1. THE IMPACT OF HEALTH INFORMATION TECHNOLOGY ON QUALITY IMPROVEMENT
THE INSTITUTE FOR FAMILY HEALTH
Kwame A. Kitson, MD
VP of Quality Improvement
Institute for Family Health
16 East 16th St
New York, NY 10003
institute2000.org
www. institute2000.org
HIT Workshop
New York, NY
July 9, 2009

2. LEARNING OBJECTIVES
NOW THAT YOUR ORGANIZATION HAS ACCESS TO DATA, HOW DO YOU TRANSLATE THAT INTO MEANINGFUL USE ?
HOW CAN THE USE OF DATA AND REPORTING IMPACT PATIENT SAFETY ?
HOW CAN THE USE OF DATA AND REPORTING IMPROVE QUALITY MEASURES PERFORMANCE ?

3. MEANINGFUL USE OF HIT DATA
“MORE DATA = MORE PROBLEMS”

4. MEANINGFUL USE OF HIT DATA
A mountainful of data yet a finite amount of resources to handle it.

5. MEANINGFUL USE OF HIT DATA
“Beware lest you lose the substance by grasping at the shadow .” Aesop
Solution- Target measures and target resources in the most efficient ways possible.

6. MEANINGFUL USE OF HIT DATA
Electronic Patient Outreach Team Created
Outreach to 20,000 patients per year by telephone and mail based on clinical reporting.
Automatic Outreach is done year round for uncontrolled hypertensives, uncontrolled diabetics, patients with no visit greater than a year, drug recalls (i.e., VIOXX), delayed immunizations, cancer screening and ad hoc requests.
Funding primarily came from our improved performance on health plan CQI financial incentives. Later on, grant funding became available to sustain 2.0 FTE.

7. PATIENT SAFETY
DRUG RECALLS

8. THE IFH RESPONSE TO THE VIOXX RECALL
FDA SENDS AN ALERT BY
INTERNAL VIOXX REPORT GENERATED
664 PATIENTS IDENTIFIED VIA REPORTING
WITHIN 35 MINUTES OF RECEIVING FDA
ALL BUT SIX PATIENTS CONTACTED
BY TELEPHONE OR MAIL WITHIN 10 DAYS

9. AND CONTRAINDICATIONS
PATIENT SAFETY
DRUG INTERACTIONS
AND CONTRAINDICATIONS
INTERNAL EHR VENDOR LINKED DRUG- DRUG INTERACTION WARNINGS
CUSTOM REPORTING
ASTHMA PATIENTS ON BETA BLOCKERS
PREGNANT PATIENTS ON CLASS D OR X MEDICATIONS
BEERS CLASSIFIED MEDICATIONS IN THE ELDERLY

10. PATIENT SAFETY IDENTIFYING AND PREVENTING
INAPPROPRIATE MEDICATION PRESCRIBING
CUSTOM REPORTING
NARCOTIC ANALGESICS
METFORMIN IN PATIENTS WITH RENAL DISEASE

11. IDENTIFYING AND PREVENTING INAPPROPRIATE CODING
PATIENT SAFETY
IDENTIFYING AND PREVENTING INAPPROPRIATE CODING
CUSTOM REPORTING
PROBLEM LIST AUDIT REPORTS IDENTIFIED MISCODING OF PATIENTS (HIV, DIABETES).
THIS LED TO ENHANCEMENTS IN DECISION SUPPORT WHICH PREVENTED FURTHER REOCCURENCES.

12. PERFORMANCE IMPROVEMENT IN QUALITY MEASURES
MACROSOLUTIONS
(i.e. DECISION SUPPORT,
GLOBAL WORKFLOW
CHANGES)
ACCESS TO DATA
ALLOWS FOR
GREATER ABILITY
TO PINPOINT PROBLEMS
IDENTIFICATION OF DEFICIENT MEASURES
MICROSOLUTIONS
(i.e. INDIVIDUAL
PROVIDER ATTENTION)

13. PERFORMANCE IMPROVEMENT IN QUALITY MEASURES
CQI INTERVENTIONS ARE APPLIED WITH CONTINUED REASSESSMENT
DECISION SUPPORT ALERTS ACCOMPANIED BY WORKFLOW CHANGES.
IFH – AGGRESSIVE IMPLEMENTATION OF BEST PRACTICE ALERTS 9 MONTHS AFTER GO-LIVE

14. IFH BEST PRACTICE ALERTS
PRIMARILY BASED ON HEDIS CRITERIA
PneumoVax
Seasonal FluVax
Breast Cancer Screening
Cervical Cancer Screening
Lead Screening
HGBA1C Testing & Control

15. IFH BEST PRACTICE ALERTS
Ophthalmology consults for diabetics.
Peak Flow measurements for all asthmatics
Nephrology consults for patients with greater than 1.8 serum creatinine.
LDL Screening
Annual RPR Screening in HIV

16. PNEUMOVAX

17. COLORECTAL CANCER SCREENING
All sites listed were fully on the EHR as of Jan 2003

19. The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.
Michelangelo