How to d e s i g n and r e f i n e effective EMR tools for CRC screening

1. How to design and refine effective EMR tools for CRC screening Gloria D. Coronado, PhD Beverly Green, MD, MPH

2. Technological advances

3. How to design EMR tools… Engage clinic staff Original thinking Revised thinking Refine tools Select specifi-cations Train teams Prototype tools Test tools

4. Key messages • How to build effective EMR tools: • Assemble your team; • Identify goals – save time, accurately identify patients, improve rates, avoid unintended consequences – choose specifications; • Consider workflows and data sources • Anticipate unintended consequences • Train, re-train • Revise workflows and tools • PDSA • EMR work sessions

5. https://www.kpchr.org/stopcrc/public/stopcrcpublic.aspx?pageid=10&SiteID=1https://www.kpchr.org/stopcrc/public/stopcrcpublic.aspx?pageid=10&SiteID=1

6. Assemble your team • Leadership buy-in • Clinical staff (providers, MAs, front desk staff, etc.) • Quality improvement leads for testing • Training, and re-training

7. Select design specifications • What is important? • What is possible? • Review what others have done • Real-time data • Sustainability and long-term use • Rely on Health Maintenance and STOP CRC codes • Over time can rely only on Health Maintenance • Automate as much as possible • Design could be used across EMR platforms

8. Consider unintended consequences

9. Think about workflows and data sources… Original thinking Revised thinking

10. Clinic workflows Understanding variations in fecal testing by clinic

12. Step-wise exclusions EMR tools in Reporting Workbench, driven by Health Maintenance; Step-wise exclusions for: Invalid address Self-reported prior screening Completion of CRC screening

13. Registry Function Key design features Real-time lists of patients eligible for each intervention step; Inclusion /exclusion codes and Health Maintenance (may rely solely on Health Maintenance, if accuracy is high); Generate letters for all patients on list (with clinic logo); Order fecal tests for all patients on list (bulk ordering) Interactive; real-time updates for stepped programs Non-interactive; one-time data pulls

14. Sample exclusions

15. Plan-Do-Study-Act approach

16. Selected PDSAs

17. EMR Work session process Individual ideas were written on post-its Develop persona Describe the typical consumer of the program. What are concerns of typical consumer of the program? Ideas are grouped by topic, then prioritized. Possible solutions were identified for top priority. “Eliminate errors in ‘Z’ process”

18. Vote on the Most Important • Eliminate manual scrubbing and improve info at a glance • Decrease time to mail kit • Increase match between communication methods and patient preference • Decrease number of reports • Increase provider buy-in on FIT Kits • Increase interoperability between modules (PL, Surghx, HMA) • Reduce time in searching for previous colonoscopy • Improve process by eliminating printing delay • Reduce time spent creating orders • Reduce time and materials by increasing patient portal use. • Reduce staff time by understanding individual status with a patient report

19. Conclusion • Multiple, iterative steps in designing and refining EMR tools for long-term use: • Assemble team • Select specifications • Develop and refine tools • Train staff • Repeat • Understanding clinic workflow and where data are stored in the EMR is important; • Start small, consider unintended consequences, and prepare for iterative process.

20. STOP CRC Research Team; • OCHIN; • Participating Clinics • STOP CRC Advisory Board Acknowledgments Funding source: NIH Common Fund [UH2AT007782 and 4UH3CA188640-02] and Kaiser Permanente Community Benefit