1. 1 Colorado Associated Community Health Information Exchange Lisa Schilling, MD, MSPH AHRQ Annual Conference Sept. 8, 2008 Creating a Shared Quality Improvement Reporting System

2. 2 CACHIE Participants 14 Colorado federally qualified community health centers Colorado Community Managed Care Network Colorado Community Health Network Others

3. 3 Presentation Objectives Illustrate the use of business process analysis to inform user requirements

4. 4 CACHIE Goals To promote the use of information technology to support quality reporting and improvement across the CHC networks –To design, build, & implement a shared system for quality reporting among 6 CHCs with 4 disparate EMR/PMS –To assist CHC with EMR template implementation to improve care provision, documentation & measurement.

5. 5 Data Information Provide Care Document Care Measure Care Template

6. 6 What is a business process? Business process: A “business process” describes a set of activities and tasks that logically group together to accomplish a goal or produce something of value for the benefit of the organization, stakeholder, or customer. Dictionary

7. 7 Why Use Business Process Analysis? Everything is not as it appears to be: –Unintended internal and external consequences –It’s not just a “flip of the switch” –Technology must complement workflow Expectancy: –Exceeding capacities Fashion: –Unnecessary complexity –Remaining current Stakeholder interest: –Varying levels over time –Developing consensus

8. 8 Business Process Analysis Business Process Redesign Requirements Definition THINK How do we do our work now? Define goals and objectives Model context of work Identify business rules Describe tasks and workflows Identify common task sets RETHINK How should we do our work? Examine tasks and workflows Identify inefficiencies Identify efficiencies with repeatable processes Refine business processes and rules Remodel the context of work Restructure the tasks and workflow DESCRIBE How an information system can support our work? Define tasks to be performed for optimized business processes Describe the implementation of business rules Describe in words and graphics how an information system is to be structured Determine scope of next phase of activities Method

9. 9 BPA Example #1 Outcome:Provide a “fast food” customer with their order efficiently and receive payment.

10. 10 Amount Due Payment Order Detail Legend Order taker Greeting Change Order Burger Station Fry Station Drink Station Food inventory Supplies (wrappers) Food inventory Supplies (oil) Beverage inventory Supplies (straws, cups) Burger Order Fry Order Drink Order Burger Drink Fries Transaction Output Outcome Input Reports, receipts Restaurant Order Fulfillment Process Context Diagram Customer

11. 11 CACHIE BPA Purpose Align the Information system (IS) with the organization’s mission, –need a clear model of the desired outcomes and the business processes that result in those outcomes. IS should support and enhance business processes. Creating a shared system required that we understand CHC business process similarities and differences.

12. 12 CACHIE BPA Goals Develop a common definition of quality improvement reporting system Describe and visually document how quality improvement efforts are accomplished Describe how the quality improvement efforts will function with the quality IS Develop a list of functional requirements to drive information system design and implementation

13. On The Road Clinica Sunrise ValleyWide PeakVista HighPlains MountainFamily

15. 15 BPA Example #2 Outcome: Improve the provision and documentation of guideline concordant care in primary care clinic.

16. 16 Provide & Document DM Eye Care Goal: Provide DM pts guideline concordant care Objective: Ensure DM pts receive eye exams Business rules: Electronic referrals are not possible, referrals to both internal and external providers. Trigger: DM pt presents for care (other?) Task Set: Care for any acute needs, refer for DM care Outcome: Provide & document DM eye care

17. 17 Document Care Legend Provider Enter Eye Referral Internal Ophthalmologist External Ophthalmologist Med Records Referral to Retinal Exam documented Scan Transaction Output Outcome Input Quality Reports Providing and Documenting Guideline Concordant Care EMR- Codified, text, scan Diabetic Patient Ophth note

18. 18 BPA- other topics Lab ordering & results handling, Documentation of foot exams & self- management goals, Incorporation of new or modified guidelines into their patient care processes, into their EMR templates, into their quality reporting, Current methods of creating & using quality reports from EMR data, challenges and successes.

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20. 20 What We Learned Templates –Not uniformly available, –Require costly professional support to develop/modify, –Require lots of CHC staff time, –When available, not always used, –Not automatically linked with “forms” -> double data entry, –Desire for more & improved

21. 21 What We Learned- con’t Quality Reporting –Great variability among CHC capacity –Requires professional support ($$) to develop reports –Reporting limited by $$$ –Reporting limited by system –Desire for data (re-)use

22. 22 What We Learned- con’t Quality Reporting-2 –Analyze at provider, pod, clinic site, CHC level –Analyze discrete specified time periods –Track trends for individual patients –Provide pre-built reports (UDS, etc) –Easily create reports for individual CHC needs –Save & share built reports –Run “huddle” reports based on scheduled patients

24. 24 It Takes a Village… CACHIE Steering Committee Ross Brooks, Director Molly Brown, Manager Art Davidson, Co-Medical Director Jason Greer, HIT Director Molly O’Fallon, Clinical Quality Director Lisa Schilling, Co-Medical Director Dan Tuteur, CCMCN Ex. Director HIT Committee David Adamson, Mountain Family HC Kitty Bailey, CCHN Andrew Bienstock, Salud Family HC David Fleurquin, Pueblo Community HC Pete Gutierrez, Denver Health, Committee Chair Annette Kowal, CCHN Pete Leibig, Clinica Family Health Services Konnie Martin, Valley-Wide Health Systems, Inc. Pam McManus, Peak Vista Community HC Mitzi Moran, Sunrise Community Health Paul Olson, Peak Vista Community HC John Santistevan, Salud Family HC Pat Tellez, Metro Community Provider Network AHRQ Marybeth Farquhar

25. 25 Contacts CACHIE Project Manager Ross Brooks ross@cchn.org CACHIE Medical Directors Lisa Schilling lisa.schilling@ucdenver.edu Arthur Davidsonart.davidson@dhha.org