Public health system transformation under the Affordable Care Act APHA Amanda Parsons, MD, MBA Deputy Commissioner Presentation November 8th, 2013
PRIMARY CARE INFORMATION PROJECT PCIP started as a mayoral initiative in 2005 Mission Improve the quality of care in medically underserved areas through health information technology (HIT) Success Over 6,200 providers have implemented an EHR and received Meaningful Use assistance 915 small practices, 23 large practices 50 community health centers 54 hospitals & outpatient clinics 1
PRIMARY CARE INFORMATION PROJECT The Hub allows secure exchange of data with PCIP practices. - Send out queries - Receive aggregate patient counts overnight The Hub currently covers: 640 practices 1.6 M patients in 2011 4 M patients since 2009 Data obtainable through hub queries Chronic health conditions and clinical risk factors Use of clinical preventive services and screening Recommended counseling services Chronic disease management 2
THE DATA WE GET IS USED TO PROVIDE FEEDBACK TO PATIENTS AND TO DO POPULATION HEALTH SURVEILLANCE Provider dashboards Population health BMI distribution Obesity in NYC Patients: BMI Distribution in 2010 Data from 217 PCIP practices which returned non-error values from 9/2/2011-9/11/2011.
THE PRESENCE OF DATA RECOGNIZED FOR AUTOMATED QUALITY MEASUREMENT VARIED FROM 10% TO ~100% 4
WE ARE SEEING IMPROVEMENTS IN QUALITY (OVERALL PROGRESS IN PCIP 2 YEAR TREND) % Average Practice Performance Rate 80 70 66.7 74.8 60 58.4 55.3 59.6 64.1 57.7 50 40 46.4 48.9 35.0 46.2 30 29.30 20 Oct-09 Jan-10 Apr-10 Jul-10 Oct-10 Jan-11 Apr-11 Jul-11 Oct-11 T1 T2 T3 Antithrombotic Tx BP Control in HTN Hemoglobin A1c Testing Smoking Cess Intervention Time Antithrombotic therapy Blood pressure control Hemoglobin A1c Testing Smoking Cessation Intervention Oct 2009 (T1) 58.4 55.3 46.4 29.3 Oct 2010 (T2) 66.7 58.5 50.6 34.5 Oct 2011 (T3) 74.8 64.1 57.7 46.2 Difference between T1 and T2 8.3* 3.1 4.2 5.2 Difference between T2 and T3 8.1* 5.5* 7.1* 11.7* Difference between T1 and T3 16.4** 8.8* 11.3* 16.9** *: p<0.05; **: p<0.001
LARGER PRACTICES SEEM TO PERFORM BETTER- A BP EXAMPLE HTN Panel size Time Practices with more hypertensives (larger denominator) scored better than practices with smaller denominators Hypotheses include PCIP large practices are mostly FQHCs, which may cause bias More non-md clinical staff More robust QI efforts Better transparency around provider provider performance Source: PCIP Hub query of practices with HTN data (n=605), subset for those with > 40 HTN patients in the denominator. BP measure is all pts 18-100 with dx of HTN with BP of <140/90. 6
FEEDBACK FROM TROUBLE SHOOTING WITH PROVIDERS SHOWS MANY ARE STRUGGLING WITH MEASURES WE THOUGHT WOULD BE EASY Easy Medium Hard Demographics Active Med List Exchange information Vital Signs Active Allergy List Clinical summaries Smoking status Up-to-date problem list Electronic copy to pt CPOE ERx Security Risk Assessment CDSS Medication Reconciliation Patient education Clinical Quality Measures Transitions of care Drug-Formulary check Access to electronic data Lab results Patient reminders Generate list of patients Immunization registry Syndromic surveillance 7
FROM VENDOR PROVIDED MEANINGFUL USE DASHBOARDS, WE CAN SEE THAT MOST PROVIDERS ARE IMPROVING ON MOST CORE MEASURES Source: ecw MAQ Dashboard data of 1533 providers who had an NPI, were live and had MAQ data in 2011 & 2013 8
Provider Performance (%) BUT ARE STRUGGLING ON SOME OF THE HARDER MENU MEASURES 100 90 80 70 60 50 40 30 20 10 0 Clin Labs Pt Remind Timely access Pat Ed Med Recon Trans of Care Meaningful Use Stage 1 Menu Measures Mean 2011 Mean 2013 Median 2011 Median 2013 Threshold Source: ecw MAQ Dashboard data of 1533 providers who had an NPI, were live and had MAQ data in 2011 & 2013 9
CURRENT AREAS OF FOCUS Helping providers understand how to document in their EHR through training and feedback -How to document something was done (e.g. education ) or not applicable (e.g., no meds) Reshaping workflows so that all practice staff can contribute to patient care and Meaningful Use Working with vendors to make EHR workflows more intuitive and to ensure appropriate functionality - Ensuring all LOINC codes are added, reviewing MU calculations, making features more user-friendly etc.. 10
Thank you for your time & thank you to the amazing PCIP team. 11