EMR Upgrade for HCV Screening and Treatment. Andrew Hamilton, RN, MS

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1 EMR Upgrade for HCV Screening and Treatment Andrew Hamilton, RN, MS

2 Overview Overview of Alliance of Chicago Community Health Services Description of HIT Enabled HCV Screening & Treatment CDS Project Review Baseline Data Discuss Preliminary Results Share Lessons Learned and Next Steps

Screening & Treatment CDS Project Review Baseline Data

3 Facts about US Community Health Centers Nearly 1,100 health center grant recipients operate more than 7,000 community-based clinics One of every 19 people living in the U.S. now relies on a HRSAfunded clinic for primary care. HRSA-supported health centers treated more than 21 million people in Nearly forty percent of patients treated have no health insurance and one-third are children 61,000 Individuals Diagnosed with HCV

now relies on a HRSAfunded clinic for primary care.

4 History and Mission of Community Health Centers First funded by the Federal Government as part of the War on Poverty in the mid-1960s. Designed to provide accessible, affordable personal health care services for people living in medically underserved communities Mission encompasses quality, access, and responsiveness to particular needs of the community served. Typical services include primary care (Including Pediatrics, Internal Medicine, OB/GYN, and Family Practice), dental, behavioral health, nutrition, case management and health education.

encompasses quality, access, and responsiveness to particular needs of the community served.

5 Health Centers at the Forefront of Quality and Health Information Technology Comprehensive model of comprehensive primary care predating Medical Home concept Long history of formal chronic disease management, evidence based practice and reporting on national measures. Federal investment Health Center Controlled Network model to support adoption of HIT has resulted in examples of advanced use and resembles REC strategy of ONC Focus on quality while respecting limitations in resources have led Health Centers to explore strategies to promote efficiency

Federal investment Health Center Controlled Network model to support adoption of HIT has resulted in examples of advanced use and

6 Typical Health Center tracks/reports multiple quality measures HRSA UDS Health Disparities Collaborative program HIV measures Ryan White/HIVQUAL State required reporting Third party payer measures Measures for individual funding programs (private/public)

Ryan White/HIVQUAL State required reporting Third party payer

7 Alliance of Community Health Services Overview HRSA funded Health Center Controlled Network founded by 4 Federally funded Health Centers located on the Near North Side of Chicago Aim is to provide infrastructure through which Centers can share services at higher quality and lower cost. Focus on Information Technology as tool for quality Initial demonstration project funded by AHRQ and HRSA in partnership with AMA to integrate clinical decision support related performance measures into a commercial EMR Included collection of race ethnicity and socioeconomic barriers Ongoing HIT related research and evaluation

Focus on Information Technology as tool for quality Initial demonstration project funded by AHRQ and HRSA in partnership with AMA to integrate clinical

9 Alliance HIT Community Health Centers Urban & Rural 11States 7 Rural Centers 33 Health Centers 22 Sites 110 Service Delivery Sites ~500 FTE Practitioners 26 Urban Centers ~350,000 Patients served 88 Sites ~1,000,000 Annual encounters

Service Delivery Sites ~500 FTE Practitioners 26 Urban

10 Pillars of Alliance Strategy EHRS implementation and support Innovation Research and Data Use Consulting/technical Assistance

11 Network Role in HIT Implementation and Support Health Centers Health Center Network Product/ Software

12 Health Centers Working Independently Health Center Health Center Health Center Health Center Health Center Health Center Health Center

13 A Learning Community Health Center Health Center Health Center Health Center Network Health Center Health Center Health Center

14 Project Overview Pilot Program to implement a shared Clinical Decision Support (CDS) Tool at clinics in two US cities (Chicago, IL and Huston, TX) that participate in the Alliance Network/Learning Community Focus of CDS was to support both screening and treatment of HCV Baseline data compiled related to screening and testing of HCV Capture data on use of CDS and impact of screening and treatment post CDS Implementation

Focus of CDS was to support both screening and treatment of HCV Baseline data compiled related to

15 Clinical Content Development Process Key area of clinical need identified and prioritized by the Alliance Clinical Committee Subject Matter Experts (SMEs) are assigned to work with the Alliance Informatics Team to Design and Build the clinical templates Built templates are tested for usability and accuracy Alliance Clinical Committee Approves Content to go into use based on testing Alliance Informatics team creates necessary training material to support use

the clinical templates Built templates are tested for usability and accuracy Alliance Clinical Committee Approves

