Transcript TSI 2009 PP revised

&
Present
“How to use EHR for Research and
Quality of Care Initiatives”
Clinical Research
Provides advanced care options to patients at
no cost
Enables Physicians to become knowledgeable
of “cutting edge” therapies for their patients
Provides an additional revenue stream to the
clinic in this time of reduced reimbursement.
Factors Affecting Providers
Participation in Research
Demands of Clinical Practice
Limited Awareness of Trials
Time Constraints for evaluating study feasibility
Remembering inclusion/exclusion criteria
Difficulty following enrollment procedures
Reasons Patients Participate in Clinical
Research
Recommended by their doctor
Advancing medicine or medical knowledge
Helping others with disease
Obtaining better treatment
Education about their condition or treatment
Research Facts
A Harris poll in 2003 showed less than 10 % of
the US population has ever participated in
clinical trial, but 77 % say if asked they would
consider it
Only 16 % of adults believe they have ever had
the opportunity to participate in clinical trial,
but 10 % of this group did participate when
approached
Clinical Trial Feasibility
Depending upon the type of
database search capabilities of their
EHR, a Physician or Research
Department Manager may take
anywhere from 4 to 12 hours to
determine if a study is viable based
on the study parameters and the
clinic’s patient population
Patient Eligibility
Research nurse coordinators typically
spend 20 to 24 hours a week reviewing
charts to determine patient eligibility for
a research study.
On average less than 3% of charts
prescreened are enrolled in studies!
Provider Notification
Currently many clinics use visual aids such as
whiteboards, note cards to carry, and flyers in
exam rooms to assist the physicians memory of
enrolling clinical trials.
Studies show patients are more likely to enroll
if the clinical trial is discussed with the patient
during their office visit.
Patient Retention
Once a patient is enrolled in a clinical
trial many events may occur that can
cause the patient to be disqualified and
dropped from the study.
These events include disallowed
medications and timing of labs or
procedures that can be avoided with
proper notice.
Can Assist your Research Department
to
Research Candidate Evaluation System
ReCES 5x is an application set designed to perform real-time
encounter based evaluations of research study qualification
parameters to aid in the identification of potential clinical trial
research participants. Searches can also be executed against your
entire patient database to determine potential candidates before
a study begins.
Primary Benefits
Significantly reduce the number of chart reviews required to find
potential study participants
Real-time nature of the ReCES system allows for the evaluation
of Acute condition studies
Providers able to assess the interest of the patient in research
participation while the patient is in the clinic
More studies can be evaluated with a lower burden on
providers which increases provider participation and generates
higher quality candidates
Key Features - Patient Qualification Criteria
Map virtually ANY FIELD in the EMR database as a study qualification
parameter
Field level parameters can be grouped as inclusion or exclusion to
evaluate multiple fields as a single parameter
Diagnosis code inclusion & exclusion criteria that can be configured
to search the EMR Diagnosis Module, Order table (KBM),
IMAssessment (default) or any user defined template fields
Medication inclusion & exclusion criteria using the NextGen
medication list
Key Features - Patient Qualification Criteria
Field evaluation criteria - Text, date, numeric and decimal values.
Range checks for number and date fields, exact and partial matches
for text fields. The ability to designate a minimum number of data
points for evaluation as well as a maximum timeframe for the values
Limit the study to any particular combination of enterprise, practice
or location
No limit on the number of parameters a study can have
Real-time alert displayed to the provider when a
patient qualifies for one or more studies
Proven Financial Results
Increase Revenue
Increase Provider Participation
Increase Study Enrollment
Reduce Disqualified Study Patients
Potential Quality of Care Initiatives
Problems Include
Medicare requires each clinic to determine which
initiatives they will report on and then a mandatory
percentage of patients must be documented and reported
on to meet their criteria for payment.
Initiatives selected must be performed and documented on
a timely basis in order to meet payment guidelines.
Some initiatives are monitored on both a clinic and
individual physician level.
Incentive Challenges
Physicians need to:
Understand the incentives and what must be done to
qualify for them
Perceive the value of the incentives to be worth their
time and efforts
Believe the incentives will be good for their patients
Have sufficient control over the clinical activities
required to achieve the targets
Be assured incentives are administered fairly
Incentive Challenges
Unintended consequences
Can be as strong as intended
ones
Will pursuing quality related
initiatives distract providers
from other important clinical
activities for their patients?
Incentive Challenges
Strategic questions:
Will P4P primarily reward providers who
are already doing well, or can it also
stimulate lower performers to improve
quality?
Where should incentives be directed – to
individuals, groups, hospitals, or a mix?
Incentive Challenges
Success factors for providers:
Get involved with purchasers as early as possible in
the design, implementation and evaluation of P4P
programs
Focus on the quality of care measures so we’re not
just “scoring”, but healing
Continue migration to health information
technology to enable full utility of P4P programs
Incentive Challenges
AMA, AAFP and other provider
groups have concerns about:
Payers influencing medical decisions
Faulty performance measures
Too much record keeping
Too much emphasis on cost cutting
Fair and equitable program
incentives
In e-Health, “e” needs to stand for
evidence-based medicine
e-Health records, e-Prescribing and e-Reporting of
adverse drug events are significant applications of
health IT
Integration of evidence-based medicine with health
IT provides greatest opportunity to improve the
value of health care in America
Continuing to develop ways for health IT to deliver
the best and most current evidence on treatment
effectiveness and outcomes to providers, payers and
consumers
“So, when can I push the F7 key and
aggregate all the health care data I need
while knowing I entered the data in the correct location?”
Can make your Quality of Care Initiatives easier
and help
Integrated Quality Care Monitoring System
CareSentry 5x is an Integrated Quality Care Monitoring System
that provides three levels of functionality to help standardize
and manage your patient's care:
Qualification — Identification of patients that are at risk for specific disease
profiles or qualify for inclusion in specific care plans.
Monitoring — Alerting providers during an encounter that specified care guidelines
have not been met or scheduled procedures/labs are due and prompting providers
to complete required information during an encounter for better documentation.
P4P Compliance — Insures compliance with P4P data collection guidelines required
by insurance carriers.
Primary Benefits
Standardize Your Care Plan for Specific Disease Profiles
Throughout Your Organization
Monitors Insurance Specific Requirements Based on the
Visit Level Insurance Assignment
Flag Almost any Field in the EMR as a Monitored
Parameter
Improves Documentation and Can be Used as a Training
Aid for Providers New to the EMR
Key Features - Patient Qualification Criteria
Map virtually ANY FIELD in the EMR database as a study
qualification parameter
Highly configurable evaluation rules and expressions for
qualification and monitored parameters
Insurance based parameters can be added to a profile which
are displayed only if the visit level insurance matches the
carrier
Monitored parameter values are saved and can be analyzed in
CareSentry from the profile level or patient level without
running extensive reports in NextGen
Key Features
Provider responses to profile status notifications are monitored
so provider compliance with profile requirements can be
measured
Preliminary qualification scans which include demographics,
diagnosis and medications to find patients that qualify for
profile inclusion and added to profile watch lists before realtime monitoring begins
Simbiote’s signature grid interface for almost unlimited grid
layout customization for profile analysis
Proven Clinical and Financial Results
Increase Your Clinic’s Percentage Goals
Increase Your Clinic’s Provider Participation
Increase Your Clinic’s Revenue
Increase Your Clinic’s Standardization of Care
&
THANK YOU!
For participating in this Webinar
Should you desire any further information concerning Clinical Research Trials or
Quality of Care Initiatives, please contact your TSI HealthCare representative
Or Call
800-354-4205
www.tsihealthcare.com