The Ultimate Software Ecosystem

Transcription

1 The Ultimate Software Ecosystem Caring for California s Heartland Moderated By: Sean Folweiler About CVHN Consortium of 13 Federally Qualified Health Centers in California 124 Health Center Sites 21 Counties Provides 2.5 million encounters annually Over 600, patients annually 77% are at or below 100% federal poverty level 1

2 CVHN Projects Integrated Video Conference Network Hosting i2itracks Hosting Learning Communities Statewide collaborative for QI and HIT Preparing Community Health Centers for Meaningful Use HIE and Meaningful Use workgroups Every System Is Perfectly Designed to Achieve Exactly the Results It Gets --Don Berwick 2

3 Overarching Goal Improved dhealth Care for Self Family Community Focus on Community Health Improvement Questions to be answered today. What is Population Health Management? How do we improve the community s Health? Will one system do it all? 3

4 What is Population Health Management? Population - Every patient fits into a group of like patients that need some standard of care Automation of care that falls outside the 15 minutes the patient spends with the provider Proactive care knowing what your patients need before they come in or know they need to come in Analysis of outcomes for study and improvement If we respect the people we want to p p p serve, and if we show them that we respect them, then they will give us a chance to help them. If not, they won t. This is the secret: respect. --Hajia Mary Issaka 4

5 Population Health Management The evolution of Population Health Management (PHM) Software Registries Chronic Disease Management Systems (advanced registry) PHM Every patient fits into a group of like patients that need some standard of care Children who need immunizations Women who need paps or mammograms Diabetic patients who need a flu shot, foot check, or a referral to a dentist Create and view panels of patients defined by specific characteristics track any population in need Population Health Management Improve Quality Improve Efficiency assessment of performance through data access and analysis One task can affect many patients Simple tools for re care Group like patients to receive the same care Easy outreach and alerts for coordinated health care interventions Take tedious /time consuming task and automate them Improve quality of life for individuals, reduce healthcare cost, minimize effects of disease and lack of preventive care Save time, save money, reduce error, healthier patients 5

6 How do we improve the community s Health? Understanding of Data How, What, and Where to collect What does the data Say Less Time, Most Benefit How much benefit before diminishing returns is experienced Understanding Population needs Software Ecosystems PMS DHR PHMS People Payroll GL EHR 6

7 EHR and Population Health Management: The Ultimate Software Ecosystem EHR and Population Health Management Teresa Weir IS Application Support/Trainer Golden Valley Health Centers operates community health centers in 26 locations serving most of Merced and Stanislaus Counties. Most Golden Valley locations provide a full array of primary health care services. Our locations include: Medical; Family Practice, Pediatric, and OB/GYN, Dental, Chiropractic, Podiatry, Health Education, Behavior Health Services, Homeless, School Based site, Optometry, and 3 Mobile Medical units. 7

8 Our corporate office is in Merced, which is about 280 miles north of Los Angeles and about 120 miles southeast of the Bay Area. Golden Valley uses several integrated systems in our infrastructure PMS Practice Management System EHR Electronic Health Record PHM Population Health Management Dentrix Dental EHR MASS200 Billing and Finance 8

9 When reviewing the need to have both an EHR and Population Health Management system it is easy to think that your EHR can provide the benefits of both systems. While both systems are designed to collect and manage a patients medical information, they are entirely two separate creatures indeed. 9

10 EHR An EHR is specialized in collecting data for an individual patient. PHM A PHM system specializes in collecting data on an individual patient and gives you the ability to manage your patients population on various levels. You can t make an apple into an orange, but if you use them together and you get a pretty tasty treat. Managing Diabetic patients HbA1c- Using our EHR During the patient visit the provider can document their visit notes and order an HbA1c lab. The provider will receive a message letting them know when the patient s HbA1c result has been posted in the EHR. The provider can review the result and take the necessary actions for each patient s results individually. 10

11 Using our PHM The provider can pull up a patients individual lab results and take action, just like in our EHR. Our staff can create a customized search to give you all patients for a particular provider or site who haven t had a visit in the last 3 months and who have an HbA1c level >=9%. This information can be used in a number of ways, it can be printed as a report to have someone contact these patient, or you could print customized letters reminding all these patients they need to make an appointment with their PCP What s important to remember when looking at the two systems is that they complement each other s specialized design. You can enter your patient s vitals in your EHR and through an interface send that data a over to your PHM system, so you can later do a search to find all patients who have an elevated blood pressure so you can put them into a customized tracking type and easily manage their hypertension. 11

