Electronic Medical Records: Using Cutting Edge Technology to Improve Care in STD Clinics in New York City 2006 National STD Conference Kate F. Washburn, MPH 1 Maushumi Mavinkurve, MPH 1 Rachel Paneth-Pollak, MPH 2 Stephen Giannotti 1 Susan Blank, MD, MPH 2,3 1 Bureau of Informatics and Information Technology, New York City Department of Health and Mental Hygiene 2 Bureau of Sexually Transmitted Disease Control, New York City Department of Health and Mental Hygiene 3 Division of Sexually Transmitted Disease Prevention, Centers for Disease Control and Prevention, Atlanta GA

Background NYC’s Bureau of Sexually Transmitted Disease Control (BSTDC) –10 clinics throughout the 5 boroughs of NYC –Over 100,000 visits/year –Clinics offer a range of free services including: STD evaluation, Emergency contraception, anonymous and confidential HIV counseling and testing, PAPs, Hepatitis immunization, and Hepatitis C testing

STD Electronic Medical Record Timeline Spring 2002 – Summer 2004 Application built internally by DOHMH and pilot tested by several clinic staff Joint effort between BSTDC and Bureau of Informatics and Development August 2004 – September 2005 Implemented in 10 STD clinics throughout NYC Web-based and accessible from all DOHMH workstations

STD Electronic Medical Record Cost In-kind salaries for 1 project manager, 1 project specialist, and 2 computer programmers $240,000 in hardware and stipends for 4 training consultants

STD-EMR Functionality Registers confidential patients (with electronic signature) and anonymous HIV clients Medical record modules include: –Reason for visit –Chief complaint –Medical, sexual and medication history –Physical exam –Labs (stat, referral and HIV) –HIV counseling and testing –Hepatitis vaccines –Counseling and referrals Other features include label printing, missing results queue, supervisor and medical chart review queues, and record search

Objectives Provide examples of how STD-EMR increases productivity and generates quality assurance measures Demonstrate how EMRs can guide programmatic decisions and improve decision-making regarding patient care

Increase Productivity STD-EMR reduced time taken to fill out and file paper –Consolidation of HIV counseling and testing forms –Easy search of records for registration and provision of results

Increase Productivity Daily/Hourly Monitoring (by Clinic or Central office) –Patient Wait Times –Number of patients seen per physician and counselor

Increase Productivity Monthly Reports –Physician Productivity report Shows the actual number of patients seen per physician and the average number of patients/day across all clinics –Counselor Productivity report Ad-hoc reports of the number of HIV pre-tests done per counselor in a particular clinic

Improve Quality of Data Collected Completeness, readability and uniformity of medical records –STD-EMR modules include radio buttons, drop down lists, and pre-formatted data fields to ensure medical information is accurate and quantifiable –Built in alerts for required questions

Improve Quality of Data Collected Accuracy of diagnosis and treatment –Built in logic prompts if patient is eligible for emergency contraception –Recommended treatments pop-up when diagnosis is selected –Link to PDF of the latest CDC STD Treatment Guidelines (2002)

Improve Quality of Data Collected STD-EMR creates a user-friendly summary of every chart for review by PIC and FLS. The system: –Differentiates charts by lab result (positive, non-negative, negative) –Permits electronic request for action – sending letters, routing charts to Supervisor, filing charts

Guide Programmatic Decisions Reallocation of Resources –3 staff assigned to manual scanning of forms (HIV) redeployed to clinics or other duties –Physical space used to store paper charts in clinics now used for other purposes –With electronic transfer of lab results, clerks will assist patients and provide results over the phone rather than manually enter results

Guide Programmatic Decisions STD-EMR data used to evaluate the cost effectiveness of specific lab tests –Oral and anal GC cultures –Cervical and urethral gram stains

Conclusions –Continuity of care across clinics –Identify bottlenecks in the clinic –Readily assessable compliance with policies and procedures –Free-up clinic space and redeploy staff –Enhance completeness and quality of data collected at each patient visit –Improve customer service and quality of care

Next Steps Patient print outs for personal records –Date and result of previous PAPs –Serology history Reminder letters automatically generated and printed –Next Hepatitis A/B vaccine –Follow-up or repeat test needed Additional prompts to remind physicians/counselors of necessary medical care

Acknowledgements Julia Schillinger Preeti Pathela Steve Rubin Hadi Makki All BSTDC Clinic Staff

Contact Information Kate Washburn Deputy Director, Informatics and Development Bureau of Informatics and Information Technology New York City Department of Health and Mental Hygiene