The use of EMR tools in IFH’s Diabetes Initiative Elizabeth I. Molina Ortiz, MD MPH Diabetes Medical Director, IFH Mt Hope Family Practice

Objectives Simply having EMR in office is a good start, but not enough Studies have demonstrated no difference between paper charts and adoption of EMR (without decision support) Need to add decision-support tools for improved care

Objectives The following slides will demonstrate two types of decision support: Actionable during patient encounter Guide outside of patient encounters

EMR tools to improve care to patients living with diabetes At patient encounter: Nursing BPA for monofilament and A1c testing Physician and CDE Smartsets for easy documentation and ordering Outside of patient encounter: IFHstats Track clinical measures by site or by provider Easily identify at risk patients from panel Identify disparities in outcomes

During encounter: nursing BPAs

During patient encounter: nursing BPAs Automatic review of chart, actionable orders appear if A1c or monofilament testing needed Completed prior to provider visit

During encounter: Smartsets

During encounter: Smartsets In one screen, provider prompted to choose note (which prompts appropriate documentation), labs, referrals, diagnosis and LOS

Outside of patient encounter: Diabetes Registry Important first step towards monitoring care at population level Versatile, vast amount of information Basis for IFH stats

Outside of patient encounter: IFHstats IFHstats allows us to: Monthly track individual patient’s important diabetes clinical markers (10 markers based on NCQA DPRP) Monthly track population’s clinical markers (presented by provider, clinic, or institute-wide) Track progress towards meeting national goals Determine when ready for application and accreditation

IFHstats: Easily accessible

IFHstats – Track Progress by Site

IFHstats – Site lists active providers

IFHstats – or by provider

IFHstats – Areas for improvement highlighted

IFHstats – Easily review diabetic panel and clinical markers

IFHstats – Download and sort data

IFHstats – Identify disparities

IFH’s Diabetes Initiative: Notable Improvements (Nov – March) Ability to monitor patient population in important clinical markers Westchester increase rate of A1c<7% by 10% Amsterdam decreased rate of A1c >9% by 11% Mt Hope increased rates of ophthalmology consults by 7% Sidney Hillman increased rate of neuropathy screen by 21% 62% patients at Phillips screened for nephropathy (up by 12%) Ability to use PDSA cycle, monitor progress, identify success, and propagate it