Benjamin Tsoi, MD, MPH Director of HIV Diagnostics Bureau of HIV/AIDS Prevention and Control NYC Department of Health & Mental Hygiene

Transcription

1 Benjamin Tsoi, MD, MPH Director of HIV Diagnostics Bureau of HIV/AIDS Prevention and Control NYC Department of Health & Mental Hygiene

2 Integrated Sexual Health Services Program Collaboration & Service Integration (PCSI) Transmission and clinical outcomes of HIV, STDs, and viral hepatitis are influenced by co-occurrence of these diseases HIV, STDs, and viral hepatitis share common risks and modes of transmission Certain populations are at elevated risk for multiple diseases

3 Project Overview Objective: Maximize provider use of electronic health records (EHRs) for HIV screening & other infectious diseases Main focus (HIV screening): Routinize HIV test offer (with documentation) to patients ages Increase HIV screening in clinical settings Other focus (STD/gonorrhea): Improve adherence to current gonorrhea treatment guidelines Assess and increase use of extragenital gonorrhea NAAT testing for MSM Other focus (HCV testing) Increase age-based hepatitis C screening (those born ) Increase hepatitis C screening for HIV + patients Increase hepatitis C RNA testing for antibody positive patients

4 Key Outcome Measure Minimum goal of 25% of all eligible patients tested Eligibility: Patients aged with a clinic visit Without a previous HIV diagnosis or have an HIV test ordered in the last 12 months

5 Project Timeline (12 months) Spring 2013 Summer 2013 Fall 2013 Winter 2013/14 Recruit and engage FQHCs Needs assessment Baseline data collection TA and training Conference call Workshop 1 TA and training Interim data reporting TA and training Workshop 2 Follow-up data reporting

6 Needs Assessment HIV Provider knowledge of New York State HIV testing law & recs. FQHC s ability to appropriately bill for HIV testing services Current work flow for HIV offer, consent, & test Current EHR structure to collect data on HIV offer, consent, & test Ability to generate data abstracts/reports to monitor activities Ability to modify workflow to routinize HIV screening Ability to modify EHR to document HIV consent, offer, & test STDs/HCV Current EHR structure to collect sexual risk data Current protocol for gonorrhea screening among MSM Ability to implement extragenital gonorrhea screening among MSM Current protocol for gonorrhea treatment Ability to meet current gonorrhea treatment guidelines Current protocol for hepatitis C screening & ability to document

7 Baseline Data Collection # Eligible patient visits Visit with a patient aged years without HIV test within last 12 months or HIV diagnosis # Eligible patient visits with HIV test offer # Eligible patient visits with HIV test

8 Notes Data are prior to the start of the project Number of patients offered HIV testing may be an underestimate because several entities did not have a structured way to capture/pull offer data. Providers also may not have used the structured field consistently 1 site was only able to pull data for annual visits 1 site began using EHR in April sites experienced challenges pulling offer and testing data from their EHR; DOHMH staff working with entity to increase data pulling capacity Baseline HIV Test Data Monthly Average Number & Percent 15 sites for CY 2012 Monthly Average Measure Eligible patient visits Eligible patient visits with HIV test offer Eligible patient visits with HIV test Number (Range) 823 (91 2,242) 93 (0 325) 68 (0 242) Percent (Range) - 11% (0% 55%) 8% (0% 78%)

9 Technical Assistance & Training Conducting site visits Provide on-site Trainings HIV Testing training HIV Billing training Provide TA on EHR modification

10 Conference Call with FQHCs Orientation call to introduce FQHCs to each other Begin discussion of challenges and successes Preparation for first in-person workshop

11 Workshop I July 30, 2013 Goals Share HIV offer and testing practices, workflow & data Discuss challenges faced and lessons learned FQHC entities presented HIV offer and testing workflow and practice Offer and testing data Lessons learned & challenges Urban Health Plan s Experience with Routinizing HIV Screening Lessons Learned from Primary Care Information Project (PCIP) Next Steps

12 TA & Training Activities On-site & telephone data meetings Ongoing trainings on HIV testing and billing TA/training on EHR use & modifications Conference calls ongoing and planned STD screening & treatment conference call Hepatitis C HIV testing

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15 Lessons Learned Buy-in is important to implement change High-level administrators to designate responsible agent of change Data must be usable Data in question must be collected Data must be easily retrieved (free text fields vs. structured data fields) Knowledge is power Feedback on data is important to motivate change Awareness of deficiency led several entities to make modifications on their own Review and feedback of data to providers need to happen regularly Meet FQHCs & providers where they re at Data reporting and analysis capacity varies Provider comfort with EHR and offering testing remains a challenge No magic bullet solution Clinic workflow, provider engagement & EHR all necessary for meaningful change EHR reminders are helpful but alert fatigue No one size fits all solution Clinic workflow and EHR format need to meet differing needs of each FQHC EHR modifications are dependent on current system at FQHC

16 Acknowledgements Elizabeth Terranova, PCSI Projects Specialist Project Coordinator Michelle Kim, HIV Program Evaluation Manager Jennifer Fuld, PCSI Coordinator Kate Washburn, STD Special Assistant to Assistant Commissioner Laura Jacobson, PCIP HUB Manager Fabienne Laraque, Disease Control Medical Advisor Katherine Bornschlegel, Communicable Diseases City Research Scientist

17 Thank you! Questions?

18 Using EHR Prompts to Streamline Routine HIV Testing and Other Health screenings in FQHCs Partner FQHC Organizations ^ Bedford Stuyvesant Family Health Center, Inc. # Brownsville Community Development Corporation " HELP/PSI, Inc.! Heritage Health and Housing, Inc % Morris Heights Health Center, Inc X William F. Ryan Community Health Center, Inc DPHO Catchment Areas Average HIV rate per 100, X X X X! " % % Miles Source: NYC DOHMH Division of Disease Control, PCSI Syndemic Project, 2012 ± ^ # # # # #