Pamela Ferrari RN Director of Performance Improvement and Clinical Knowledge Support

1. Use of Computerized Clinical Decision Support System and Registry Functions to Track and Improve Clinical Outcomes Pamela Ferrari RN Director of Performance Improvement and Clinical Knowledge Support Open Door Family Medical Center Inc

2. What is CDSS?(Clinical Decision Support) "Clinical decision support (CDSS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and health care." AMIA, A Roadmap for National Action on Clinical Decision Support, June 13, 2006.

3. Goal and Aims of CDSS • To bring relevant knowledge to bear on the health care and well being of a patient or a population of patients. • To make data about the patient easier to access or more apparent to a provider. • To foster optimal problem solving, decision making and action by a provider “Clinical Decision Support-The Road Ahead” edited by Robert Greenes

4. Types of CDSS • Pop-ups and out of range alerts in the EMR- • Example out of range vital signs, and labs. • Templates • Structured data collection • Order sets • Recommend treatment of specific conditions • CDSS/Alerts • Based on preventive guidelines and medical history • Provider reference • Up-to-date, Epocrates

5. Pop-up alerts: Red Font Identifies Elevated Blood Pressure

6. Templates:Structured data collection

7. Order Sets: Hypertension

8. CDSS/Alerts: Based on preventive guidelines and medical history

9. CDSS Alerts: Trigger an Order Set for BP control

10. Provider Buy-in • Good ideas are not adopted automatically. They must be driven into practice with courageous patience. • Hyman RickoverUS (Polish-born) admiral (1900 - 1986)

11. The Importance of Provider Panel Integrity

12. Provider feedback needs to be applicable to their patients • We use Rendering Provider/Primary Caregiver for most reporting, • We expect each patient to be seen by Primary Caregiver at least annually. • We set a goal that 80% of our patients should be seen by PCG annually.

13. PI Project for 2009

14. Examples of CDSS that have improved care • Diabetes A1c screening lab alerts • Hypertension EKG Order sets • Self management. Structured data templates. • Asthma Action Plans. Structured data templates.

15. Improving A1c screening for diabetic patients

16. The CDSS Alerts remind Providers to get an A1c

17. Order Sets tell Provider when the last A1c was performed

18. Provider/Site Feedback Reports

19. Self-management template, increased compliance with documentation of goals

20. Structured text is inserted into progress note

21. Examples of structured data we collect • Diabetes and hypertension control • Medication adherence • Diet and exercise assessment • Last eye exam and result • Last foot exam and result • Self-management goals • Results of autism screen • Asthma control and Asthma Action Plan

22. Examples of templates we use • Well-baby visits--include all anticipatory guidance as well as developmental screening • Chronic Disease Templates--Asthma, Hypertension and Diabetes • Acute Disease Templates • Pregnancy test templates encourage enrollment in prenatal care

23. Diabetic foot exam

24. Structured data flows to Chronic Care Outcome reports and Flow sheets

25. Diabetes Flow sheet

26. Hypertension order set increased the number of patients with ECG.

27. Asthma Template documents both underlying severity and current control

28. Using data to improve care • List all diabetic patients whose last A1c was >9 and call them to come in for diabetes education. • List all patients without an Asthma Action Plan and invite them to an Asthma Night • List all hypertensive patients who said that they were not watching their diet and invite them to a presentation on the Dash Diet.

29. Improved Outcomes for the Practice

31. Provider Report Card for Diabetes