Alla Kamenetsky, DBM/A
Boston Health Care for the Homeless Program
2009 Annual Clinical Quality Conference
March 6,2009
Using an EMR to Support
Diabetes Collaborative Reporting
Health Disparities Collaborative since 2002 (DM)
Staff of ~300
110-bed inpatient respite service
Over 70 service delivery sites including shelters, soup
kitchens, streets and 3 teaching hospitals
Specialty service programs include mental health, dental,
HIV and Family Team
Annual budget of approximately $24 million
More than 13,000 patients in 106,000 ambulatory visits
yearly
More then 703 diabetics in 4931 visits yearly
Funding sources include: Medicaid, federal grants, private
foundations and philanthropic revenue
2
First EMR implemented in 1996
Commercial EMR implemented 2002
EMR and all enterprise applications accessible
anywhere via simple Internet browser
Laboratory results (most) interfaced into EMR
8 primary clinic sites connected via wide area
network
Electronic encounter form and billing process
3
Establish patient self‐management goals
Track and report on key quality indicators
% with HGBA1C done 2x /year (3 months apart)
Average HCBA1C result
% on ACE’s or ARB’s
% of with controlled BP (<130/80)
% with yearly dental exam
Eye exams
Microalbumin testing
4
Role of HIT
Management Goal
•
Embed workflow into EMR
•
Health maintenance reminders and alerts
•
Apply clinical standards
•
Standardize across all sites and all patients
Capture quality measures
•
EMR data entry form for DM management
•
Lab results interface
•
EMR training
Establish patient self‐
management goals
•
EMR form for case management documentation
and follow‐up including self‐management goals
Report on quality
measures
•
Flexible, web‐based reporting tools
•
Reports and queries on data quality
•
Patient follow‐up site reports
Spread
5
EMR should accommodate…
Flexible form design tools for capturing key data
Programming language to embed workflow
Tools to support alerts and reminders
Well structured and documented relational data model
Interfaces from external systems (lab)
Reporting tools should accommodate…
Easy access (ideally via web) to reports
Centrally administered and hosted
Well‐designed security model and password‐protected
“Self‐service” access to real‐time data
6
24 x 7 help desk support
Training, training, training
IT staff participation on clinical committees
Expertise in data analysis and database
management
IT staff with understanding of clinical workflow
Good project management skills
7
46.2%
32.5%
37.3%
71.3%
49.3%
7.9
507
2008
Measure
Goal
2005
2006
2007
Cohort size*
203
250
279
Average HGBA1C
<7
8.3
8.1
7.9
2 HBA1C in last year (3 months apart)
>90%
27.6%
38.25
43.7%
ACE’s or ARB’s for patients age > 55
>70%
63.5%
70.1%
90.3%
Controlled BP (<130/80)
>40%
40.9%
41.2%
37.6%
Yearly dental exam
>70%
23.2%
37.9%
29.4%
Documented self‐management goal
>70%
50.7%
62.6%
85.7%
8
*
Cohort increased to include all active patients with active Dx of Diabetes, who were seen by MD, PA, NP more
than 2 times in last 12 months.
Definition of our DM cohort
Complex data queries
Logistical and practical issues re: dental referrals
Compliance with clinical documentation standards
Clinician EMR training, and retraining
Data quality and validation
P4P performance tracking
9
List of Collaborative Reports
Available via Web
10
Diabetes Collaborative Reports I
Diabetes Collaborative Reports II
Boston Health Care for the Homeless Program
PATIENTS SEEN 4 PLUS TIMES AT SFH
BETWEEN 1/1/2009AND 3/1/2009
DATA FROM THE UNSIGNED NOTES
DOES NOT APPEAR IN THE REPORT
MRN
PATIENT
Times PCP Last Dental
Last HGBA1 Last SMG
Last BP
Seen Date/Overdue* ValueDate/Overdue* Date Reading / Date 00000204
4Kirkpatrick, NP, Stacy 10/30/2008 6.9 12/5/2007* 1/31/2008 136 / 75 4/16/2008 00000405
9Pierce, MD, Catherine 5/2/2008 6.6 3/21/2008 1/17/2008 122 / 68 5/12/2008 00063145
8Kirkpatrick, NP, Stacy 4/30/2007* 7.3 1/28/2008* 2/28/2008 148 / 96 4/16/2008 00011674
5Schwartz, NP, Lisa 1/10/2008 9.3 4/3/2008 4/3/2008 110 / 78 5/5/2008 00004288
5Kirkpatrick, NP, Stacy 9.0 3/13/2008 6/27/2007 132 / 80 4/17/2008 00026572
8Fitzgerald, NP, Anne 6.7 2/7/2008 2/21/2008 157 / 92 4/15/2008 00070744
5Unassigned, PCP 7.4 3/5/2008 116 / 70 4/28/2008 00062154
10Fitzgerald, NP, Anne 7.1 12/4/2007* 126 / 93 5/5/2008 00057763
5Unassigned, PCP 8.5 3/18/2008 9/4/2007 118 / 72 5/6/2008 00016439
4Unassigned, PCP 7.6 2/8/2008 2/21/2008 132 / 73 3/20/2008 00000161
10Pierce, MD, Catherine 8.0 12/3/2007* 126 / 88 3/18/2008 00032379
9Fitzgerald, NP, Anne 11/7/2007 5.6 4/30/2008 4/24/2008 154 / 86 5/12/2008 00036964
6Saunders, NP, Kathleen 1/23/2008 7.1 2/6/2008 192 / 5/6/2008 00060324
10, 4/16/2008 7.0 3/14/2008 135 / 92 5/9/2008 PATIENTS SEEN 4PLUS TIMES AT SFH BETWEEN1/1/2009 AND3/1/2009
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