Electronic Health Record Innovations to Improve Patient Tracking, Care and Health Outcomes - SC s Chronic Care Collabora

1. Electronic Health Record Innovations to Improve Patient Tracking, Care and Health Outcomes- SC’s Chronic Care Collaborative - Joy F. Brooks, MHA CDC’s Heart Disease and Stroke Prevention Annual Grantee Meeting September 16, 2010 We all know that health information technology is the way to improve health care quality and safety while simultaneously holding down costs. It’s a struggle getting there, however. Each of us is learning our respective roles as well as how to leverage partner resources and expertise. This is the key to becoming effective change agents in this exciting period of rapid change!We all know that health information technology is the way to improve health care quality and safety while simultaneously holding down costs. It’s a struggle getting there, however. Each of us is learning our respective roles as well as how to leverage partner resources and expertise. This is the key to becoming effective change agents in this exciting period of rapid change!

2. Learning Objectives Discuss SC DHEC’s effective engagement with the state’s QIO and role in supporting EHRs in the Collaborative environment. Examine the program model and how this Collaborative, through targeted coaching and capacity building, led to meaningful use of EHR and QI throughout the system of care. Describe the benefits of the targeted RHIO model for rapid cycle improvement and sustainability. Outline current EHR initiatives stemmed from HDSP capacity building project that are ongoing within the RHIO and outline next steps.

3. Collaboration Provided technical assistance to regions Provided technical assistance to regions

4. Logic Model:SC Breakthrough Series “Bridging the Gap in Chronic Care” Collaborative - LRHN FY 2007-2009

5. Regional Application of Collaborative Model FY ‘05 – ‘06 statewide traditional Collaborative model yielding limited improved outcomes In 2008, concentrated Collaborative in the Lakelands Rural Health Network (LRHN) -located in Public Health Region 1 LRHN is a non-profit RHIO created to provide physicians and other health entities access to collaborative services and a “safety net” for residents in this rural area of SC LRHN recruited 9 practices in FY ‘08 to participate,15 in ’09 LRHN is the conduit that leads the organization, the Health Information Exchange. The mobilization of this health information across this region of our state was ahead of its time when it developed in 2004 and continues be a leader in the statewide implementation of the SC Health Information Exchange project (SCHIEx). LRHN is the conduit that leads the organization, the Health Information Exchange. The mobilization of this health information across this region of our state was ahead of its time when it developed in 2004 and continues be a leader in the statewide implementation of the SC Health Information Exchange project (SCHIEx).

6. “In an Emergency, Doctors need your medical information STAT and you might not be able to give it to them. With electronic heath information exchange, your doctors could securely access your medical history in just a few seconds. A few seconds just might save your life.” - I would call a great example of “meaningful use” of an EHR, wouldn’t you? “In an Emergency, Doctors need your medical information STAT and you might not be able to give it to them. With electronic heath information exchange, your doctors could securely access your medical history in just a few seconds. A few seconds just might save your life.” - I would call a great example of “meaningful use” of an EHR, wouldn’t you?

7. SC Hybrid Collaborative Model Three full-day Learning Sessions reduced to two 3-hour dinner sessions to meet practice needs. Consultative Site Visits provided to bring each practice to equal level of readiness for participation. Teleconferences, LISTSERV and technical support provided during action periods. FY ‘08, seven clinical measures chosen for monitoring diabetic pt population with CVD; FY ‘09, 10 indicators measured. Data submitted monthly and comprehensive reports prepared on progress; expertise of SC’s Medicare QIO, Carolina’s Center for Medical Excellent (CCME), readily available to participating practices.

8. 2008-2009 Clinical Indicators Blood Pressure: Most recent patients with BP > 140/90 mmHg Blood Pressure: Most recent patients with BP < 130/80 mmHg Cholesterol Levels: Most recent LDL Cholesterol > 130 mg/dl Cholesterol Levels: Most recent LDL Cholesterol < 100 mg/dl HbA1c Levels: Most recent HbA1c value < 7.0% HbA1c Levels: Most recent HbA1c value > 9.0% Foot exam: Patients with foot exam in the past year Eye exam: Patients with retinal eye exam in the past year Nephropathy Assessment: Patients with nephropathy assessment in the past year Tobacco-cessation counseling: Patients with smoking status who have been offered cessation advice or treatment The indicators in bold were added in 2009 The indicators in bold were added in 2009

