Transcript presentation - The Institute for Family Health

Electronic Health Records:
What’s in the pot of gold
at the end of the rainbow ?
Neil S. Calman, MD
1
The Goals….
Improve Quality, Safety, Efficiency and Reduce
Health Disparities
Increase Engagement of Patients and Families
Improve Care Coordination
Improve Population and Public Health
Ensure Privacy and Security Protections of
Personal Health Information
2
Progression of HIT
at the Institute
EHR/PMS
Implementation
2002
Clinical
Decision
Support
2003
Quality
Reporting/
Improvement
2004
HIE/
Patient
Portal
2008
!!!
EHR = Electronic Health Record
PMS = Practice Management System
HIE = Health Information Exchange
3
1
Supporting population
based care
4
5
Colon Cancer Risk Scoring
6
2
Linking to the
Nation’s public health
surveillance system
7
The Benefit of Early Detection of Syndromes
Number of Cases
Symptom Onset
Severe Illness
t
Release
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Days
8
Single patient visit
yields complex EHR data
• Patient Address
• Race / Age / Gender
• Medical history
• Temperature
• Height/weight
• Respirations
• Provider Location
• Reason for visit
• Problem list
•
•
•
•
Procedures
Medications
Lab results
Diagnoses
9
EHR Fever
0.060
Blue
0.45
= ER “flu/fever”
0.40
Purple = EHR Fever >100 F
0.35
Red
0.30
= Flu “A” isolates
0.050
0.040
Violet = Flu “B” isolates
0.25
0.030
0.20
0.020
0.15
0.10
0.010
0.05
0.00
7/8/03
Percentage of measured temperatures
Percentage of fever/flu chief complaints
0.50
0.000
8/8/03
9/8/03
10/8/03
11/8/03
12/8/03
1/8/04
2/8/04
3/8/04
4/8/04
5/8/04
6/8/04
10
Fever AND respiratory syndrome
0.025
0.45
0.40
Blue
0.35
Brown = EHR T≥ 100o and
Respiratory Syndrome
0.30
0.020
= ER “flu/fever”
0.015
0.25
0.20
0.010
0.15
0.10
0.005
0.05
0.00
7/8/03
Percentage of combination syndrome
Percentage of FevFlu chief complaints
0.50
0.000
8/8/03
9/8/03
10/8/03
11/8/03
12/8/03
1/8/04
2/8/04
3/8/04
4/8/04
5/8/04
6/8/04
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Patients of
the Institute
for Urban
Family
Health
Institute patient fevers peaked
13 days before ER visits for
Fever and Flu – this indicates
that health center data may be
the first “signal” of an
impending epidemic.
Institute fever data responded to
Flu B outbreak-ED data did not
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13
14
3
Bringing public health
information to the point of
care in real time
15
DOH sends alert
to community re
Legionella cases
in Parkchester
community in the
Bronx
Practice Alert in EHR for
this center only if patient
presents with cough –
matched to Legionella
order set to assist
provider in Dx and Tx
16
17
18
19
20
4
Developing Clinical
Decision Supports
over a
Broad Range of Measures
21
Clinical Decision Support –
Impact on Vaccine Administration in Adults
22
23
10 Take New York Indicators
1.
Have a Regular Doctor or Other Health Care
Provider
2. Be Tobacco-Free
3. Keep Your Heart Healthy
4. Know Your HIV Status
5. Get Help for Depression
6. Live Free of Dependence on Alcohol and Drugs
7. Get Checked for Cancer
8. Get the Immunizations You Need
9. Make Your Home Safe and Healthy
10. Have a Healthy Baby
24
5
Developing the EHR to
monitor quality of care
across practice sites
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Patients Seen at Least Once by Their
Primary Care Provider
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Men >35; Women>45 Who have
had their cholesterol tested
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Men >35; Women>45 Who have
had their cholesterol tested
28
Depression Screen with PHQ2
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Depression Screen with PHQ2
30
/2
00
07
5
/3
1/
20
05
09
/3
0/
20
05
11
/3
0/
20
05
01
/3
1/
20
06
03
/3
1/
20
06
05
/3
1/
20
06
07
/3
1/
20
06
09
/3
0/
20
06
11
/3
0/
20
06
01
/3
1/
20
07
03
/3
1/
20
07
05
/3
1/
20
07
07
/3
1/
20
07
09
/3
0/
20
07
11
/3
0/
20
07
01
/3
1/
20
08
03
/3
1/
20
08
05
/3
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%
31
10
/3
1/
20
11
06
/3
0/
20
12
06
