Transcript EHRS as a Tool to Improve Hypertension Control

EHRS as a Tool to Improve BP Control
1. Brief history of OQIUN, CCI. Began 1999 using data
cards. Started working with multiple practice sites using
different EHRS in 2003; currently >350 clinical sites using
>25 EHRS. Relationships are critical to success !
2. Registry function: NCQA Heart Disease / Stroke
Prevention Recognition program reporting with 5 indicators
(BP control [75%], Lipid panel [80%], Cholesterol (LDL)
control [50%], aspirin or another antithrombotic [80%],
smoking status / cessation advice or Rx [80%].
Score for each physician, composite for each clinic,
comparison to all other providers / clinics in database
4. Population management tool (all patients for each provider
left vertical), 5 indicators across the top. Sortable columns
Quality Reports and Certifications
Quality Reports and Certifications
OQUIN Heart and Stroke Recognition Program Patient Report
NCQA, Bridges to Excellence, DHEC, and OQUIN
Confidential Report for "Example Provider" Summer 2011
in control
minimum
out of control
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Patient Name
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Doe, John
Provider Results
Blood Pressure
min, <145/95
control, <140/90
min=5, cont=10
sort by ↑↓
125/75
10
no data
0
135/88
10
145/95
5
125/75
10
125/75
10
145/95
5
135/88
10
155/100
0
135/88
10
125/75
10
125/75
10
125/75
10
145/95
5
125/75
10
140/95
5
125/75
10
125/75
10
125/75
10
125/75
10
125/75
10
140/95
5
125/75
10
125/75
10
125/75
10
≥75%
82%
LDL Cholesterol
min, <130
control, <100
min=5, cont=10
sort by ↑↓
129
5
145
0
99
10
99
10
90
10
no data
0
129
5
85
10
no data
0
99
10
120
5
85
10
129
5
145
0
120
5
99
10
90
10
85
10
85
10
85
10
85
10
120
5
99
10
90
10
120
5
≥50%
70%
Complete
Lipid
Profile
yes=10
sort by ↑↓
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
no
0
yes
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yes
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yes
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yes
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yes
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yes
10
yes
0
yes
10
yes
10
yes
10
yes
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yes
10
yes
0
yes
10
yes
10
yes
10
≥80%
92%
Uses last labs, must have labs within last 2 years or values will show 0
Aspirin /
Antithrombotic
yes=10
sort by ↑↓
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
no
0
yes
10
yes
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yes
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yes
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yes
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yes
10
yes
10
yes
10
no
0
no
0
yes
10
no
0
≥80%
76%
Smoking
Status/Advice
Treatment
yes=10
sort by ↑↓
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
10
no
0
yes
10
yes
10
yes
10
yes
10
yes
10
yes
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no
0
yes
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yes
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yes
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yes
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yes
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yes
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yes
10
yes
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yes
10
≥80%
88%
Heart/Stroke
ABC'S Points
min=40
cont=50
sort by ↑↓
45
20
50
45
50
20
40
50
0
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45
50
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EHRS as a Tool to Improve BP Control
1. Key data in discrete or structured fields
2. Correct provider and clinic attribution
3. Correct patient demographics and vital signs
including an accurate and representative BP
(Elevated BP without Dx of HTN [ICD9 769.2])
4. Correct, complete and current medications
5. Comorbid diagnoses, e.g., CHD, CKD, CHF, DM
6. Smoking status
7. Lab data
Meaningful Use – Stage 2.
1. Use computerized provider order entry (CPOE) for medication,
laboratory and radiology orders directly entered by any licensed
healthcare professional who can enter orders into the medical record
per state, local and professional guidelines
2. Generate and transmit permissible prescriptions electronically (eRx)
3. Record the following demographics: preferred language, sex, race,
ethnicity, date of birth
4. Record and chart changes in the following vital signs: height/length
and weight (no age limit); BP (age 3+); calculate and display BMI
5. Record smoking status for patients ≥13 years old
6. Use clinical decision support to improve performance on high-priority
health conditions. (Rx protocols for hypertension, LDL-goal (CHD risk
or statin dose if 2013 guideline)
7. Provide patients the ability to view online, download and transmit their
health information within four business days of the information being
available to the eligible professional (EP)
Meaningful Use – Stage 2
8. Provide clinical summaries for patients for each office visit
9. Incorporate clinical lab-test results into Certified EHR Technology as
structured data
10. Generate lists of patients by specific conditions to use for quality
improvement, reduction of disparities, research, or outreach
11. Use clinically relevant information to identify patients who should
receive reminders for preventive/follow-up care and send these
patients the reminders, per patient preference
12. Use clinically relevant information from Certified EHR Technology to
identify patient-specific education resources and provide those
resources to the patient
13. Use secure electronic messaging to communicate with patients on
relevant health information
Meaningful Use – Stage 2
14. Protect electronic health information created or maintained by the
Certified EHR Technology through the implementation of
appropriate technical capabilities. The EP who receives a patient
from another setting of care or provider of care or believes an
encounter is relevant should perform medication reconciliation
15. The EP who transitions their patient to another setting of care or
provider of care or refers their patient to another provider of care
should provide a summary care record for each transition of care
or referral
16. Capability to submit electronic data to immunization registries or
immunization information systems except where prohibited, and in
accordance with applicable law and practice
17. Use secure electronic messaging to communicate with patients on
relevant health information
Using an EHRS to Improve BP Control
• Whenever possible use the EHRS as designed and maximize
consistent use of discrete and structured field data
• Standardize data entry across the clinic and practice group
• Implement a BP measurement protocol that aims to obtain an
accurate and representative BP in a discrete / structured field
• Make sure the medication list is accurate
• Incorporate labs into structured fields of the EHRS
• Agree on a BP treatment protocol that will work for most patients
and adhere to it
• Maintain a hypertension registry with at least monthly updates
and accountability
• To maximize benefit, use the ABCS of CVD prevention with
actionable, POC information and support