Health Quality Innovation

California Health Care Foundation Offers Leadership Learning Resources for Health IT

The California Health Care Foundation (CHCF) website articulates the thoughts of many safety net health care leaders:  "Information technology is still fairly new and untested in health care, making experimentation, analysis and evaluation critically important".

CHCF.org offers web-based resources for health care safety-net leaders looking to learn more about health information technology (HIT).  CHCF regularly conducts research and commissions surveys and reports on emerging technology trends and related policy and regulatory issues and the results are available electronically on CHF.org. 

Here are some the recent publications available from CHCF.org:

Chart Abstraction: EHR Deployment Techniques

March 2010:  Entering clinical data from paper files into electronic health records (EHRs) causes a temporary loss in clinic productivity. In this issue brief, networks of community clinics share insights about effective chart abstraction.

Speeding Adoption of Electronic Health Records in Community Clinics

January 2010:  Seven grantees representing four models of EHR deployment were funded to accelerate the adoption of EHRs in the safety net. CHCF is publishing a series of issue briefs to highlight lessons learned.

Telepsychiatry in the Emergency Department: Overview and Case Studies

December 2009:  Telepsychiatry is used in some emergency departments to make the process of evaluating and treating patients with mental health issues more efficient. This paper examines seven ED telepsychiatry programs in terms of structure, financing, and challenges.

Creating EHR Networks in the Safety Net

April 2008:  This issue brief explores the network approach to the implementation of electronic health records (EHRs) and its potential to increase EHR adoption rates among California's community clinics and health centers.

Electronic Health Records versus Chronic Disease Management Systems: A Quick Comparison

March 2008:  This fact sheet compares the key features of these essential health IT systems and examines the pros and cons of different approaches for a new implementation. A video discusses disease registry tools.

Click here to go to CHCF.org to view additional Health IT Reports and Resources

Challenges and Barriers to Clinical Decision Support (CDS)

Clinical Decision Support (CDS) has been demonstrated to help safety-net health care clinicians with their efforts to improve efficiency and effectiveness of care for the patients they serve.  But the challenge facing safety-net clinic leaders is how to develop an effective CDS system?

This March 2010 AHRQ report, Challenges and Barriers to Clinical Decision Support (CDS) Design and Implementation Experienced in the AHRQ CDS Demonstration briefly describes the two AHRQ CDS demonstrations, as well as the challenges and barriers that the contractors encountered during the initial periods of their CDS demonstration project, how they addressed these obstacles, and the effectiveness of their strategies. The goal of this report is to share the experiences of the contractors throughout the planning, design, and implementation phases to aid others who are considering funding or undertaking similar efforts.

Lessons learned by health care provider organizations:

• The goals of CDS development and implementation projects should align with organizational priorities to promote buy-in from both management and staff.
• The organizational working environment should foster meaningful EMR usage, including not only software and hardware needs but also the attitudinal changes needed to support adoption.
• Engaging a well-respected clinician “champion” to lead CDS education, training, and implementation efforts will promote clinician adoption.
• Institutions wishing to utilize a knowledge management process will need access to personnel with specialized knowledge in clinical informatics and experience in designing new tools or using existing tools to support CDS development.

Read or download the full report from AHRQ ....

Collaborating with Health Centers to Leverage HIT for System Improvement

In this policy brief published on-line May 2010 by National Academy for State Health Policy (NASHP), authors Elizabeth Osius and Shaun Alfreds summarize the efforts of three states (Massachusetts, Oregon, and Tennessee) to promote interstate and public-private partnerships between state governments, FQHC's and other stakeholders to leverage HIT investments and tools to accomplish  shared goals of not only IT adoption but health care delivery improvement.

Key points/Lessons Learned: 

• share lessons and work in collaboration, offering information from multiple perspectives; organizations
  such as the PCA and Health Center Controlled Networks (HCCNs) make for natural partners with the state due to their on-the-ground experience with CHCs and HIT adoption;
• partner in ARRA-related applications because support and partnering are necessary to attain clinical transformation;
• encourage and leverage the leadership of the safety net, where innovations can spur activity throughout
  states’ delivery systems;
• overcome policy and legal roadblocks;
• assure that technologies are not being implemented for technology’s sake, but are being implemented
  with an eye toward outcomes;
• move, when appropriate, from a focus on EMR adoption to how effectively the EMRs empower providers to truly improve the delivery of care; and,
• assure alignment between state health care policies and delivery systems serving the states’ vulnerable populations.

Click here to go to NASHP website to view article.

The future of health information technology in the patient-centered medical home.

This article clarifies the linkages between health information technology and the patient-centered medical home, with practical recommendations for supportive regulations.