/3
1/
20
01
06
/3
1/
20
02
07
/2
8/
20
03
07
/3
1/
20
04
07
/3
0/
20
05
07
/3
1/
20
06
07
/3
0/
20
07
07
/3
1/
20
08
07
/3
1/
20
09
07
/3
0/
20
10
07
/3
1/
20
11
07
/3
0/
20
12
07
/3
1/
20
01
07
/3
1/
20
02
08
/2
9/
20
03
08
/3
1/
20
04
08
/3
0/
20
05
08
/3
1/
20
06
08
/3
0/
20
07
08
/3
1/
20
08
08
/3
1/
20
09
08
/3
0/
20
08
South Campus Depression Screening
100%
E13th PHQ2 CQI
Project starts
90%
Phase II spread at all sites
other than SHHC
80%
70%
60%
50%
40%
30%
20%
10%
Amsterdam
East 13th
Homeless
Mount Hope
Parkchester
Phillips
Sidney Hillman
Urban Horizons
Walton
0%
32
Recorded Smoking History
33
Recorded Smoking History
34
Pneumococcal Vaccine >65yrs old
35
Pneumococcal Vaccine >65yrs old
36
37
38
6
Using EHR data to
determine primary care
practices that are
associated with
improved outcomes
39
Provider Nutritionist Referral
Rate vs. Pts Average HgBA1c
9
Most Recent HgbA1C
8.5
22
1
8
0.9
7.5
7
9
12
6.5
0.0%
10.0%
20.0%
30.0%
40.0%
Rate of Nutrition Referral
50.0%
60.0%
70.0%
40
7
Using EHR data to
elucidate and help
eliminate racial
disparities in health
outcomes
41
Last Hemoglobin A1c by Race
8
7.8
Latino
7.86
n=1555
7.6
7.4
7.2
7
6.8
White
7.03
n=423
Black
7.44
n=2122
Asian
7.12
n=76
6.6
HgbA1c
42
90
80
70
60
50
40
30
20
10
0
White
Black
Latino
Asian
Insulin/Sens
Agent %
1 HgbA1c %
2 HgbA1c %
LDL test %
43
Reductions in HgbA1c with
Treatment by Race /Language
8.5
8
7.5
7
6.5
1st HgbA1C
Most Recent
White
7.23
6.95
Black
7.80
7.44
Latino-Eng
8.02
7.75
Latino- Span
8.12
7.81
Other
7.82
7.48
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Percent Survival Rate
Five-year Cancer (all sites)
Survival Rate
70
65
60
55
50
45
40
35
30
1970
White
Black
1975
1980
1985
Year
SOURCE: CDC/NCHS, Health, United States, 2004
1990
1995
2000
45
Life Expectancy at Birth
Life Expectancy (Years)
80.0
White
75.0
Black
70.0
65.0
60.0
1950
1960
1970
1980
Year
SOURCE: CDC/NCHS, Health, United States, 2004
1990
2000
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Infant deaths per 1,000 live
births
Infant Mortality Rates
30
25
White
20
Black
15
10
5
0
1965 1970 1975 1980 1985 1990 1995 2000 2005 2010 2015 2020
Year
SOURCE: CDC/NCHS, Health, United States, 2004
47
Death Rates per 100,000 Males
Age-adjusted death rates for diseases of
the heart per 100,000 males
600.0
500.0
400.0
300.0
200.0
100.0
White
Black
0.0
0 82 84 86 88 90 92 94 96 98 99 01
8
19 19 19 19 19 19 19 19 19 19 19 20
Year
SOURCE: CDC/NCHS, Health, United States, 2004
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Dissemination of
Results; Credits
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Authored Publications
• Calman NS, Kitson K, Hauser D “Using
Health Information Technology to
Improve Health Quality and Safety in
Community Health Centers”. Journal of
Progress in Community Health
Partnerships: Research Education and
Action.1(1):83-88. Spring 2007
• Calman, NS, Golub M, Kitson K,
Ruddock C. Electronic Health Records:
The Use of Technology to Eliminate
Racial Disparities in Health Outcomes.
In: Medical Informatics: An Executive
Primer. Health Information and
Management Systems Society,
Chicago, IL. Kenneth Ong, MD, Editor.
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January 2007.
Authored Publications
• Sengupta S, Calman NS, Hripcsak G.
A Model for Expanded Public Health
Reporting in the Context of HIPAA. J.
Am. Med. Inform. Assoc. 25 June 2008
51
Our work has been
featured in a number
of publications by
others and has been
used as the
foundation for
others to build upon
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Commonwealth
Fund
“Quality
Matters”
May 2006
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Miller RH and Ward CE
Health Affairs Jan-Feb
2007
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Awards
Partner in
NYCDOH
CDC Center
of Excellence
in Public
Health
Informatics
HIMSS
Physician
IT
Leadership
Award
2005
Non-profit
Excellence
Award 2008
Technology
and Focus
on Mission
2007
Public Health
Award
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