Transcript Connected Primary Care

Connected Primary Care
Preventive care and chronic
disease management at Mayo
Clinic
Rajeev Chaudhry MBBS MPH
Consultant Primary Care Internal Medicine
Leader, Health Information Management Systems
Leader, Mayo Clinic Connection Platform, Center for Innovation
Employee and Community Health
( Mayo Clinic’s Primary Care )
•105 Physicians
•154 Nurses ( 12 new case
managers)
•182 Allied Health employees
•6 Practice locations
•2 Divisions, 1 Department
( Internal Medicine, Family
Medicine and Pediatrics)
Mayo’s Primary care’s Connected
Care needs
• Systems must be designed to enable longitudinal
care compared to “usual” episodic care :
• Know who our patients are
• Know what our patients need in a proactive manner
• Alert patients and provide them “coordinated”
access
• We must “care for” the patient at all times, not just
when they request our care for a symptom related
illness
• When we see them we need to provide all the care
they need
Who we need to provide
“connected” care for…
• All preventive services for 140,000 patients ( cancer
screenings, immunizations, metabolic screenings and
wellness counseling)
• Chronic disease management
•
20,000 Hypertension patients
•
10,000 Depression patients
•
8,000 Diabetes patients
•
7,000 Asthma patients
•
7,000 Coronary Artery Disease patients
•
3,000 Congestive Heart Failure patients
•
And many other chronic conditions
• Acute Illness management for all 140,000 patients
So what we needed…
• Information systems to know needs of all of
our patients needs for care
• Utilizing our allied health staff to offload
responsibilities from MD’s both at population
level and for patients being physically seen (
GDMS-Vitalhealth Software) for preventive
care and care for chronic conditions so that
our MD’s can spend their valuable time caring
for patients and not spending their time
searching for the information
Health Information Management
Systems at Mayo
• Point of care –Generic Disease
Management System ( GDMS, 2007)
• Population Management and Quality
Reporting (Microsoft Amalga, 2009)
• Cost and utilization Reporting
( Currently physician portal)
GDMS Application Structure
Mayo Clinic
EMR Data
Web
Services
MICS
Cl. Notes
Labs, Vitals
Preventive services
Problem list
Immunizations
Allergies
CRD
Demographics
Vital Health
GDMS
Web interface
GDMS
application
Colonoscopy
Flex Sig
GI
Tobacco use
PPI
GDMS
database
CP1309217-13
GDMS ECH User Satisfaction Survey
April 2008, All staff n=122
Time saved per patient for preventive
services, diabetes and CAD care
• 3.9 minutes per patient for MD's
• 2.7 minutes per patient for LPN's
• 2.17 minutes per patient for CA's/
appointment coordinators
CP1309217-8
GDMS
ECH Zoster Vaccine Volumes
600
500
400
ECH
376%
increase
PCIM
300
200
FM
100
2007
D
ec
Ja
n
Fe
b
Fe
b
M
ar
A
pr
M
ay
Ju
n
Ju
l
A
ug
Se
pt
O
ct
N
ov
Ja
n
0
2008
CP1309217-4
Percent of People that Received AAA Screening after their Appointment and had not
Received the Screening in the past 5 years in 2007and 2008
30.00%
25.29%
25.00%
21.84%
20.00%
Percentages
20.00%
18.24%
15.75%
2007
15.00%
2008
10.00%
3.80%
5.00%
0.00%
4.05%
3.22%
0.00%
0.00%
Mayo Family Clinic
Northwest
Mayo Family Clinic
Northeast
Family MedicineBaldwin
Mayo Locations
Primary Care Internal
Medicine
Total
ECH Satisfaction Survey for GDMS – April 2008
Physicians n=38
4. The GDMS recommended action for patient age and sex-specific average risk
preventive services help me with identifying the services that need to be
scheduled
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
26
11
0
0
0
%
70.3
29.7
0.0
0.0
0.0
0
20
40
60
80
100
5. The GDMS recommended action for patient tests needed for diabetes mellitus
(DM) help me with identifying the tests that need to be scheduled
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
24
12
2
0
0
%
62.3
31.6
5.3
0.0
0.0
0
20
40
60
80
100
6. GDMS supports my work flow and improves efficiency in providing average risk
preventive services and testing for diabetes patients
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
24
11
2
0
0
%
64.9
29.7
5.4
0.0
0.0
0
20
40
60
80
100
CP1309895-1
EMR Interfaces Overview for HIMS at Mayo
Clinical
Notes
MICS
Lastword
Immunizations
Allergies
Problem List
MSS/GPAS
Labs
Vitals
Patient Appointments
Provider Panels
Views/Queries/
Reports
Preventive Services
Rules/
Applications
Data Base
Tobacco Use
External Services
PPI
Reg
Patient Visits
Cost
Medications
Mastectomy
Hysterectomy
DSS
Dept.
Systems
EOP
SIRS
Amalga UIS Applications at Mayo
Data from Clinical Systems
Parsing of data for application
Systems for end users
Systems are designed to lead to Standardized care
Registry view to get “real time”
information of all the Diabetic patients
List of all the Diabetic patients to be contacted in “next 30
days” with “real time” data
List of all the patients that “care manager” needs to contact in
next 7 days for “optimal care”
Patient “detail view” enabling navigating from all the patients
to one patient in “real time”
“Plan of care” module to record patient’s preferences
and “goal setting”
Past processes of care
Consume
r
Clinic
Preventive Services
Report
received
Call patient
MD to RN
Call MD Office for Mammogram
Appointment Office
takes message
MD reviews
message
Mammogram done
OK to
RN
Mammogram
ordered
Call back appt.
office
Retrieve
Message
Message to
RN
RN to Appt.
Office
Call
Patient
Not Home
Population Management (Prevention
and Diseases) New Process
Consume
r
Clinic
Mayo
Population
Management
Pull data of all 140,000 patients
ECH
130,000
patients
Services performed
Schedule services due
( visit or non visit based)
Identify who is due
(Evidence based)
Communication to
patients
Call PAC
Will population management
help Primary Care
•Population-based systems to improved
breast cancer screening by 33% in a
randomized controlled trial for 12,000
patients.
•Only 0.5 FTE appointment secretary
needed to manage the needs of all
patients
Chaudhry R, Scheitel S, McMurtry E, et al. Web-Based Proactive System to Improve
Breast Cancer Screening: A Randomized Controlled Trial. Arch Intern Med 2007; 167:606611.
Will population management help
Primary Care-Contd.
• Diabetic patients managed with a
single contact based on information
systems had significant improvement
in low-density lipoprotein control
(35.4% vs 13.3%; P=.004). The
intervention group also had a greater
percentage of patients who also
showed better control of hemoglobin
A1c
• Chaudhry R, Tulledge-Scheitel SM, Thomas MR, Hunt VL, Liesinger JT, Rahman AS,
Naessens JM, Davis LA, Stroebel RJ, Clinical Informatics to Improve Quality of Care: A
Population-Based System for Patients With Diabetes Mellitus, Primary Care
Informatics, 2009 ; 17: 95-102
33
Population informatics-based system to improve
osteoporosis screening in women in a primary care
practice.
• 25% of the 689 patients responded to the letter and completed osteoporosis
screening. Patients who had osteoporosis screening received appropriate
treatment.
J Am Med Inform Assoc. 2010 Mar-Apr;17(2):212-6.
Kesman RL, Rahman AS, Lin EY, Barnitt EA, Chaudhry R.
Thanks !
Needs of Patients Come First
— Dr. Mayo
Questions?