Electronic Health Record Systems Public Health Functionality

Transcription

1 Electronic Health Record Systems Public Health Functionality Mat Kendall Director of Operations Primary Care Information Project (PCIP) NYC DOHMH

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3 TCNY 10 Priority Health Interventions 10 priority interventions Large burden, killing thousands of NYers and causing hundreds of thousands of preventable illnesses each year Proven amenable to intervention Best addressed through coordinated action by City agencies, health care providers, community organizations, businesses, individuals Important and winnable battles Affecting every New Yorker Proven and possible means to prevent Things we can do something about today

4 Identify and Build Partnerships Public sector cannot and should not address these health problems alone Many players have a stake in improving health of New Yorkers and can play key roles Coordination can promote progress in areas historically resistant to effective interventions

5 Primary Care Information Project (PCIP) Mission Vision: Increase the To improve quality of population care in health medically through appropriate health underserved areas through health information information technology and technology health (HIT) information exchange. Program Areas Program Areas: Primary Care erx Expansion Health Information Consortium (PCHIC) EHR Adoption Health Information Exchange Electronic Health Record (EHR) Adoption Public Health Informatics Center of Excellence

6 NYC Community Health Centers (CHCs) Location of CHC Facilities Provide primary care to 500K+ medically underserved New Yorkers Networks throughout NYC 50% on Medicaid, 20% uninsured Community/public health focused Community based leadership

7 PCIP s Approach to Assisting CHCs Convene CHCs and leverage their collective size and existing expertise Engage CHCs and provide them with appropriate EHR systems Develop system to easily link CHCs with evolving RHIOs Apply existing DOHMH expertise/knowledge Create a framework that welcomes other non-chc primary care providers

8 Progression of HIT Adoption Basic IT Understanding Modular HIT EHR Clinical Decision Support HIE

9 DOHMH Support for HIT Adoption in CHCs Funding Goals Support for CHCs $25 million in City funds to support PCIP $15 million capital for EHR expansion $4 million capital for HIT modular expansion project $3.2 million in State funds to support EHR adoption Provide 1,000 + clinicians with EHR systems Provide 1,000 handheld computers to CHC providers Assisted to develop the Primary Care Health Information Consortium (PCHIC)

10 Mission of PCHIC To support the leadership role of NYC communitybased primary care providers in their efforts to use health information technology to improve health outcomes, eliminate health disparities, and increase access to health data among traditionally underserved populations

11 Primary Care Health Information Consortium (PCHIC)

12 TCNY Indicators Primary care focused Public health priority areas Mindful of national efforts (AQA, NQF, etc.) Looking towards EHR-based reporting Developed set of TCNY indicators Implemented at the Institute for Urban Family Health Obesity measure approved by NQF Extend to NYC clinical partners

13 Measurement Early objective to develop measures for each TCNY priority health area Establish baseline before clinical decision support (CDS) tools are implemented Set target goals for each measure Outcome measure of effectiveness of CDS tools

14 Quality Measurement Practices will be able to benchmark individual providers and their entire practice against citywide data in blinded comparison Automated/confidential monthly reporting to DOHMH on all indicators Data will be stored in Citywide Quality Repository

15 Quality Improvement Decision support logic models will assist in improved adherence to clinical guidelines through reminders at the point of care Workflow redesign assistance will be provided to assistance practices in maximizing quality gains (e.g. recall lists, standing orders, etc.)

16 Clinical Decision Support A computer program that helps with clinical decision making Knowledge management systems Assist with problem solving (e.g., diagnosis) and decision making (e.g., treatment planning)

17 Clinical Decision Support Tobacco Best Practice Alert PATIENT VISIT Is patient under age 13? YES STOP--no alert needed NO ANY RECORDED SMOKING STATUS? NO BPA #1 Activated: "enter smoking status" YES Identify most recent smoking status date and type Clinician clicks a status radio button WAS STATUS ENTRY VERIFIED? NO BPA #1 not satisfied What is most recent status? YES NEVER SMOKED FORMER SMOKER CURRENT SMOKER Store Date of smoking status entry BPA #1 satisfied

18 Clinical Decision Support Impact on Vaccines

19 Linkage to Public Health Information Systems Potential for bilateral communication with providers Syndromic Surveillance Immunization Registry School Health Lead Registry Reportable Diseases RWJ Foundation Proposal

20 National Center of Excellence in Public Health Informatics Grant (CDC) Model for Public Health role in HIT Creating successful HIT adoption Impact on clinical quality, safety, efficiency Impact on public health operations

21 Research and Evaluation

22 Intervention Potential Health Impact of HIT adoption among CHCs Influenza immunizations Pneumococcal immunizations Colon cancer screening Improved diabetes management Improved CHF management Improved asthma management Totals ER visits avoided ,157 3,444 2,472 18,777 Outpatient visits avoided 444 1, ,086 18,595 23, ,745 Days in bed avoided 9,093 28, , , , ,468 37,310 20,661 29,667 91,292 The data in this table are derived by applying national utilization estimates to the New York City CHC demographic profile. Methods described in detail at - Workdays gained 1,607 2,047 - Deaths avoided , ,984