12 Using our PHM system we can manage a specific patient population through customized tracking types, searches, and registry reports with ease. Our EHR product is geared towards enabling us to enter point of care information on an individual patient. While we are able to set up customized templates to hold data in our EHR, the data is pretty much used as a paper chart was. You can t extract data easily from our EHR and looking for population data is next to impossible. Our PHM System allows the individual user to extract customized searches easily on any information that is input into our PHM system, whether it is manually input or through our PMS/PHM or EHR/PHM interfaces. Referral Tracking Our providers create a referral note in our EHR and message it to their referral staff. The referral staff creates, manages, and tracks the referrals in our PHM. They then message the provider using our EHR to complete the referral cycle. Pap Management Our medical assistant staff prepare the pap order in our EHR and send it off to Quest Diagnostics. The result is sent back to both our EHR and PHM systems. Our pap tracking staff are utilizing our PHM external pap manager to map our pap results. For normal pap results at letter is set our of PHM every two weeks to inform patient of their result. For abnormal paps we utilize our PHM follow-up and pap tracking to manage treatment at our Women s Health sites. These sites are not yet using our EHR system. 12

13 Panel/Case Management We have developed customized panel management tracking types in our PHM to track the progress of getting our patients to return to see their PCP for various needs: Elevated HbA1c levels or Missing HbA1c labs Missing Foot or Retinal Screenings Children who are in need of well child exam EyePACS Using our EHR our providers can refer their patients to have a retinal photograph done. Using our PHM system we capture the retinal photographs and send them to UC Berkeley using the EyePACS software in our PHM. Our retinopathy staff using a third party software called Zen Image Printer export the EyePACS case so it can be imported into our EHR. Once the finalized report has been sent to our PHM through EyePACS the staff then export the report using the Zen Image Printer and import it into EHR so the provider will have access to color report in the patient electronic medical record. 13

14 Reports and Searches We put so much important information into our EHR that we are unable to retrieve for reporting purposes. Along with customize searches and reports using our PHM system we are able to easily run standardized performance measurement reports such as: CSLC report UDS Table 6A, 6B, and 7 We actively use the Diabetes and Asthma collaborative report to give to our Chronic Care Task Force and Associate Medical Directors What s important to understand it that your organization may use several software programs. PMS Practice Management System EHR Electronic Health Record PHM Population Health Management Each system is designed to perform specific tasks and by using these systems together you can reach your ultimate goal of providing the best care possible for your patients. 14

15 Contact Information Golden Valley Health Centers Teresa Weir IS Application Support/Trainer Christine L. Burkhart, Performance Improvement/Risk Management Catherine Rada, Corporate Compliance Officer/Grants Administrator Mendocino Community Health Clinic, Inc. MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 15

16 Our Mission Mendocino Community Health Clinic provides access to excellent healthcare services for the most vulnerable people in our community. Located in Northern California, approximately two hours north of San Francisco. Originally, MCHC delivered around 70 patient visits each day. In 2010, including patients at all three of our sites, that figure will rise to over 500 patients per day. In Mendocino County, we provide services to approximately 18,000 patients through our Hillside Health Center located in Ukiah, and our Little Lake Health Center located in Willits. In Lake County, we provide services to approximately 7,000 patients through our Lakeside Health Center located in Lakeport. JCAHO accredited since 2000 MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Services Provided Primary Care Dentistry Counseling, Psychotherapy and Psychiatry OB and Women s Health Chronic Disease Management Specialty Health Services MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 16

17 Hillside Health Center 333 Laws Avenue, Ukiah, CA Serving the Mendocino County community since 1992 MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Lakeside Health Center 5335 Lakeshore Blvd., Lakeport, CA Serving the Lake County community since 1999 MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 17

18 Little Lake Health Center 45 Hazel Street, t Willits, CA Serving Willits and Mendocino communities since 2002 MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Population Management History The models on which the collaborative are based facilitate an interactive process-improvement approach with rapid clinical change. Participation in the following collaborative registries: HIV/AIDS Diabetes Cancer Screening MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 18

19 Practice Management / EMR System Purchased current system in 2004 Implemented practice management first Barriers to obtaining specific patient population data in an efficient and cost effective manner included: 1) Required multiple resources to provide clinical outcomes 2) Extensive amount of manual entry into registry 3) Unable to sustain resources for data entry 4) Resulted in less complete information available to providers and a lack of confidence in the data MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. EMR Implementation Began EMR implementation in 2008 with 4 primary care providers With the assistance of outside EMR consultants, remaining primary care providers implemented EMR at Hillside Health Center in 2009 Implementing primary care providers at remote sites in February and March 2010 MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 19

20 EMR CAN DO IT ALL! Feedback from our IT staff indicated that we could report on anything in the patient s EMR Did not see the value in supporting two separate systems Registries could be a thing of the past Providers did not value the integrity of the data due to resources to support timely data entry MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Retrieving data out of your EMR should be as simple as traveling from Northern California to Southern California You can use multiple l means of transportation, t ti but by the time you have arrived at your destination you have exhausted all of your resources, are tired, frustrated and the trip is unfulfilling. You can hire a private pilot to fly you in a lear jet, but there is only one flight a day. It s a nice way to travel but unfortunately, not very cost effective. You can drive yourself and take a direct route straight down Hwy. 5 from the Oregon border all the way to Mexico. MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 20