Health Aff (Millwood). 2010 Apr;29(4):614-21. Bates DW, Bitton A. Division of General Internal Medicine at Brigham and Women's Hospital in Boston, Massachusetts, USA. dbates@partners.org

Abstract

Most electronic health records today need further development of features that patient-centered medical homes require to improve their efficiency, quality, and safety. We propose a road map of the domains that need to be addressed to achieve these results. We believe that the development of electronic health records will be critical in seven major areas:

• telehealth,
• measurement of quality and efficiency,
• care transitions,
• personal health records, and,
• most important, registries, team care, and clinical decision support for chronic diseases.

To encourage this development, policy makers should include medical homes in emerging electronic health record regulations. Additionally, more research is needed to learn how these records can enhance team care.

Click here for the PubMed Abstract and link to the full text article.

Not Perfect, but Better: Primary Care Providers' Experiences with Electronic Referrals in a Safety Net Health System

Electronic referrals represent an opportunity to use health information technology to improve access to subspecialty care.  Whether that opportunity is fully realized depends on a number of factors from planning to design implementation to provider supply to organizational culture. 

In this article published in the Journal of General and Internal Medicine and on PubMed Central, Y. Kim, MD and colleagues report how San Francisco Hospital and Trauma Center (SFGH) implemented and evaluated a electronic referral system to help local primary care providers refer to SFGH for subspecialty care.  The results showed the large majority of primary care providers found the electronic referral system improved overall clinical care, although some providers reported a negative impact of using the system on their workflow. 

This is a valuable article for understanding the scope of possibilities for enhancing clinical care when health systems work and local primary care providers make intelligent use of technology to strengthen care for safety net patients.

Read the full article here....

Physician Insights on Barriers to Care for Diabetes Patients

A new study by J.C.Crosson, et.al. and published in the Journal of the American Board of Family Medicine reports on physicians' perspectives of barriers to care for diabetic patients with CVD risks.  The barriers range from health system obstacles to socioeconomic obstacles to lack of patient motivation.  While physicians have a role in addressing some of these barriers, many barriers are beyond the ability of the physician to address.  There is clearly a need for more comprehensive approaches involving a range of professionals collaborating for quality improvement. 

^{Read the full study online here...}

 

 

Electronic Prescriptions Shown to Reduce Errors by Seven-Fold

The use of electronic prescribing has become a central strategy in assuring patient safety and improving quality in the context of the patient-centered medical home.  The evidence base for electronic prescribing continues to grow, as shown in a recent study led by physician-scientists from Weill Cornell Medical College.  This study is one of the first to compare e-prescribing to handwritten methods, and the results are compelling.  Studies like this are important for demonstrating the value of technology-driven innovation and starting dialog about change with health care practice teams and administrators.

Read a concise summary of the study here..

Helpful Webinars on Health Information Technology for Quality Improvement and PCMH

In May 2008, The Commonwealth Fund, Qualis Health and the MacColl Institute for Healthcare Innovation at the Group Health Research Institute initiated a demonstration project to help safety net primary care clinics become high-performing patient-centered medical homes (PCMHs) and achieve benchmark levels of quality, efficiency and patient experience. The goal of the Safety Net Medical Home Initiative (“the Initiative”) is to develop and demonstrate a replicable and sustainable implementation model for medical home transformation.

The project is producing a series of webinars on different facets of PCMH development.  One topic area is health information technology and the PCMH model of care.  Two recent webinars are available for viewing online. 

• HIT and Meaningful Use (March 31, 2010)
  Moderator: Donna Daniel, PhD, Director Technical Assistance, Qualis Health
  Speaker: Jeff Hummel, MD, Medical Director, Washington-Idaho Regional Extension Center, Qualis Health 
• Using EHR Tools to Support Medical Home Workflows (January 26, 2010)
  Speaker: Jeff Hummel, MD, MPH, Qualis Health

The webinars provide an in-depth overview of what it takes to lead change and optimize health information technology in the context of the patient centered medical home.  You can either view the slides and listen to the webinar, or download the slides alone. 

Click here to access the slides and webinars.

 

California Health Care Foundation Evaluates Role of Chronic Disease Registries

The California Health Care Foundation (CHCF) website provides many useful tools for those interested in the role of health information technology support in chronic disease care.  CHCF has published numerous reports related to health information technology and all reports are available on the CHCF website. 

The following three CHCF reports offer an extensive overview and discussion of Chronic Disease Registries and may useful for organizations evaluating the role of health information technology in their overall chronic illness care program.

IT Tools for Chronic Disease Management: How Do They Measure Up? (Laura Jantos and Michelle Holmes, ECG Management Consultants, Inc., July 2006) This report compares two information technology tools, chronic disease management systems (CDMSs) and electronic medical records (EMRs), to judge their effectiveness in improving outcomes for patients with chronic illness, and reducing costs of care.

Chronic Disease Registries: A Product Review (NAS Consulting Services, May 2004) This report helps physicians and provider organizations make informed decisions about choosing a disease registry product.

Using Computerized Registries in Chronic Disease Care (First Consulting Group, February 2004) This report provides an overview of the function and use of computerized disease registries and outlines issues for consideration in obtaining registry software and integrating registry products into the routine work of the physician practice.