Community Physicians of Indiana Engineering Forms to Improve Quality of Care and Physician Efficiency Ryan Houghton, M.D.

Transcription

1 Community Physicians of Indiana Engineering Forms to Improve Quality of Care and Physician Efficiency Ryan Houghton, M.D.

2 Disclosure No additional relationships or conflicts of interest besides employment at Community Health Network.

3 Outline of Presentation Show potential of EMR Principles of an effective EMR Show how we utilized EMR to: Improve quality of care Improve physician efficiency

4 Community Health Network 5 hospitals centered in central Indiana Network employed primary care group consisting of 180+ physicians Multiple network employed specialty groups Pillars of Network: Patients first Systems approach to healthcare delivery Teamwork

5 Challenge of Healthcare Improvement Patient Quality of care Access to care Satisfaction of care

6 We don t do it right like we should N Engl J Med 2003;348:

7 Women age 40 and over who reported they had a mammogram within the past 2 years, 1999, 2003, and 2005 Centers for Disease Control and Prevention, National Center for Health Statistics, National Health Interview Survey, 1999, 2003, and 2005

8 State variation: Women age 40 and over who reported they had a mammogram within the past 2 years, 2004 Centers for Disease Control and Prevention, National Center for Health Statistics, Behavioral Risk Factor Surveillance System, 2004

9 CPI study-not published

10 Challenge of Healthcare Improvement Patient Quality of care Access to care Satisfaction of care Cost Effectiveness Physician reimbursement Physician time off Physician satisfaction

11 Primary Care Office Visit (personal observation) Cost effectiveness Quality of care Office Visit Length (Time) Ann Intern Med. 1997;127:

12 Primary Care Office Visit (personal observation) Better Tool Cost effectiveness Quality of care Office Visit Length (Time) Ann Intern Med. 1997;127:

13 Tools to Improve Healthcare EMR Team approach Shared information

14 Complexity of Shared Information Primary MD Specialists EMR Urgent Care Hospital ER Imaging Laboratory

15 Team approach: Delegate responsibility to lowest possible level MD NP, PA, etc. MA, RN, office staff, etc. EMR

16 Designing EMR Forms for Purpose

17 Typical Office Visit HSR: Health Services Research 42:5 (October 2007)

18 Principles of Effective EMR Effective Human-Computer Interface Anticipation, Autonomy, Consistency, Fitt s Law, Latency Reduction, Learnability Pareto Principal: 80/20 Rule 80% of effects come from 20% of causes

19 H ealthaffairs, V o l u m e 2 0, N u m b e r 2, 2001

20 80/20 Rule 2 tier approach EMR needs to be 100% inclusive EMR only needs to focus on <20%

21 Creation of BSG Forms Goal to improve quality of care Means to reach goal was via improving physician efficiency Easy navigation of information Display data in visually relevant manner Shared baselines

22 Easy access: Everything one click away Simplicity: Only 6 forms in initial encounter Large screen: 1000 format width

23 Display comments Large information boxes Free text for efficiency

24 Everything visible upon display

25 Normal exam Chronic abnormal findings in one location

26 One location to track changes Pull in past data

27

28 Display relevant medications Common chronic problems

29 Easy access to information Summary: Limit wasteful steps navigating chart Maximize space though prevent cluttering

30 Color commands Commands based upon agreed criteria

31 Color provides quick information recognition

32 Show changes Color coding for easy information display Form button reflects pertinent information

33 Past data Order test Refuse/na protocol Enter info Documentation as byproduct Colored buttons

34 Data Display Summary: Utilize standard colors for pertinent information display

35 Shared Baselines Agreed upon standards that can apply to majority of patients

36 Explanation HPI Problem specific questions Assessment/Plan

37 Acute Back Pain Algorithm Neurological deficit yes no Constitutional symptoms yes no Other red flags no Conservative management Labs and X-ray yes X-ray Constitutional symptoms no Spinal MRI yes Labs and Spinal MRI

38 Recommendation present though options available Buttons perform multiple functions

39 Incorporate relevant information Medication options

40 Shared Baselines Influence/improve decisions while increasing efficiency Create relationships between primary care and network

41 Feedback

42 Automatically sends flag to specified user

43 Thanks to Community Physicians of Indiana