Kwame A. Kitson, MD VP of Quality Improvement Institute for Family Health 16 East 16 th St New York, NY 10003 kkitson@

1. THE IMPACT OF HEALTH INFORMATION TECHNOLOGY ON QUALITY IMPROVEMENT THE INSTITUTE FOR FAMILY HEALTH Kwame A. Kitson, MD VP of Quality Improvement Institute for Family Health 16 East 16th St New York, NY 10003 kkitson@ institute2000.org 212-633-0815 www. institute2000.org HIT Workshop New York, NY July 9, 2009

2. LEARNING OBJECTIVES • NOW THAT YOUR ORGANIZATION HAS ACCESS TO DATA, HOW DO YOU TRANSLATE THAT INTO MEANINGFUL USE ? • HOW CAN THE USE OF DATA AND REPORTING IMPACT PATIENT SAFETY ? • HOW CAN THE USE OF DATA AND REPORTING IMPROVE QUALITY MEASURES PERFORMANCE ?

3. MEANINGFUL USE OF HIT DATA • “MORE DATA = MORE PROBLEMS”

4. MEANINGFUL USE OF HIT DATA • A mountainful of data yet a finite amount of resources to handle it.

5. MEANINGFUL USE OF HIT DATA • “Beware lest you lose the substance by grasping at the shadow.” Aesop • Solution- Target measures and target resources in the most efficient ways possible.

6. MEANINGFUL USE OF HIT DATA • Electronic Patient Outreach Team Created

7. PATIENT SAFETY • DRUG RECALLS

8. THE IFH RESPONSE TO THE VIOXX RECALL FDA SENDS AN ALERT BY EMAIL INTERNAL VIOXX REPORT GENERATED 664 PATIENTS IDENTIFIED VIA REPORTING WITHIN 35 MINUTES OF RECEIVING FDA EMAIL ALL BUT SIX PATIENTS CONTACTED BY TELEPHONE OR MAIL WITHIN 10 DAYS

9. PATIENT SAFETY DRUG INTERACTIONS AND CONTRAINDICATIONS • INTERNAL EHR VENDOR LINKED DRUG- DRUG INTERACTION WARNINGS • CUSTOM REPORTING ASTHMA PATIENTS ON BETA BLOCKERS PREGNANT PATIENTS ON CLASS D OR X MEDICATIONS BEERS CLASSIFIED MEDICATIONS IN THE ELDERLY

10. PATIENT SAFETY IDENTIFYING AND PREVENTING INAPPROPRIATE MEDICATION PRESCRIBING • CUSTOM REPORTING NARCOTIC ANALGESICS METFORMIN IN PATIENTS WITH RENAL DISEASE

11. PATIENT SAFETY IDENTIFYING AND PREVENTING INAPPROPRIATE CODING • CUSTOM REPORTING PROBLEM LIST AUDIT REPORTS IDENTIFIED MISCODING OF PATIENTS (HIV, DIABETES). THIS LED TO ENHANCEMENTS IN DECISION SUPPORT WHICH PREVENTED FURTHER REOCCURENCES.

12. PERFORMANCE IMPROVEMENT IN QUALITY MEASURES MACROSOLUTIONS (i.e. DECISION SUPPORT, GLOBAL WORKFLOW CHANGES) ACCESS TO DATA ALLOWS FOR GREATER ABILITY TO PINPOINT PROBLEMS MICROSOLUTIONS (i.e. INDIVIDUAL PROVIDER ATTENTION)

13. PERFORMANCE IMPROVEMENT IN QUALITY MEASURES CQI INTERVENTIONS ARE APPLIED WITH CONTINUED REASSESSMENT • DECISION SUPPORT ALERTS ACCOMPANIED BY WORKFLOW CHANGES. • IFH – AGGRESSIVE IMPLEMENTATION OF BEST PRACTICE ALERTS 9 MONTHS AFTER GO-LIVE

14. IFH BEST PRACTICE ALERTS PRIMARILY BASED ON HEDIS CRITERIA • PneumoVax • Seasonal FluVax • Breast Cancer Screening • Cervical Cancer Screening • Lead Screening • HGBA1C Testing & Control

15. IFH BEST PRACTICE ALERTS • Ophthalmology consults for diabetics. • Peak Flow measurements for all asthmatics • Nephrology consults for patients with greater than 1.8 serum creatinine. • LDL Screening • Annual RPR Screening in HIV

16. PNEUMOVAX

17. COLORECTAL CANCER SCREENING All sites listed were fully on the EHR as of Jan 2003

19. The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it. Michelangelo