1. The use of EMR tools in IFH’s Diabetes Initiative
Elizabeth I. Molina Ortiz, MD MPH
Diabetes Medical Director, IFH
Mt Hope Family Practice

2. Objectives Simply having EMR in office is a good start, but not enough
Studies have demonstrated no difference between paper charts and adoption of EMR (without decision support)
Need to add decision-support tools for improved care

3. Objectives
The following slides will demonstrate two types of decision support:
Actionable during patient encounter
Guide outside of patient encounters

4. EMR tools to improve care to patients living with diabetes
At patient encounter:
Nursing BPA for monofilament and A1c testing
Physician and CDE Smartsets for easy documentation and ordering
Outside of patient encounter:
IFHstats
Track clinical measures by site or by provider
Easily identify at risk patients from panel
Identify disparities in outcomes

5. During encounter: nursing BPAs

6. During patient encounter: nursing BPAs
Automatic review of chart, actionable orders appear if A1c or monofilament testing needed
Completed prior to provider visit

7. During encounter: Smartsets

8. During encounter: Smartsets
In one screen, provider prompted to choose note (which prompts appropriate documentation), labs, referrals, diagnosis and LOS

9. Outside of patient encounter: Diabetes Registry
Important first step towards monitoring care at population level
Versatile, vast amount of information
Basis for IFH stats

10. Outside of patient encounter: IFHstats
IFHstats allows us to:
Monthly track individual patient’s important diabetes clinical markers (10 markers based on NCQA DPRP)
Monthly track population’s clinical markers (presented by provider, clinic, or institute-wide)
Track progress towards meeting national goals
Determine when ready for application and accreditation

11. IFHstats: Easily accessible

12. IFHstats – Track Progress by Site

13. IFHstats – Site lists active providers

14. IFHstats – or by provider

15. IFHstats – Areas for improvement highlighted

16. IFHstats – Easily review diabetic panel and clinical markers

17. IFHstats – Download and sort data

18. IFHstats – Identify disparities

20. IFH’s Diabetes Initiative: Notable Improvements (Nov – March)
Ability to monitor patient population in important clinical markers
Westchester increase rate of A1c<7% by 10%
Amsterdam decreased rate of A1c >9% by 11%
Mt Hope increased rates of ophthalmology consults by 7%
Sidney Hillman increased rate of neuropathy screen by 21%
62% patients at Phillips screened for nephropathy (up by 12%)
Ability to use PDSA cycle, monitor progress, identify success, and propagate it