EHRS as a Tool to Improve BP Control

1. EHRS as a Tool to Improve BP Control • Brief history of OQIUN, CCI. Began 1999 using data cards. Started working with multiple practice sites using different EHRS in 2003; currently >350 clinical sites using >25 EHRS. Relationships are critical to success ! • Registry function: NCQA Heart Disease / Stroke Prevention Recognition program reporting with 5 indicators (BP control [75%], Lipid panel [80%], Cholesterol (LDL) control [50%], aspirin or another antithrombotic [80%], smoking status / cessation advice or Rx [80%]. • Score for each physician, composite for each clinic, comparison to all other providers / clinics in database • 4. Population management tool (all patients for each provider left vertical), 5 indicators across the top. Sortable columns

2. Quality Reports and Certifications

3. Quality Reports and Certifications

4. Key data in discrete or structured fields Correct provider and clinic attribution Correct patient demographics and vital signs including an accurate and representative BP (Elevated BP without Dx of HTN [ICD9 769.2]) Correct, complete and current medications Comorbid diagnoses, e.g., CHD, CKD, CHF, DM Smoking status Lab data EHRS as a Tool to Improve BP Control

5. Meaningful Use – Stage 2. • 1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines • 2. Generate and transmit permissible prescriptions electronically (eRx) • 3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth • 4. Record and chart changes in the following vital signs: height/length and weight (no age limit); BP (age 3+); calculate and display BMI • 5. Record smoking status for patients ≥13 years old • 6. Use clinical decision support to improve performance on high-priority health conditions. (Rx protocols for hypertension, LDL-goal (CHD risk or statin dose if 2013 guideline) • 7. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the eligible professional (EP)

6. Meaningful Use – Stage 2 • 8. Provide clinical summaries for patients for each office visit • 9. Incorporate clinical lab-test results into Certified EHR Technology as structured data • 10. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach • Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference • Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient • Use secure electronic messaging to communicate with patients on relevant health information

7. Meaningful Use – Stage 2 • 14. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation • 15. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral • 16. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice • 17. Use secure electronic messaging to communicate with patients on relevant health information

8. Using an EHRS to Improve BP Control • Whenever possible use the EHRS as designed and maximize consistent use of discrete and structured field data • Standardize data entry across the clinic and practice group • Implement a BP measurement protocol that aims to obtain an accurate and representative BP in a discrete / structured field • Make sure the medication list is accurate • Incorporate labs into structured fields of the EHRS • Agree on a BP treatment protocol that will work for most patients and adhere to it • Maintain a hypertension registry with at least monthly updates and accountability • To maximize benefit, use the ABCS of CVD prevention with actionable, POC information and support