Transcript Slide 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
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 ?
MEANINGFUL USE OF HIT DATA
 “MORE DATA = MORE PROBLEMS”
MEANINGFUL USE OF HIT DATA
 A mountainful of data yet a finite amount of
resources to handle it.
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.
MEANINGFUL USE OF HIT DATA
 Electronic Patient Outreach Team Created
PATIENT SAFETY
 DRUG RECALLS
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
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
PATIENT SAFETY
IDENTIFYING AND PREVENTING
INAPPROPRIATE MEDICATION PRESCRIBING

CUSTOM REPORTING
NARCOTIC ANALGESICS
METFORMIN IN PATIENTS WITH RENAL DISEASE
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.
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)
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
IFH BEST PRACTICE ALERTS
PRIMARILY BASED ON HEDIS CRITERIA
• PneumoVax
• Seasonal FluVax
• Breast Cancer Screening
• Cervical Cancer Screening
• Lead Screening
• HGBA1C Testing & Control
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
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9
Number of Vaccinations Given
60
Monthly Pneumonia Vaccinations Among 65+
50
75%
40
65%
55%
30
45%
35%
20
25%
10
15%
5%
0
-5%
Electronic Reminders Begin
Percent Vaccinated (Since Jan 2002)
PNEUMOVAX
Electronic Health Record Reminders
Increase Preventive Services
95%
85%
COLORECTAL CANCER SCREENING
Colorectal Screening IFH Sites 2005 to 2008
100%
90%
BPA FOR COLORECTAL
SCREENING INITIATED
JAN 2008
80%
70%
EAST 13TH ST. FAMILY HLTH CTR
60%
MT. HOPE FAMILY HEALTH CENTER
PARKCHESTER FAMILY HLTH CTR
50%
PHILLIPS FAMILY PRACTICE
SIDNEY HILLMAN FAMILY HLTH CTR
40%
URBAN HORIZONS FAMILY HLTH CTR
WALTON FAMILY HEALTH CTR
30%
20%
10%
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0%
All sites listed
were fully on
the EHR as of
Jan 2003
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1
PARKCHESTER DEPRESSION SCREENING RATE
100%
90%
NURSING
PERSONNEL
SHORTAGE
NURSING
SHORTAGE
RESOLVED
STEPPED UP VIGILANCE
TO BPA ADHERENCE
80%
70%
60%
50%
PARKCHESTER
40%
30%
20%
10%
0%

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