EHRs in Quality Improvement Alice Loveys, MD, FAAP, FHIMSS Florida Pediatric Medical Home Demonstration Project (C4K) Learning Session 3 December 7, 2012

Disclosure  I have the following financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity Consultant for: Optum Insight  I do not intend to discuss an unapproved/ investigative use of a commercial product/device in their presentation.

Objectives  Quality Improvement EHR Targets  Identify the “Crosswalks” Areas that satisfy multiple QI programs CHIPRA MU  Focus Targeted Areas for Improvement Priority Areas for Intervention  Asthma

Objectives  Show EHR Examples Vendor Independent Workflows

Dr. Ali Loveys Background  Practice Pediatrician  Electronic for over 10 years – HIMSS Davies Award Winner – Chair of Committee  Co-Author Go-Live: Smart Strategies from Davies Award-Winning EHR Implementations – Physician Engagement  AAP – Advisor to the Child Health Informatics Center

Dr. Ali Loveys Background  CMIO for a group the targets HIT Optimization in specific projects such as PCMH MU – NYS Regional Extension Center Health Information Exchange HIPAA Security  Work with >100 vendors 100% VENDOR NEUTRAL

EHRs in Use  Allscripts  Athena Clinicals  Caretracker  eClinical Works  eMedys (Trimed)  Epic  GE Centricity  Meditabs  Office Practicum  Paper (OOPS)

EHR Elements  Where data goes in depends on HOW we want it to come out.  Problem Lists – ICD-9 Codes  CPT Codes  Health Maintenance, Disease Management; Preventive Care  Immunization Modules  Reporting Tools – Dashboards, Registry Reporting; MAQ Dashboard

EHR Optimization Approach  Team Leaders  Practice Assessment  Tasks broken down into manageable steps Practices need to continue to practice New Concept about every two weeks  Communication Tools

EHR Optimization Approach  Crosswalks NCQA EHR Incentives Meaningful Use Health Information Exchanges Payer Programs  COLLABORATION Use the same tools where possible

EHR Optimization Approach  EHR is JUST A TOOL  Create Policies for QI Area What protocol are you using?  Map Workflow Who does what? Where do they do it? What do they do it with?

Example Vital Signs  When are they taken?  Where?  Crosswalk CHIPRA MU PCMH  Workflow OPTIONS No one perfect way to do things

Workflow

Targeted Areas for Improvement Asthma  Chronic Medical Condition Coordination of Care PCMH  MU Clinical Quality Metric Reporting Clinical Decision Support Rule  CHIPRA Measure Annual Number of Asthma Patients with 1 Or More Asthma Related ED Visits

Practice Assessment Policy Asthma Control Test and Asthma Action Plan ACT: May 2012: 43%, August 2012: 53% Action Plan: May 2012: 36%, August 2012: 45% How often does the practice evaluate? How are asthmatics Identified? How are medications tracked?

Crosswalks for Asthma? Meaningful Use  Core Objectives Implement one clinical decision support rule  Follow NHLBI Guidelines for the diagnosis and treatment of asthma Report ambulatory quality measures to CMS/States  3 apply specifically to Asthma Provide clinical summaries for patients for each office visit  Comprehensive Asthma Action and Care plan Protect electronic health information  Regardless of Program Maintain an up-to-date problem list of current and active diagnoses  Structured Data entry with Asthma Diagnosis Maintain active medication list  Structured Data of all medications

Using the EHR in MU Crosswalks Asthma  Menu Objectives Generate lists of patients by specific conditions  Identify all patients with an Asthma Diagnosis Send reminders to patients per patient preference for preventive/follow-up careSend reminders to patients per patient preference for preventive/follow-up care  Identify recommended Asthmatic care such as Annual Flu Shots Annual Spirometry Bi-annual ACT Summary of care record for each transition of care/referrals  Referrals of Asthmatics to specialists  Transfer of Asthmatic to ED

Using the EHR in MU Crosswalks  Clinical Quality Metrics All EPs must report on all 3 core measures, even if the denominator is zero. For each of those Core CQMs for which the denominator is zero, an EP must report an equal number from the Alternate Core Measures. If the denominator is zero for all of those Alternate measures then the EP must report this as well. All EPs must report on 3 additional measures from the remaining 38 published CQMs.

Crosswalk Clinical Quality Metrics MU  Asthma Assessment Percentage of patients aged 5 through 40 years with a diagnosis of asthma and who have been seen for at least 2 office visits, who were evaluated during at least one office visit within 12 months for the frequency (numeric) of daytime and nocturnal asthma symptoms

Crosswalk Clinical Quality Metrics MU  Use of Appropriate Medications for Asthma The percentage of patients 5-50 years of age during the measurement year who were identified as having persistent asthma and were appropriately prescribed medication during the measurement year. Report three age stratifications (5-11 years, years, and total).

Crosswalk Clinical Quality Metrics MU  Asthma Pharmacologic Therapy Percentage of patients aged 5 through 40 years with a diagnosis of mild, moderate, or severe persistent asthma who were prescribed either the preferred long-term control medication (inhaled corticosteroid) or an acceptable alternative treatment.

Asthma Workflow EHR Elements  Diagnosis Structured in problem list ICD-9  (493.00, , , , , , , , , , , , , ).  Medications Structured in Medication List

Asthma Workflow EHR Elements  Health Maintenance ACT Evaluation  The CPT code c1005F Flu Vaccine  CPT codes multiple Spirometry  CPT codes multiple Asthma Action Plan  CPT code with modifier

Asthma Workflow EHR Elements  Patient Handouts  Reporting

EHR Example

Other Quality Metrics  Childhood Immunizations  Pharyngitis

Crosswalk Clinical Quality Metrics MU  Childhood immunization Status Childhood immunization Status The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella (MMR); two H influenza type B (HiB); three hepatitis B (Hep B), one chicken pox (VZV); four pneumococcal conjugate (PCV); two hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday. The measure calculates a rate for each vaccine and two separate combination rates

Crosswalk Clinical Quality Metrics MU  Appropriate Testing for Children with Pharyngitis The percentage of children 2–18 years of age who were diagnosed with Pharyngitis, dispensed an antibiotic and received a group A streptococcus (strep) test for the episode.

Questions  Contact Information