Chapter Quality Network Asthma Pilot Project LS4 Reflections from Maine in the Summer Amy Belisle, MD August 2010

2 Disclosure Statement I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity

3 Best Tools/Practices Great tools from AH! Program-Flip charts, med charts Getting ACT/Track consistently done in office Make an “EQIPP compatible” encounter form for paper charts to make data enter easier and changing EMR templates to include EQIPP goals Spirometry- big improvement from most groups implementing spirometry in office or making a referral; changing systems to get spirometry done in hospitals

4 Best moment “My best moment- when I met with the providers and some of them said they did not want to be in the project anymore- our last provider mtg. Somehow we got through this and really had a good conversation about what QI is and what it means- in this case to the pt who has Asthma- a chronic illness with an associated morbidity and mortality if not managed appropriately. I think they heard me.”

5 Challenges Ways to encourage buy in and teach QI to a group- “one of our biggest issues was that providers did not reconcile the process and philosophy of QI and this was an extra barrier...” Working with IT- “making kids important” so that they shift some resources from adult IT projects to kids Finding a usable, relevant EMR template for asthma and linking with registry

6 Challenges Lack of reimbursement for time- no P4P yet for quality asthma care Not enough time for asthma education in office visits by nurses- need to develop further resources in community Need to get more buy-in from senior leadership in the beginning; most of this started on the practice level- need to engage leaders especially to get help with IT changes Need to identify key players in large organizations especially if you have not been doing the QI projects in the past

7 I need more: More discussion of a process map for the flow of maintaining a Registry/Data - this process seems integral to the concept of sustainability Need more help on how to manage a registry once it is implemented- how to integrate with EMR, how often to scrub lists/data/patients, how to use data for change Need to develop a language to speak with IT about changes- very difficult to think individual docs can do the change process on their own especially when we don’t speak the same “language” Need to think about how you change from EQIPP data collection to a Registry

8 Maine AAP CQN Pilot: Lessons Learned Lots of people in state doing QI work- AAP was a good way to bring people together Strong AAP base- most of our practices came from our introduction at the Maine AAP Conference- they committed very early to the idea and were enthusiastic

9 Lessons Learned Technology takes time to change…..especially when adjusting EMR templates and registries By bringing practices together- able to make more headway on EMR issues than one practice alone Great to learn from experienced groups on how to use a registry Does the AAP have any leverage with the big EMR companies to take the best EMR templates developed out of this project that also incorporate all the EQIPP questions to have them develop better template products for pediatric providers?

10 Lessons learned 9 months is a good length for a pilot- 6 months too short, 12 months a bit long In person learning sessions were really terrific- great to meet practices from across the state, energy helped sustain the project Make it fun- pizza, prizes, theme songs! Amazed at the effort that each practice put into storyboards, process map, etc.

11 Lessons Learned We were lucky to have a very involved and interested asthma program in the state that was willing to share it’s experts and expertise. Really able to build on past efforts Site Visits from the Asthma Educator in the AH! Program in between LS was very valuable for practices Also lucky to have the Maine CDC- Asthma Council willing to support the project with funding and materials- made our jobs easier as we did not have to worry about extra money needed for project

12 Lessons Learned Lucky to have such fabulous support from Vanessa, Hollis, and Judy at the AAP- kept this project running strong! Good organizational support and vision from the top is the key when trying to coordinate so many different groups