Using Electronic Health Records to Increase Early Cancer Detection September 21, 2010

Describe the national Primary Care Prevention Initiative Objectives Describe the national Primary Care Prevention Initiative Discuss use of electronic health records to improve the appropriate use of preventive services including screening for colorectal and breast cancer

Quality improvement organization Who is IFMC Quality improvement organization Ensure Medicare beneficiaries receive high quality care Team of multiple experts Physicians, nurses, pharmacists, QI experts, IT specialists and data analysts Three year contract goals CMS revises and gives direction

Primary Care Prevention Initiative Participation Nationally - 2200 PCP physician practices Iowa – 21 PCP physician practices Timeframe August 2008 through July 2011

Primary Care Prevention Initiative Health promotion and disease prevention Maximize the use of the EHR Use performance data Identify performance gaps

Why Focus on Primary Care? Primary care physicians have it in their power to improve the screening rates 80-90% of people >age 50 see an MD each year

The goal is that more patients will receive What is the Goal? The goal is that more patients will receive Influenza vaccine Pneumococcal vaccine Colorectal cancer screening Breast cancer screening

How the Project was Designed Recruitment Practice assessment Practice assistance Data reporting

Tracking of preventive care given to a patient Strengths of an EHR Tracking of preventive care given to a patient Clinical reminders at the point of care Tracking of tests/immunizations given Reports of patients not receiving test/immunizations Population performance measurement

Five-Step Improvement Process Select populations and quality measures and assess baseline performance Diagnose and plan Implement changes Review the data Re-diagnose, plan, implement

PDSA

Intervention #1: Improve Date Entry Data Capture Mammography Ordering/referral for mammography Patient refusal of mammography Mammography done Next due date Colorectal cancer screening Initiation of fecal occult blood test screening Ordering/referral for colonoscopy Patient refusal of screening Colonoscopy, FOBT or other testing completed

#2: Integrate Clinical Reminders/Alerts Alerts and reminders Pop-up alert Color-coded alert

#3: Redesign Workflows to Improve Outcomes Patient care should be organized around Disease management and screening guidelines Routine screening for disease and/or complications of disease Patient self-management support activities

#4: Use Clinical Reports Identify patients with specific diagnoses or medications Identify patients overdue for specific therapies or suggested preventive screenings Prompt communication with patients requiring follow-up

Prevention Data so Far… Performance Data

Moving on to the Pilot Program!

Project partners The FIT Kit Project Iowa Cancer Consortium - Barriers to Screening Workgroup American Cancer Society IFMC - Quality Improvement Group, Prevention Team

How Providers Implemented Queried their EHR to identify patients overdue for colorectal cancer screening Physician to patient education

Each Provider Site Received 200 Fecal Immunochemical Tests FIT Kits with stamped envelopes Reagent Letter template Included 200 stamped envelopes ACS brochures and instructional DVDs Tracking tool Educational material for staff

Only two samples are needed No dietary restrictions Better return rate Advantages of FIT Kits Only two samples are needed No dietary restrictions Better return rate Cost

Increase CRC screening rate Changing provider practice pattern Early Progress Increase CRC screening rate Changing provider practice pattern Use of EHR to identify overdue patients Combined overdue letters with mammogram reminders

What’s Ahead for EHRs and Physician Practices…

HITECH Paper records HITECH Act EHRs & HIE Pre 2009 2009 2014 A system plagued by inefficiencies EHR Incentive Program and 60 Regional Extension Centers Widespread adoption and meaningful use of EHRs

Building an Interconnected, Patient-Centric Care System

Resulting in Improved Quality, Safety and Efficiency Better Communication and care coordination Safer Treatment via e-Prescribing More efficient Coding and billing Faster Delivery of information and results

Stakeholders are On Board “We are committed to EHR adoption that streamlines physician practices and helps them continue providing high-quality care to patients.” American Medical Association “HIT is critical to improving quality and effectiveness of patient care… physicians in small, rural practices must receive technical support during implementation and use of IT.“ American Academy of Family Physicians “Widespread adoption of electronic health records in this nation could be used by doctors to both improve patient outcomes and assess ongoing clinical competence for purposes of medical licensure.” Federation of State Medical Boards

Meaningful Use Stage 1 Stage 2 Stage 3 HIT-Enabled Health Reform 2009 HITECH Act 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes)

Eligible Providers Eligible Providers in Medicare Professionals Doctor of Medicine or Osteopathy Doctor of Dental Surgery or Dental Medicine Doctor of Podiatric Medicine Doctor of Optometry Chiropractor Hospitals Acute Care Hospitals* Critical Access Hospitals Eligible Providers in Medicaid Eligible Professionals Physicians Nurse Practitioners Certified Nurse Midwives Dentists Physician Assistants working in a Federally Qualified Health Center or rural health clinic that is so led by a PA Eligible Hospitals Acute Care Hospitals (now including CAHs) Children’s Hospitals

Free Webinars Need More Information? Oct. 14 “Health Information Exchange: “Protecting Your Patient and Your Practice” Oct. 26 Workflow Redesign: “Improving Processes and Flow” Nov. 9 Project Management: “Change is a Positive Thing” Nov. 30 Evaluation and Improvement: “Optimizing EHR Benefits” All webinars provided at 12 noon Register at www.IowaHITREC.org

Better Quality for the Right Reasons The world of medicine is moving to a measurement improvement mode Knowing about your quality of care The ultimate goal is better patient outcomes

Sheryl Marshall smarshall@iaqio.sdps.org 515-273-8844 Questions Sheryl Marshall smarshall@iaqio.sdps.org 515-273-8844 This material was prepared by IFMC, the Medicare Quality Improvement Organization for Iowa, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 9SoW-IA-POPR-08/10-367