9. 2008 Performance Measures

10. 2009 Performance Measures

11. Aggregate Data Reports Foot exam measure had the greatest absolute increase of 40%. LDL < 100 mg measure improved by 21%. Exceeding NCQA goals for A1C, LDL, Nephropathy and HTN. Foot Exams nearly met goal, overall increase of 24%. Most practices identified the Eye Exam indicator for PDSA cycles and many entered cooperative agreements with area Ophthalmologic providers to increase compliance. Although great strides have been made thus far, LRHN is committed to continuous QI. Vital partnerships in this effort, including SC DHEC and CCME, have been integral to their continued success. (period ending March 2009) Although BP control was at 37%, meeting NCQA standards, this is clearly an area of identified opportunity. LRHN has continued to focus on this area of QI. Also of note is that this targeted pt population was comprised of the practices’ diabetic pt population, and often more challenging to maintain BP control.(period ending March 2009) Although BP control was at 37%, meeting NCQA standards, this is clearly an area of identified opportunity. LRHN has continued to focus on this area of QI. Also of note is that this targeted pt population was comprised of the practices’ diabetic pt population, and often more challenging to maintain BP control.

12. Benefits of RHIO Model Increased accountability Enhanced communication among practice participants Improved efficiency, conserving resources through reduced travel Enabled strategic use of Consultative Site Visits in one concentrated geographic region Support through leveraged health system resources at the local level Commitment to the health of the practices’ shared community System level change, which ultimately improves patient care, is at the heart of this work. We believe this model shows great promise because of the enhanced communication and accountability the practices within the RHIO have to one another as it relates to their commitment to the health of their shared community.System level change, which ultimately improves patient care, is at the heart of this work. We believe this model shows great promise because of the enhanced communication and accountability the practices within the RHIO have to one another as it relates to their commitment to the health of their shared community.

13. Keys to Success Physician Champion(s) – absolutely critical! EHR abstraction resource support is essential Consultative Site Visits are invaluable tools prior to Learning Sessions and throughout Action Periods to identify barriers, opportunities, and areas where support can be provided by the state and the QIO consultants Flexibility and meeting the practices where they were

14. LRHN Today Recipients of millions in grant dollars to expand existing EHR throughout the region, installing and connecting to the Health Information Exchange. Leaders in the SCHIEx statewide Health Information Exchange initiative leading to significant advances in Public Health surveillance and improved quality of care for South Carolinians. CCME continues to partner with LRHN with a regional extension grant developing templates for EHRs. Collaborative QI initiative with Diabetes and CVD indicators continues with regular data exchange from HDSP “Bridging the Gap” Collaborative. $5.6 M most recently awarded to LRHN in ARRA funds (American Recovery and Reinvestment Act)$5.6 M most recently awarded to LRHN in ARRA funds (American Recovery and Reinvestment Act)

15. Successful QIO and Practice Collaboration Environmental: history of collaboration or cooperation in community; partner seen as a legitimate leader or expert Partner attitudes: mutual respect; understanding, trust, appropriate cross section; collaboration meets self-interests, compromise Process / Structure: members share stake in process/outcome, roles defined, flexibility Communication / Interpersonal relationships: informal and frequent; established informal relationships and communication links Purpose: concrete, attainable goals and objectives, shared vision and unique mission Resources: Sufficient funds, staff, time, skilled leadership Critical to the successful engagement of your QIO and practices rests on the health of these essential factors: (Concepts from Mattessich et al (2001) re: elements of successful collaboration) Engaging CCME as liaison between public health and clinical practice is strategic to ease the reluctance on the part of practicing physicians to engage in multidisciplinary collaborations. QIO facilitates a common problem of “analysis paralysis” faced by practices in navigating their EHR and interpreting data which leads to meaningful use and effective QI. Critical to the successful engagement of your QIO and practices rests on the health of these essential factors: (Concepts from Mattessich et al (2001) re: elements of successful collaboration) Engaging CCME as liaison between public health and clinical practice is strategic to ease the reluctance on the part of practicing physicians to engage in multidisciplinary collaborations. QIO facilitates a common problem of “analysis paralysis” faced by practices in navigating their EHR and interpreting data which leads to meaningful use and effective QI.

16. Check us out… www.scdhec.gov/hdsp

17. Contact Information Joy F. Brooks, MHA Director Heart Disease & Stroke Prevention Division SC DHEC - Bureau of Community Health & Chronic Disease Prevention 1800 St. Julian Place Columbia, SC 29204 803-545-4497 BrooksJF@dhec.sc.gov Also, the Lakelands Rural Health Network and the highlighted work of their Health Information Exchange can be found at www.lhrn.org (Dawn Wichmann, Exec. Director) Carolina’s Center can be reached by visiting www.thecarolinascenter.org, (Jennifer Anderson, EHR Consultant) Also, the Lakelands Rural Health Network and the highlighted work of their Health Information Exchange can be found at www.lhrn.org (Dawn Wichmann, Exec. Director) Carolina’s Center can be reached by visiting www.thecarolinascenter.org, (Jennifer Anderson, EHR Consultant)