1. Contraception and Family Planning Content Profile IHE October 2013

2. The Problem Contraception is a major preventive health service Variables are not fully integrated into most EHR systems – Pregnancy intention – Method of contraception Resulting inefficiencies include: – Substantial back end work to extract/export data – Costs of adding custom fields – No standardized reporting mechanisms

3. Title X Family Planning Program HHS’s Office of Population Affairs Since 1970 Dedicated to providing contraceptive services and related preventive health services Grantees report key performance and utilization data on ~5 million patients seen in 4,300 clinical settings Reporting via the Family Planning Annual Report (FPAR)

4. Larger Reproductive Health Context Pregnancy intention and contraceptive method are essential health indicators for: – Primary and specialty care clinicians – Healthcare administrators – Academic researchers – Non-profit advocacy organizations – Local, state, and federal governmental entities Primary care providers use this data to: – Determine appropriate prescription meds for patients with chronic conditions – Encourage contraceptive use among patients with serious health problems

5. Benefits of Standardizing Ensures this important data is collected among reproductive-age patients in a systematic, structured, and more easily-extractable way Presence of method field encourages providers to address contraceptive needs of patient Standardized data collection allows for comparison across domains and the use of clinical quality measures

6. Health Center Use Case 1 Work-around 1 is to create a set of dummy CPT codes for contraceptive methods Approximately 22 additional codes added to paper billing sheet Entered into practice management system by billing staff Requires additional staff training/time Prevents vital data from being stored in EHR alongside related clinical information

7. Health Center Use Case 2 Work-around is to pay software vendor to add custom Pregnancy Intention and Contraceptive Method fields to EHR Costs up to $5,000 per field Custom fields cause problems during system upgrades including: – Additional time-consuming testing – Functionality issues – Need to update reports – Possible need to recreate the field with corresponding difficulties using historical data

8. Clinical Use Case Contraceptive method field may exist in EHR but might be stored on the Patient History template – During intake, Medical Assistant collects method in use prior to visit – Best practice is for clinician to record planned future method at end of visit – Clinician must leave the Assessment or Plan template and go back to the History template to record the data. – This step is time-consuming and frequently skipped, resulting in missing data and, possibly, in overlooking patient’s contraceptive needs

9. Patient Use Case 1 EHR does not contain a method field and a woman is not asked whether she wants to become pregnant in next year - her contraceptive needs are not addressed She leaves visit with no method and returns a short time later with an unintended pregnancy Unintended pregnancies are higher risk for poor health outcomes for both mother and child

10. Patient Use Case 2 Pregnancy intention fields do not exist in EHR and a woman desires pregnancy, but her pregnancy intentions are not addressed She may not receive vital preconception information such as: – Smoking cessation – Folic acid use – STD screening

11. OPA Title X Family Planning Program FPAR Forms & Instructions for Table 7 – http://www.hhs.gov/opa/pdfs/fpar-forms-and- instructions-2011.pdf SNOMED – ICD-9/10, CPT and HCPCS – Codes for some (but not all) contraceptive methods and for non-specific contraceptive encounters HL7 v2.x HL7 CDA Standards & Systems

12. IHE profile would have a greater likelihood of being accepted as part of the ONC's MU or CCHIT standards Clinical quality measures related to contraception will be depend on the existence of quality data Pregnancy intention and contraceptive use data are not currently easy to collect: – Sporadically collected – Difficult to collect this data well through CPT and/or ICD codes – Not all methods are dispensed or prescribed (e.g. abstinence or withdrawal) – Visit-level data (required by Title X) complicated- a method may be dispensed at one visit but still be in use at a subsequent visit Why IHE

13. Only way to address these data collection challenges is through the standardized use of fields specifically designed to capture the data required IHE profile process could address the content definition for these fields as well as potentially make workflow recommendations to address additional challenges in collecting complete and accurate data Why IHE

14. christina.lachance@hhs.gov peacockk@cfhc.org