17 Setting Goals for Clinical Content Develop written goals for the new/revised content Promote best practice guidelines for priority conditions Support data collection for reporting purposes Enhance usability and efficiency of use

guidelines for priority conditions Support data

18 What is a Subject Matter Expert? EHRS user appointed by a site s Chief Medical Director and/or the Alliance Clinicians Committee SME Responsibilities Provide expert feedback to build consensus with other SMEs for deciding the content s features Support core tenets of content process and champion the content upon go-live Take part in feasibility testing/clinical simulations Communicate with Alliance content team

Responsibilities Provide expert feedback to build consensus with other SMEs for deciding the content s

19 Design Content Efficiency Refers to how efficient a user, a clinical care team, and the entire system are able to utilize clinical content in the EHRS. Accuracy & Safety Refers to the accuracy & completeness of data capture to promote safe decision making in the EHRS. Satisfaction Refers to the extent to which the clinical content is intuitive, supportive of the entire patient care process, & incorporates user feedback

Accuracy & Safety Refers to the accuracy & completeness of data capture to promote safe decision making

20 Site Level Usability Testing Specific round of testing for the developed content This user is not a regular user. This user was NOT an SME for the content being tested. Provide feedback on ease of use, accuracy of decision support, and overall satisfaction.

This user was NOT an SME for the content being tested.

21 Approval of Content Dual approval SMEs Alliance Clinicians Committee Once approved, the committee a training and rollout strategy is developed Training sometimes includes content AND practice guideline

22 Training & Roll Out Consensus decision-making on the training and rollout plan for the developed content. SMEs who designed and approved the content also help to champion and support the training and rollout plan. Example plans may include Formal training Supportive documentation (e.g., FAQ document) Workflow review & go live support Guideline Training

23 NACHC Focus Group Identification of Need for HCV CDS Convened Members clinicians from CHCs with high incidence of people living with HCV Explored Models of care integrated, vertical, referral Expense of treatment Identified the Need for policy and funding similar to RWCA Also recommended deployment of decision making tools to support HCV screening and Treatment

24 IAPAC & Alliance Partnership IAPAC approached the Alliance to scope out the resources needed to design, build, and implement HCV CDS tools Scope also contemplates the spread of these tools to other CHCs IAPAC also identified clinician experts to support the design process

25 HCV Subject Matter Experts Alliance Sites Caroline Teter (Lead) John Stryker Caroline Thurlow Mary Tornabene Melvin Levine Tim Long IAPAC Jose Zuniga Mark Sulkowski Douglas Dieterich Alliance Staff Shannon Pohl Mary Kay Herman Andrew Hamilton

26 Identified Pilot CHCs Erie Family Health Center (Chicago) Heartland Health Outreach (Chicago) Howard Brown Health Center (Chicago) Legacy Community Health Center (Huston) Near North Health Service Corporation (Chicago)

27 Baseline Data 5 CHCs Unique Patients seen in 2012 Percent Diagnosis of HCV % Screened for HCV % Sex Patients Female 745 Male 1568 Other 1 Age Patients

28 Initial Design/Prototype Translated paper guidelines to electronic format Determined ideal location of CDS in the context of overall clinical workflow Utilized lessons learned from developing other disease management modules Determined data elements needed for CDS and quality reporting Planned for adaptability for future changes/updates to the guidelines

36 Content Rollout Provided access to real-time and recorded webinar style trainings Issued a one page FAQ Offered on-site/live training Go-live was scheduled for March 1, 2013

37 USE Preliminary Results Use of CDS by Sites by Week Center A Center B Center C Center D Center E 2 0 Week 1 Week 2 Week 3

38 Observations Workflow variation at site level Newness of SMEs including non-emr Users HCV Treatment is new to site level care teams Data Elements were not initially available from the commercial EMR vendor Reference CDS models for HCV are not widely available

39 Opportunities Incorporate Telemedicine enabled consultation with specialty providers (Project ECHO at U of C) Monitor population outcomes for those patients engaged in HCV Care Conduct Patient Centered and Comparative Effectiveness Research to learn more about variations in HCV Treatment in Primary Care

40 Questions? Andrew Hamilton

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