21 Multiple Means of Transportation Run a series of reports from our practice management system Import to Excel Merge all of the data from the various reports Difficulty in obtaining one report with all of the required fields needed for mandated reporting such as our annual UDS reports Edit the report to remove duplicated and/or merged data After all of this, you can finally take a look at the data you actually want to analyze such as clinical outcomes on a specific population Generating provider reports in a timely and cost effective manner still remain a constant issue MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Private Pilot Hire additional staff trained in Crystal reporting Learn Crystal reporting and work through h data mapping from a very complex huge database that isn t intuitive it may be easier to learn how to fly the plane. Submit all requests for data to IT department staff Rural environment is difficult to recruit and retain high level of analytical, crystal reporting staff required for EMR data analysis. Not cost effective MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 21

22 Drive Straight Through Interface EMR with population management system Fulfill mandated reporting requirements in a cost effective manner Allows providers to understand validity of information Clinical reports based on standardized measures as well as specific provider interests Removes the resource barrier Timely and cost effective MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. Road Map While EMRs will continue to evolve, right now our road map is pointing i us to our population management software as the most cost effective and direct route to our destination. Thank you! MENDOCINO COMMUNITY HEALTHCLINIC, INC. A local, nonprofit healthcare organization. 22

23 The Dreams and Realities of Software Systems Dorrie Paquin-Brown BSMT (ASCP), CHCQM Suncoast Community Health Centers, Inc. (SCHC) Suncoast Community Health Centers, Inc Plant City Family Care SCHC Pediatrics Dover Health Center Ruskin Health Center 23

24 SCHC Staffing Physicians 13 Dentist -4 Midlevels 10 Nurses 16 Medical Assist - 24 Outreach staff 4 Health educators 1 Support staff 127 Administration 22 IT Staff - 3 Services Pediatrics Family Practice Internal Medicine Prenatal Care Family Planning Dental Portable Dental Pharmacy Lb Laboratory Radiology Outreach Transportation Referrals Fast Track 24

25 Current Tracking needs Pap Smears Mammograms Prenatal Tracking Diabetes Registry Coumadin Therapy UDS Reporting Family Planning ER Referrals Visit Recall Laboratory tracking Immunization registry Portable Dental Meaningful Use reporting Program Dreaming of the perfect solution 25

26 The perfect solution would be Interoperable! Able to document, monitor, and manage health care delivery for the medical and dental home of our patients and families for the purpose of providing quality health care and improved health outcomes in a safe and efficient manner. still dreaming Clinical documentation Order entry Pharmacy Mgt Clinical Tracking Clinical decision support Case Management Outreach Reporting UDS Grant Management Meaningful Use and more 26

27 and still dreaming Extensive knowledge of FQHC organizations billing requirements Provide functionality for all clinical staff Licensed Independent Practioners Nurses Quality Improvement Officers Risk Managers We were told by the demoing EHR vendors That we would get all of this in an EHR We did believe That we would get all of this in our EHR 27

28 The Reality There is no one perfect system! As in every other instance in life The dream and the reality are different things 2006 INITIALLY, I was the first to say I didn t think we would need Tracks after EHR implementation 2008 Learned the complexity of implementation and limited functionality of EHR 2009 Realized the EHR would not be able to do what we needed in reporting nor tracking. This is not limited to the EHR we choose it is across the board. 28

29 What is your Level of Population Health Management? Because of our extensive QI projects the limitations of our EHR became obvious right away. If you don t have current QI projects what an EHR offers MAY be enough. it wasn t enough for us and we weren t going backwards! Our reality - It would take a software ecosystem Population Health Management System EHR Pharmacy system Laboratory system Practice Management system Electronic Claims Submission Collections Data aggregation and reporting 29

30 How we use our ecosystem EHR Electronic documentation of the patients visit (pretty notes, excellent knowledge of medical vocabulary) Order entry Laboratory and Radiology Order entry for in-house prescriptions and medications eprescribing (sending and refill requests) Referrals and Outreach How we use our ecosystem Practice Management Demographics and Financial information Scheduling Collections Electronic Claims submission Medical and Dental Claims Billing Medicaid, Medicare, County Health Plan, Third Party Insurance 30

31 Population Health Management Clinical tracking Case management Proactive and reactive process for outreach and recall Data, data, data... mining All clinical and performance reporting EHR data validation Upload to state immunization registry Our expectations weren t reasonable The model of care delivered in the community health center goes way beyond See a patient bill the payer First and foremost, we are held accountable to our patients, the communities we serve, and to BPHC and other funding sources. 31

32 We do it right we do it well CHCs - We are leaders in delivering improved quality of care and we can prove it. but not without the right software ecosystem! Today We understand that it takes a software ecosystem to fulfill our purpose: Provide quality healthcare and improve health outcomes in a safe and efficient manner. 32