Maximizing EHR for Research & Care Quality

1. & Present “How to use EHR for Research and Quality of Care Initiatives”

2. Clinical Research • Provides advanced care options to patients at no cost • Enables Physicians to become knowledgeable of “cutting edge” therapies for their patients • Provides an additional revenue stream to the clinic in this time of reduced reimbursement.

3. Factors Affecting Providers Participation in Research • Demands of Clinical Practice • Limited Awareness of Trials • Time Constraints for evaluating study feasibility • Remembering inclusion/exclusion criteria • Difficulty following enrollment procedures

4. Reasons Patients Participate in Clinical Research • Recommended by their doctor • Advancing medicine or medical knowledge • Helping others with disease • Obtaining better treatment • Education about their condition or treatment

5. Research Facts • A Harris poll in 2003 showed less than 10 % of the US population has ever participated in clinical trial, but 77 % say if asked they would consider it • Only 16 % of adults believe they have ever had the opportunity to participate in clinical trial, but 10 % of this group did participate when approached

6. Clinical Trial Feasibility • Depending upon the type of database search capabilities of their EHR, a Physician or Research Department Manager may take anywhere from 4 to 12 hours to determine if a study is viable based on the study parameters and the clinic’s patient population

7. Patient Eligibility • Research nurse coordinators typically spend 20 to 24 hours a week reviewing charts to determine patient eligibility for a research study. • On average less than 3% of charts prescreened are enrolled in studies!

8. Provider Notification • Currently many clinics use visual aids such as whiteboards, note cards to carry, and flyers in exam rooms to assist the physicians memory of enrolling clinical trials. • Studies show patients are more likely to enroll if the clinical trial is discussed with the patient during their office visit.

9. Patient Retention • Once a patient is enrolled in a clinical trial many events may occur that can cause the patient to be disqualified and dropped from the study. • These events include disallowed medications and timing of labs or procedures that can be avoided with proper notice.

10. Can Assist your Research Department to

11. ResearchCandidateEvaluationSystem ReCES 5x is an application set designed to perform real-time encounter based evaluations of research study qualification parameters to aid in the identification of potential clinical trial research participants. Searches can also be executed against your entire patient database to determine potential candidates before a study begins.

12. Primary Benefits • Significantly reduce the number of chart reviews required to find potential study participants • Real-time nature of the ReCES system allows for the evaluation of Acute condition studies • Providers able to assess the interest of the patient in research participation while thepatient is in the clinic • More studies can be evaluated with a lower burden on providers which increases provider participation and generates higher quality candidates

13. Key Features- Patient Qualification Criteria • Map virtually ANY FIELD in the EMR database as a study qualification parameter • Field level parameters can be grouped as inclusion or exclusion to evaluate multiple fields as a single parameter • Diagnosis code inclusion & exclusion criteria that can be configured to search the EMR Diagnosis Module, Ordertable (KBM), IMAssessment(default) or any user defined template fields • Medication inclusion & exclusion criteria using the NextGen medication list

14. Key Features- Patient Qualification Criteria • Field evaluation criteria - Text, date, numeric and decimal values. Range checks for number and date fields, exact and partial matches for text fields. The ability to designate a minimum number of data points for evaluation as well as a maximum timeframe for the values • Limit the study to any particular combination of enterprise, practice or location • No limit on the number of parameters a study can have • Real-time alert displayed to the provider when a patient qualifies for one or more studies

22. Proven Financial Results Increase Revenue Increase Provider Participation Increase Study Enrollment Reduce Disqualified Study Patients

23. Potential Quality of Care Initiatives Problems Include • Medicare requires each clinic to determine which initiatives they will report on and then a mandatory percentage of patients must be documented and reported on to meet their criteria for payment. • Initiatives selected must be performed and documented on a timely basis in order to meet payment guidelines. • Some initiatives are monitored on both a clinic and individual physician level.

24. Incentive Challenges Physicians need to: • Understand the incentives and what must be done to qualify for them • Perceive the value of the incentives to be worth their time and efforts • Believe the incentives will be good for their patients • Have sufficient control over the clinical activities required to achieve the targets • Be assured incentives are administered fairly

25. Incentive Challenges Unintended consequences • Can be as strong as intended ones • Will pursuing quality related initiatives distract providers from other important clinical activities for their patients?

26. Incentive Challenges • Will P4P primarily reward providers who are already doing well, or can it also stimulate lower performers to improve quality? • Where should incentives be directed – to individuals, groups, hospitals, or a mix? Strategic questions:

27. Incentive Challenges • Get involved with purchasers as early as possible in the design, implementation and evaluation of P4P programs • Focus on the quality of care measures so we’re not just “scoring”, but healing • Continue migration to health information technology to enable full utility of P4P programs Success factors for providers:

28. Incentive Challenges AMA, AAFP and other provider groups have concerns about: • Payers influencing medical decisions • Faulty performance measures • Too much record keeping • Too much emphasis on cost cutting • Fair and equitable program incentives

29. In e-Health, “e” needs to stand for evidence-based medicine • e-Health records, e-Prescribing and e-Reporting of adverse drug events are significant applications of health IT • Integration of evidence-based medicine with health IT provides greatest opportunity to improve the value of health care in America • Continuing to develop ways for health IT to deliver the best and most current evidence on treatment effectiveness and outcomes to providers, payers and consumers

30. “So, when can I push the F7 key and aggregate all the health care data I need while knowing I entered the data in the correct location?”

31. Can make your Quality of Care Initiatives easier and help

32. Integrated Quality Care Monitoring System CareSentry 5x is an Integrated Quality Care Monitoring System that provides three levels of functionality to help standardize and manage your patient's care: Qualification— Identification of patients that are at risk for specific disease profiles or qualify for inclusion in specific care plans. Monitoring— Alerting providers during an encounter that specified care guidelines have not been met or scheduled procedures/labs are due and prompting providers to complete required information during an encounter for better documentation. P4P Compliance — Insures compliance with P4P data collection guidelines required by insurance carriers.

33. Primary Benefits • Standardize Your Care Plan for Specific Disease Profiles Throughout Your Organization • Monitors Insurance Specific Requirements Based on the Visit Level Insurance Assignment • Flag Almost any Field in the EMR as a Monitored Parameter • Improves Documentation and Can be Used as a Training Aid for Providers New to the EMR

34. Key Features- Patient Qualification Criteria • Map virtually ANY FIELD in the EMR database as a study qualification parameter • Highly configurable evaluation rules and expressions for qualification and monitored parameters • Insurance based parameters can be added to a profile which are displayed only if the visit level insurance matches the carrier • Monitored parameter values are saved and can be analyzed in CareSentry from the profile level or patient level without running extensive reports in NextGen

35. Key Features Provider responses to profile status notifications are monitored so provider compliance with profile requirements can be measured Preliminary qualification scans which include demographics, diagnosis and medications to find patients that qualify for profile inclusion and added to profile watch lists before real-time monitoring begins Simbiote’s signature grid interface for almost unlimited grid layout customization for profile analysis

44. Proven Clinical and Financial Results Increase Your Clinic’s Percentage Goals Increase Your Clinic’s Provider Participation Increase Your Clinic’s Revenue Increase Your Clinic’s Standardization of Care

45. & THANK YOU! For participating in this Webinar Should you desire any further information concerning Clinical Research Trials or Quality of Care Initiatives, please contact your TSI HealthCare representative Or Call 800-354-4205 www.tsihealthcare.com