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Opportunities to facilitate community based research through Community Health Center

Alliance. of Chicago Community Health Services, LLC . Opportunities to facilitate community based research through Community Health Center . Tim Long, MD Andrew Hamilton, RN, BSN, MS NCRR Meeting May 15, 2007. What are our goals. Promote community based/translational research

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Opportunities to facilitate community based research through Community Health Center

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  1. Alliance of Chicago Community Health Services, LLC Opportunities to facilitate community based research through Community Health Center Tim Long, MD Andrew Hamilton, RN, BSN, MS NCRR Meeting May 15, 2007

  2. What are our goals • Promote community based/translational research • 2. Develop an information network that can promote research and facilitate translation of evidence based interventions into practice.

  3. Potential of HIT enabled translational research • Description of fully functional Electronic Health Record System in a network of Community Health Centers • State of adoption of Electronic Health Records Systems • Synergies of HIT enabled quality and research • Opportunities for translational research enabled by HIT

  4. Challenges to Research in Clinical Settings • Limited ability to look at population level data to suggest questions • Labor intensity of baseline and study data collection • Inefficiency of subject identification/recruitment • Clinical pressures limiting ability of clinicians to focus on research interventions • Limited ability to prompt or support clinicians to enroll subjects and implement test interventions • Logistics limit communication between academic setting and clinical site/clinicians

  5. Challenges in the Healthcare Setting • Increasing complexity of Health Care • Challenges in coordination/communication among medical providers and between supportive services and disciplines • Limited time for interactions • Difficulty accessing information in timely/organized fashion for use in decision making at the point of service • Labor intensity limiting population based data to inform system change

  6. Capabilities of Electronic Record Systems Basic • a storage and retrieval system VS Advanced • a sophisticated interactive database

  7. Considerations in implementing higher level functionality • Acceptance of common vision of quality • Adoption of evidence based standards against which to judge care quality • Agreement to conform to standardized ways of recording data • Ability to capture and process relevant data • Relevant care elements are captured as structured information • Implies that “order entry” is computerized • Data is “clean” and consistent

  8. What is the Alliance? • BPHC/HRSA funded Network • Essentially a joint venture of four independent organizations with the desire and ability to work together on building some common infrastructure • Ability to access higher quality, efficiency and economy of scale • Dedication to quality • Desire to ultimately share with others

  9. Community Health Centers first funded by the Federal Government as part of the War on Poverty in the mid-1960s. designed to provide accessible, affordable personal health care services for people living in medically underserved communities where economic, geographic, or cultural barriers limit access to primary health care. Mission encompasses quality, access, and responsiveness to particular needs of the community served. 3/13/2014

  10. principal services include: primary and preventive health care, behavioral health care, outreach, and dental care ancillary services include: laboratory tests, X-ray, environmental health, and pharmacy services related services such as health education, transportation, translation, and legal services currently more than 900 nationally with presidential initiative to increase number 3/13/2014

  11. Who CHCs Serve 2/9/2007 91.1% of clients are below 200% poverty 40.1% are Uninsured 63.5% are Racial/Ethnic minority 726,813 Migrant/Seasonal Agricultural Workers 703,023 Homeless Clients 11

  12. CHC Profile • 952 Community-Based Organization • 1356 Sites of Care across US • 14.2 Million Patients Served • 90,000 MDs/NPs, RNs, & Dentists 2/9/2007 12

  13. 2/9/2007 13

  14. 2/9/2007 14

  15. Alliance HIT project goals 1. Implement EHRS in a network of Community Health Centers in a manner that ensures consistency and accuracy of health information across all practitioners, sites and populations. 2. Develop a data warehouse that will monitor, aggregate, and provide data to be used for clinical and system quality improvement. 3. Utilize the EHRS/data warehouse to facilitate and encourage the use of evidence-based practice measures at the point of care.

  16. HIT project goals 4. Utilize the EHRS/data warehouse to facilitate continuous improvement of health care quality and safety and develop its function as a patient registry. 5. Promote and support the realization of the full potential of EHRS use in ambulatory care settings, particularly among safety net providers, to improve health care quality and safety.

  17. HIT Partnership • American Medical Association • Health Information Management Systems Society • GE Healthcare Clinical Data Services • First Consulting Group • Health Research and Education Trust • Funding agencies: HRSA ◊ AHRQ ◊ Chicago Community Trust ◊ Michael Reese Health Trust ◊ Robert Wood Johnson Foundation Commonwealth Fund ◊ Illinois Department of Public Health ◊ Chicago Department of Public Health

  18. Clinical consensus • Chronic Care Model to manage disease and populations of patients. • Network wide clinical standards. • Utilize national experts and evidence based protocols as basis for standards of care. • Utilize internal/local subject matter experts to review standards and support development of the screens.

