1. PEHR ChartChart Claims Data Breadth and Depth Population Quality Measures

2. 2 Quality Improvement Measure Category CCNC QMAF Claims CCNC QMAF Chart Audit CHIPRA C - Chart Extraction Data CHIPRA D - PEHR Reporting Obesity PreventionBMI V-codes BMI percentiles. Evidence of Counseling. BMI percentiles. Evidence of Counseling. Blood pressure percentiles. Oral Health Dental visit (annual) & dental varnishing rates Documentation of dental home. Oral Health Risk Screen and counseling. Developmental and Behavioral Health Screening rates Maternal Depression Screen. Referral/follow-up done for positive screens. Early Periodic Screening Diagnosis and Treatment (EPSDT) Well-child visits and components Adolescent Immunizations. Well-child visits and components. Adolescent Immunizations. AsthmaAsthma management and utilization Asthma Action Plan recorded NC Evaluation Data to Support QI Measures

3. CHIPRA Team/Provider Assessment Provider SurveyVendor Self-Report ToolPatient Survey CompletenessFunctionEase of interpretation Patient experience of care Medical relevanceUseability Ease of implementation Satisfaction with implementation 3 Additional Measures NC Evaluation

4. High Level Plan - Practice Major Activities and Timeframes (approx.) Ongoing Activities Roles/Resources EHR Consultant EHR Coach Office Manager Lead Clinician Other Reps from practice Recruitment Introduction to Practice Brief overview of CHIPRA Review benefits Determine practice readiness Establish MoU 2-4 weeks QI ReportingBenefits RealizationReview and Feedback Lessons Learnt, Patient Surveys and Project Closure ReportingReporting Provide overview of CHIPRA Establish Team and Roles Confirm scope, process and benefits Introduction to & completion of survey tool Orientation & Assessment 6-8 weeks EHR Consultant EHR Coach Office Manager Lead Clinician Other Reps from practice Training on enhanced functionality Testing of system Reassess EHR capability & user satisfaction Assess patient satisfaction Testing & Implementation Testing & Implementation EHR Consultant EHR Coach Office Manager Lead Clinician Other reps from practice Vendor Analyze survey responses Assess QI Objectives and set Goals Identify Training, Development and Resource Needs Analysis EHR Coach Office Manager Lead Clinician Other Reps from practice 2-4 weeks Training Workflow re-design Enhance EHR Content & Functionality Ongoing Review and provide feedback on EHR development Design & Development Design & Development AHEC Rep EHR Consultant EHR Coach Office Manager Lead Clinician Other Reps from practice 4 – 6 months ………………….

5. Real-time reporting, prompts and care alerts Additional training and improved productivity using enhanced technology National recognition by helping influence the future of EHR and national policy Better clinical data capture, storage, and retrieval Practice Benefits

6. Sample Practice Survey EHR Currently Capable? Medically Relevant? Feature in Use?Use DetailEHR Coach Notes - KEAction Required Vendor APractice A Obesityheader Req-110 The system SHALL capture patient vital signs, including weight, height or length, head circumference, blood pressure, temperature, heart rate, respiratory rate, severity of pain, and calculate/store BMI as discrete elements of structured or unstructured data. Yes Strongly Agree Yes Req-111 The system SHALL calculate and display child age and percentiles and/or z- scores for height, weight, and BMI for measure instances included in growth charts. Yes Strongly Agree Yes Req-115 System MAY store and display waist circumference and hip circumference and calculate/display waist to hip ratio in patients identified with obesity or cardiovascular risk. No AgreeNoTraining NeededDevelopment Opportunity Req-1164 The system SHOULD incorporate documentation of pertinent family history to screen children at risk for common chronic conditions such as asthma and diabetes (Trotter & Martin, 2007) Yes Strongly Agree Yes Req-1170 The system SHOULD incorporate Chronic disease and age specific educational materials, for example diabetes and asthma (Spooner, 2007; Kim & Lehmann, 2008; Brown et al., 2010; Howe, 2005) YesPartially Strongly Agree PartiallyWork-around in use Materials not built in to current system. Must buy Pediatric Care Online to use interface. (S. Driver on 4/3/2013) Training Opportunity