Measuring Pa,ent- Centred Care Integra,on of PROMs/PREMs into EHRs

Transcription

1 Measuring Pa,ent- Centred Care Integra,on of PROMs/PREMs into EHRs Nov 27-28, 2014 Francis Lau PhD, FCAHS University of Victoria 1

2 Outline Current EHR Landscape Integra,ng PROMs/PREMs into EHR Implementa,on Issues References 2

3 Current EHR Landscape - Context EHR defini,on Repository of pa,ent data over,me Infoway Summary Corporate Plan Opportuni,es for ac,on Bring care closer to home Provide easier access Support new models of care Improve pa,ent safety Enable a high performing health system Corporate objec,ves Deploy EHR for Canadians Get key informa,on into hands of clinicians Improve pa,ent experience for Canadians 3

4 Current EHR Landscape Evidence Whitepaper on coordinated EHR strategy for Canada Realist review to make sense of evidence 38 Canadian and 35 interna,onal studies, grey literature, 9 interviews ehealth value framework with investment, adop,on, value and lag,me Take home message Under right condi,ons, ehealth adop,on can be associated with clinical and health system benefits in processes, outcomes and return Evidence is strong in processes, mixed in outcomes, weak on return Ques,on is: under what condi,ons can benefits be realized & maximized 10 sugges,ons for a coordinated EHR strategy 4

5 Integra,ng PROMs/PREMs into EHR Integra,ng PROMS into EHR Estabrooks Harmonized pa,ent- reported data elements IOM Social and behavioral domain- measures phase 2 Krist 2013,2014 MOHR example in primary care Integra,ng PREMs into EHR Browne 2010 PREM as a strategy to improve primary care Ralston 2010 PREM as meaningful use criteria? 5

6 Estabrooks 2012 Harmonized pa,ent reported data elements 9 domains 3 areas 6

7 IOM 2014 Social and behavioral domains and measures 11 domains 12 measures Estabrooks Ea,ng paderns - Substance use - Sleep 7

8 Krist 2013 MOHR example in primary care 8

9 Krist 2013 MOHR example in primary care 9

10 Browne 2010 PREM as a strategy to improve primary care Defini,on of pa,ent experience elicited reports from pa,ents on what they did or did not encounter in their interac,on with providers and the healthcare system Recommenda,ons and implica,ons for EHR Use standardized, validated survey instrument Capture informa,on for all types of pa,ents Provide data at the provider and prac,ce site levels Analyze data by pa,ent demographics Use data to iden,fy system issues Improve the quality of pa,ent care Establish provider payment incen,ves Incorporate CAHPS* into medical prac,ce standards Con,nue to support regional implementa,on Develop and test new technologies *CAHPS Consumer Assessment of Healthcare Providers and Systems 10

11 Ralston 2010 PREM as meaningful use criteria? Defini,on of meaningful use Providers qualify for incen,ves with measures of care and EHR use Pa,ents gain access to info, engage in care, communicate with providers Web based tools for pa,ents at Group Health, WA 1/3 outpa,ent visits thru secure electronic messaging with providers Request medica,on refills and schedule office appointments Access to online medical test results and aher visit summaries Review lists of medical condi,ons and immuniza,ons Measuring pa,ent experiences Evaluate care experience that includes direct engagement with EHR Evaluate care that includes engagement with online services linked to EHR Reimbursement to include electronic communica,on and EHR use 11

12 Implementa,on Issues Aligning with overall EHR strategy Harmoniza,on and RE- AIM in primary care IOM Report iden,fied challenges Implementa,on issues for Canada? 12

13 Implementa,on Issues EHR Strategy 13

14 Implementa,on Issues Harmoniza,on Estabrooks 2012 Figure 1, p580 14

15 Implementa,on Issues RE- AIM Purpose Implement MyOwnHealthReport (MOHR) in primary care Methods Cluster- randomized pragma,c trial of paired- prac,ces early/delayed Electronic/paper MOHR paired with counseling and goal sekng RE- AIM: reach, effec,veness, adop,on, implementa,on, maintenance Results Reach: 591/1782 pts (50%), higher when done by staff (71% vs 30%) Adop6on: 18/30 prac,ces or 60% Krist 2014 Implementa6on: by mail done on web x3, by phone x1, on paper in office x1, staff helped pa,ents on web in office x4; added 28 minutes/visit Maintenance: None con,nued aher study, 6 adapted into PHR or pre- visit Conclusion MOHR feasible, counseling pts requires effort, prac,ces need support 15

16 Implementa,on Issues IOM Report Adding any data to EHR is challenging Collec,ng/storing social- behavioral data in EHR Collec,ng/using self- reported data Privacy protec,on Resource considera,ons Linking to public health and community agencies An,cipa,ng/preven,ng unintended consequences 16

17 Implementa,on Issues for Canada? 17

18 References 1. Canada Health Infoway. Summary Corporate Plan Lau F, Price M, Bassi J. Toward a Coordinated EHR Strategy for Canada, drah white paper, version 3.1. Queen s Health Strategy Conference Series Toward a Canadian Healthcare Strategy, Conference 2. Toronto, July Estabrooks PA, Boyle M, Emmons KM, et al. Harmonized pa,ent- reported data elements in the EHR: suppor,ng meaningful use by primary care ac,on on health behaviors and key psychosocial factors. JAMIA 2012;19: Ins,tute of Medicine. Capturing Social and Behavioral Domains and Measures in EHRs: Phase 2. The Na,onal Academy Press, Nov Krist AH, Glenn BA, Glasgow RE, et al. Designing a valid randomized pragma,c primary care implementa,on trial: the my own health report (MOHR) project. Implementa6on Science 2014; 8(73): Krist AH, Phillips SM, Sabo RT, et al. Adop,on reach implementa,on and maintenance of a behavioral and mental health assessment in primary care. Annals Fam Med 2014;12(6): Browne K, Roseman D, Shaller D, Edgman- Levitan S. Measuring pa,ent experience as a strategy for improving primary care. Health Affairs 2010; 29(5): Ralston JD, Coleman K, Reid RJ, et al. Pa,ent experience should be part of meaningful use criteria. Health Affairs 2010; 29(4):