  19. Considerations for EHRS development and implementation • Promote use of standardized templates • Structured data entry • Ease of data entry to encourage providers to capture needed information as part of care delivery • Mapping of data elements to care protocols • Content to include full spectrum of care (eg, mental health/case management)

  20. Structured Data Entry

  21. Consideration for Report Development • Competing/Multiple Performance Measurement Sets with unaligned performance measures. • Lack of Clinical Data Standards for many important medical concepts (such as Foot Exam, Pt. Education, etc) • Inconsistent data definitions across EHR Vendors

  22. Measure Example Diabetes Measurement Set (foot exam) • Measure:Percentage of patients who received at least one complete foot exam (visual inspection, sensory exam with monofilament, and pulse exam) Numerator = patients who received at least one complete foot exam (visual inspection, sensory exam with monofilament, and pulse exam) Denominator = All patients with diabetes 18-75 years of age

  23. Technical SpecificationsNumerator • Patients who received at least one complete foot exam (visual inspection, sensory exam with monofilament, and pulse exam) • Note: All three components must be completed within the reporting period but they do not have to be completed at the same visit.

  24. Technical SpecificationsDenominator • All patients with diabetes 18-75 years of age • Codes to identify patients with diabetes include: • ICD-9-CM Codes: 250, 357.2, 362.0, 366.41, 648.0) (DRGs) 294, 205 • Prescriptions to identify patients with diabetes include: • Insulin prescriptions (drug list is available) and Oral hypoglycemics/ antihyperglycemics prescriptions (drug list is available)

  25. Technical SpecificationsExclusions • Exclude patients with a diagnosis of polycystic ovaries (ICD-9-CM Code 256.4) who do not have a diagnosis of diabetes, in any setting, during the measurement year or year prior to the measurement year. • Exclude patients with gestational diabetes (ICD-9-CM Code 648.8) or steroid-induced diabetes (ICD-9-CM Code 962.0, 251.8) during the measurement year • Patients with bilateral foot/leg amputation • ICD-9-CM exclusion codes for 2.9 Foot Exam: 896.2, 896.3, 897.6, 897.7 • Other reason documented by the practitioner for not performing a complete foot exam

  26. Considerations of Technical Architecture • Hosting in a secure level 3 facility • Redundant architecture and secure backup • Ability to access system anywhere via internet • Interface engine to build and manage interfaces • Export of data to a data warehouse

  27. Potential of EHRS & Research • Decision Support • Client recruitment • Study protocols • Performance Measurement • Data collection • Study protocols • Remote hosting • Communication between study sites • Off site intervention • Data warehouse/reporting • De-identification of data • Aggregation and analysis of data

  28. Status of System use • Live at main sites of all 4 Health Centers • 125 concurrent users, approximately 225 individual users. • “Big Bang” - All staff, with full functionality of the system • Productivity at pre-implementation levels • Next wave of Alliance sites to go-live beginning in June • Planning implementation at first non- Alliance sites

  29. System Use Measures Adult Use of diabetes disease management form Use of cardiovascular disease management form Use of HIV disease management form Use of Asthma disease management form Mammogram BIRAD score documented PAP Results documented Colonoscopy Screening documented Adolescents Sexual Activity documented at office visit Violence risk documented at office visit Pediatrics Developmental assessment documented Weigh percentile documented Height percentile documented Head circumference percentile documented OB/GYN Prenatal visit with documented EDC Prenatal visit with FHR documented Prenatal visit with genetic history documented Mental Health Established treatment plan date documented Treatment plan revision date documented Signed metal health assessment documented Substance abuse screening documented 3/13/2014

  30. System Use Measures 3/13/2014

  31. Use of Diabetes Disease Management Forms 3/13/2014

  32. Performance Measures AMA/HDC Diabetes AMA/HDC CVD HIV/HIVQUAL AMA/HDC Asthma AMA/HDC Preventive Care 3/13/2014

  33. Pre/Post EHRS Go Live Diabetes Data 3/13/2014

  34. Data Warehouse • Login screen

  35. Alliance Reports Folder • AMA and HDC reports developed

  36. HDC Diabetes Report • HDC Diabetes measures along left side

  37. Can Export Report to Excel • File will download locally

  38. Can Export Report to Excel cont. • Minimal re-formatting, then submit to HDC

  39. Can Also Drill Down to Patient Detail • Note patient ID is encrypted in Portal Reports

  40. Can Also Drill Down to Patient Detail cont. • Need to run “Re-ID” macro in Excel to link encrypted patient ID to EHRS patient information Re-ID will link Pt Name to this #

  41. Correlation between EHRS elements and research plan Evidence based practice guideline • Research protocol Data elements defined • Subject criteria, pre and post data elements End user form designed to provide decision support at point of patient care • Study protocols Measures defined and Data elements mapped to reports • Baseline and study data collection plan

  42. Benefits of CHC Sector Representation of disparate populations Complete spectrum of health services Stability of service population Quality orientation – desire to implement evidence based practice and contribute to improvement Network infrastructure to support multiple site studies Experience with HIT

  43. 4/4/2006 44

  44. 4/4/2006 45

  45. 4/4/2006 46

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