues zEven EHR-enabled practices still use paper zEHR work-arounds abound ze-Rx implementation issues zRegistries: Most practices (paper & EHR) are not able to aggregate data by condition for use in clinical quality improvement zLab interfaces are difficult to establish for many practices zScanning documents is often not as helpful as initially thought

10 Summary of CPI Observations zEffective practices have well-trained and empowered non-clinician leader zInformation, idea and training gaps zMulti-tasking is taken to a new art form zHealth IT not the panacea most hope it would be yPractices havent maximized the use of paper zPractices are generally motivated and interested, but challenged to find time to fix the issues that are stealing their time

11 Patient-Centered Medical Homes zOrganize the delivery of care for all patients according to the Care Model zUse evidence-based medicine and clinical decision support tools zCoordinate care in partnership with patients and families zProvide enhanced and convenient access to care zIdentify and measure key quality indicators zUse health information technology to promote quality, safety & security of information zParticipate in programs that provide feedback on performance & accept accountability for process improvement and outcomes

12 Flow sheets >>> E-registry >>> EMR >>> HIE Rx Pad/Pen >>> e-Rx (alone) >>> EMR+eRx Books/charts >>> Handheld PDA >>> EMR + CDS Pre-Printed Education >> Computer-generated >> Customized + SMGs Appts. by Phone >>> Advanced Access >>> PHR + Web-based portal Visit-based care >>> Scheduled phone/email >> Remote monitoring Limited data review >> Dashboard >>> Benchmarking >>> Reporting EMR = Electronic Medical record HIE = health information exchange CDS = clinical decision support e-Rx = electronic prescribing PDA = personal digital assistant SMGs = self- management goals PHR = personal health record Practice Evolution …

13 NCQA Physician Practice Connections - Not Condition-Specific

14 PPC Continued...



17 Partial EHR Wish-List zPrompt collection of key data elements through multiple methods zProvide for data entry by multiple sources (patient, family – if permitted by patient; staff; populated by filtered claims) zPresent data in standardized format zPrompt for missing data based on clinical diagnoses zPre-visit presentation of data based on schedule; facilitate team huddle zContext sensitive clinical decision support that incorporates patient- specific preferences expressed through structured queries of patient and advance directives zAutomated presentation of patient clinical data versus benchmarks zEconomics/costs – transparency; presentation of data to both patient and clinical team

18 EHR - Poka-yoke zPoka-yoke - pronounced "POH-kah YOH-keh" means "fail-safing" or "mistake-proofing" avoiding (yokeru) inadvertent errors (poka)) is a behavior-shaping constraint, or a method of preventing errors by putting limits on how an operation can be performed in order to force the correct completion of the operation. The concept was originated by Shigeo Shingo as part of the Toyota Production System. Originally described as Baka-yoke, but as this means "fool- proofing" (or "idiot proofing") the name was changed to the milder Poka-yoke. One example is the inability to remove a car key from the ignition switch of an automobile if the automatic transmission is not first put in the "Park" position, so that the driver cannot leave the car in an unsafe parking condition where the wheels are not locked against movement.behavior-shaping constraint errorsShigeo ShingoToyota Production System

19 Questions?

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