1. Together.Today.Tomorrow. The BLUES Project Karen C. Fox, PhD Chief Executive Officer

2. BLUES Overview Better Life Utilizing Electronic Systems Better Life Utilizing Electronic Systems Purpose Purpose Demonstrate the effects of diabetes management practices Ambulatory clinics in rural and urban settings Utilizing well-designed, comprehensive health information technology

3. What are the major factors that are driving a need for EHR systems from a management/administrative perspective? http://www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

4. Significant increase over last year In solo and small practices motivated to implement EHRs Increase in the use of almost all data capture methods Especially structured data entry High level of implementation plans for e- prescribing, remote access to EHRs, and order entry placed by nurses or staff The Current State of EHR Implementation in the US http:// www.providersedge.com/ehdocs/ehr_articles/EHR_Trends_and_Challenges.pdf

5. The BLUES Target Service Area

6. BLUES Overview Research Aims Research Aims Successfully implement EHRs in diabetes management clinics, focusing on integration of the EHR into clinician workflows. Evaluate the impact of the EHR system on clinical processes of care and patient outcomes. Produce and distribute a generalizable, replicable model of care for implementing an integrated health IT system for diabetes management care throughout the U.S.

7. BLUES Overview Hypotheses Hypotheses Provider use of an EHR system will increase Patient use of EHR will increase Adding an EHR system to an existing model will significantly improve medication management. Adding an EHR will also improve other process-of-care measures. Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care.

8. Understanding Data: Road Maps to Successful Outcomes

9. BLUES Overview Create Systems Collect Baseline Track Outcomes Implement Systems Collect Data Evaluate Processes Evaluate Outcomes

10. CREATE EHR Analytic Modules Where to look for data Chart reviews Creating harmony within the existing system and new system Tracking mechanisms

11. IMPLEMENT

12. Clinic infrastructure Network Infrastructure in Rural Communities Current workflow and staff Lack of patient management systems Staff concerns Training and installation Single physician clinics Clinician Acceptance / Buy-In Challenges to EHR Implementation

13. Privacy and Security HIPAA Compliance Limited capability of IT Host Facility Unreliable data center infrastructure Need to build redundance Servers and networking support Infrastructure support by health care facilities (single physicians, etc.) Challenges to EHR Implementation

14. Loss of Network Service Provider Reliable Health Technology Equipment Operators at Remote Locations Key Personnel Changes Changes in Clinic Location Challenges to EHR Implementation

15. Equipment Maintenance in Remote Locations Availability of Qualified Staff Data Acquisition Provider responsibility for maintenance Access by DHA and external evaluators Challenges to EHR Implementation

16. COLLECT

17. Data Collection Methodology Assessment of longitudinal change Collection time Reporting the data Data Issues

18. Disparate practice management systems Workflow management Data elements captured EHR design modifications Required for unique measures Access to external data Medicaid Evaluating cost / benefit outcomes Data Challenges

19. Tracking Outcomes Provider use of an EHR system will increase Measure: % of visits where EHR was used Information captured by the EHRs Measure: Use of quality measurement reports Information not captured because Analytics Module was not purchased Overcame barrier by establishing audit trail

20. Tracking Outcomes Patient use of EHR will increase Measure: % of patients who access their personal health information, including medication therapy Cannot capture data because the Interactive Module was not purchased Must develop new measure to capture impact on patients

21. Tracking Outcomes Adding an EHR system to an existing model will significantly improve medication management. Measure: Formulary compliance - % of prescriptions complying with formulary Captured by EHR Analytics Module Measure: Patient Compliance with medication Determined by EHR - # filled/#prescribed

22. Tracking Outcomes Adding an EHR will also improve other process-of-care measures. Measure: % of patients receiving appropriate care for treatment Captured by EHR Analytics Module Is determined by nationally recognized medical standards of care – American Diabetes Association

23. Tracking Outcomes Adding an EHR will improve patient satisfaction, diabetes-related outcomes, and patient safety, and reduce costs of care. Measure: Patient Satisfaction improved Determined by primary data collection Measure: Diabetes outcomes Lipid profiles, BP, A1c, etc. all captured by EHR as specifically designed for the clinics

24. LESSONS LEARNED

25. Network / internet speed and capacity is critical WAN Optimizers Providers may resist financial commitment of any amount IT vendor territory issues Local business loyalty in small communities Lessons Learned

26. Have clinic personnel on your planning and evaluation committees Be flexible with training staff Design and modify current systems Have contingency plans Lessons Learned

27. When you have all of this, you impact clinic and community success! When you have all of this, you impact clinic and community success! Successful EHR Implementation + Better Patient Outcomes = Healthy Community

28. Logic Model ActivitiesOutputs Outcomes Impact Cooperation and collaboration EHR implementation System training Data collection and reporting Existing medical structure Traditional clinic system Traditional hospital structure Information infrastructure Networks and Servers Expanded services and access Patient and provider satisfaction Improved workflow Provider enrollment Reduced health care costs for providers and patients Improved chronic disease outcomes Inputs 28 Patient Health Outcomes Reduced Cost of Care Increased medical homes Increased productivity Improvement in ratio of clinicians to population

29. Together.Today.Tomorrow.