Presenter Disclosure Information FINANCIAL DISCLOSURE: None Thomas C. Bailey, MD Integrating Health Information Technology (HIT) into Clinical Practice UNLABELED/UNAPPROVED USES DISCLOSURE: None

Integrating Healthcare Information Technology (HIT) into Clinical Practice David K. Ahern, PhD, Thomas C. Bailey, MD, Charles B. Eaton MD, MS, David C. Goff, Jr, MD, PhD, Jeffrey Rothschild, MD For the Innovative Strategies Writing Group

Objectives  Illustrate approaches using information technology to improve adherence to guidelines  Identify selected barriers and facilitators for these approaches  List some of the preliminary lessons learned

Study Approaches Using HIT CPOE-based decision support for inpatient transfusions Transfusion CDS ( Rothschild ) PDA-based decision support and academic detailing for cholesterol management Guideline Adherence for Heart Health ( Goff ) Waiting room patient activation software combined with PDA-based decision support for cholesterol management Cholesterol Education And Research Trial ( Eaton ) Automated ID of inpatient candidates for primary and secondary CHD prevention to facilitate academic detailing Technology Assisted Academic Detailing ( Bailey ) Project descriptionProject

Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4. TAAD, CEART, GLAD, T-CDS CEART

Technology Assisted Academic Detailing (TAAD) Bailey et al  Automated identification of inpatient candidates for CHD prevention medications, coupled with pharmacist- mediated academic detailing to improve adherence to: CHD secondary prevention guidelines for patients with AMI Cholesterol lowering guidelines for patients with diabetes  Patient identification using automated screening CHD/AMI – troponin-based screening DM – algorithm based on prior ICD-9, glucose, HA1c, medications

Alert generated from patient data Pharmacist approaches physicians with intervention Pharmacist reviews alerts and evaluates for intervention

Barriers to TAAD  Workflow issues Timing of alert generation, response  Short lengths of stay Screening/alert to intervention time must be efficient  Personnel issues Prospective intervention requires personnel to handle alerts

Facilitators of TAAD  IT infrastructure  Flexibility to adapt to workflow  Efficient methods of candidate identification  Dedicated pharmacist resources  Pre-existing pharmacist and physician culture  High profile issues of recognized importance  Both external and internal pressures to succeed

Lessons Learned from TAAD  Technical efficiencies make the impossible possible  Resource and workflow constraints are critical considerations  In asynchronous mode of decision support, must make sure physicians follow through  A pharmacist champion coupled with regular performance feedback is key

Pt activation tool Cholesterol Education and Research Trial (CEART) Eaton, et al

Framingham Risk Equation (10-yr risk of CHD) Converted into equivalent risk adjusted age

Go To Goal Physician CDS Tool

PDA Decision Support Tool with Patient Education Screen

Barriers to CEART & GLAD  Some patients were not technology oriented and wouldn’t use computer kiosk (CEART)  Varying physician experience with PDAs and technology for decision support  Physician workflow (and apparel) issues

Facilitators to CEART & GLAD  Design and development of tools based upon qualitative and formative research with patients and physicians  Training and reinforcement in use of tools  Academic detailing regarding guidelines  Inclusion of other software (e.g, ePocrates)  Mobility and efficiency of PDA as a platform for decision support tool  Appeal and ease-of-use of patient activation tool (CEART)

Lessons Learned from CEART & GLAD  Both patients and physicians need training and reinforcement in use of technology  Both technical and organizational challenges need to be addressed  Clinical decision support enabled by HIT requires integration with workflow

Workshop Structure  Presentations Introduction of Workshop and Projects Recruiting clinical practices for clinical research: Michael Cabana Clinician behavior change Role of Informed, Empowered Patient and Family in Improving Clinical Practice through Guidelines Integrating Information Technology into clinical practice: Tools for clinical decision support and guideline implementation Organizational Change and Team Building Conclusions and Implications  Break  Demonstrations Practice assessment methods and pharmacist education materials Organizational culture survey, asthma education materials, and Heart- to-Heart education materials Palm tools for ATPIII Patient activation and more Palm tools for ATPIII Web-based education for MI Tools to support pharmacists in detailing to physicians

Questions ?