Download Describe the national Primary Care Prevention Initiative Discuss use

Using Electronic
Health Records to
Increase Early Cancer
Detection
September 21, 2010
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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
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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
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Primary Care Prevention Initiative
• Participation
– Nationally - 2200 PCP physician practices
– Iowa – 21 PCP physician practices
• Timeframe
– August 2008 through July 2011
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Primary Care Prevention Initiative
• Health promotion and disease
prevention
– Maximize the use of the EHR
– Use performance data
– Identify performance gaps
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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
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What is the Goal?
• The goal is that more patients will
receive
– Influenza vaccine
– Pneumococcal vaccine
– Colorectal cancer screening
– Breast cancer screening
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How the Project was Designed
•
•
•
•
Recruitment
Practice assessment
Practice assistance
Data reporting
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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
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Five-Step Improvement Process
1. Select populations and quality
measures and assess baseline
performance
2. Diagnose and plan
3. Implement changes
4. Review the data
5. Re-diagnose, plan, implement
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PDSA
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Intervention #1: Improve Date Entry
• Data Capture
– Mammography
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Ordering/referral for mammography
Patient refusal of mammography
Mammography done
Next due date
– Colorectal cancer screening
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Initiation of fecal occult blood test screening
Ordering/referral for colonoscopy
Patient refusal of screening
Colonoscopy, FOBT or other testing completed
Next due date
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#2: Integrate Clinical Reminders/Alerts
• Alerts and reminders
– Pop-up alert
– Color-coded alert
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#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
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#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
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Prevention Data so Far…
Performance Data
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Moving on#5to the Pilot Program!
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The FIT Kit Project
• Project partners
– Iowa Cancer Consortium - Barriers to
Screening Workgroup
– American Cancer Society
– IFMC - Quality Improvement Group,
Prevention Team
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How Providers Implemented
• Queried their EHR to identify patients
overdue for colorectal cancer
screening
• Physician to patient education
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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
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Advantages of FIT Kits
•
•
•
•
Only two samples are needed
No dietary restrictions
Better return rate
Cost
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Early Progress
• Increase CRC screening rate
• Changing provider practice pattern
• Use of EHR to identify overdue
patients
• Combined overdue letters with
mammogram reminders
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What’s Ahead for EHRs and Physician Practices…
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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
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Building an Interconnected, Patient-Centric Care System
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Resulting in Improved Quality, Safety and Efficiency
Better
Communication and
care coordination
Faster
Delivery of information
and results
Safer
Treatment via
e-Prescribing
More efficient
Coding and billing
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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
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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)
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Eligible Providers
Eligible Providers in Medicare
Eligible Providers in Medicaid
Professionals
Eligible Professionals
Doctor of Medicine or Osteopathy
Physicians
Doctor of Dental Surgery or Dental
Medicine
Nurse Practitioners
Doctor of Podiatric Medicine
Doctor of Optometry
Chiropractor
Hospitals
Acute Care Hospitals*
Critical Access Hospitals
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
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Need More Information?
• Free Webinars
– 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
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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
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Questions
• Sheryl Marshall
[email protected]
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
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