CrossRoads

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Transforming Health Care

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CrossRoads

  1. 1. CrossroadsTransforming Health Care Delivery with Informatics: A perspective from theMassachusetts General Hospital (MGH) Henry C. Chueh, MD, MS
  2. 2. Coming up...Introduce the problemSuggest a theme to solutions to the problemProvide a brief description of MGHDescribe our path through stories about toolsRevisit the theme
  3. 3. One Day in the Life of a PCP Hours needed to manage 2,500 patients... 6.0 10.6 7.4 Chronic disease (10 Dx) Prevention Free Yarnall KS, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635 Ostbye T, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209
  4. 4. “Computerized clinical information systems will help physicians close this quality gap by performing many of the repetitive, protocol-driven tasks.” (McDonald, conveyed by the "the burden of harm 1976) collective impact of all of our health care quality problems is“The current care staggering" (Chassen et al., 1998) systems cannot do thejob...trying harder will not work...changing care systems will.” (IOM, 2001) "Our recovery plan will invest in electronic health records and new technology that will reduce errors, bring down costs, ensure privacy, and save lives." (Obama, Feb 2009)
  5. 5. supplyLack of time Flawed processdemand
  6. 6. CDSS
  7. 7. MGH Primary Care (at MGH) IMA WHA Everett Revere (2) BMG MGH West MWI Charlestown Chelsea (2) (near MGH) Downtown Beacon Hill MGMG Senior Health Back Bay NECHCMDs = 178 • FTEs = 101 • Practices = 15 • Patients = 155,590
  8. 8. IT infrastructure at MGH Online registration and scheduling Outpatient electronic health records and e-prescribing Clinical data repository for results and reports Inpatient provider order entry Patient portal
  9. 9. Information “push”Decision support in diabetes Visit (A1C, SBP, LDL) patient 1 info primary care provider nd me om rec 2 info nurse care manager Modest improvements in process outcomes only
  10. 10. Patients don’t always come in for clinic visits.Clinic visits are busy.Providers are good at deciding, but bad at doing.
  11. 11. Getting there from here Loyalty cohort: Connectedness FastTrack: Enhanced CDSS/SSCD outside visits ACCORD: Involving patients
  12. 12. Who are my patients?Visit to registered PCPRepeated visits to a specific practiceAge and home address as variables
  13. 13. Connection Status PCP connected Practice connected Not connected 6% 34% 59% n = 155,590
  14. 14. MGH Preventive Metrics PCP Linked Practice Linked 85 P<0.0001 P<0.0001 P<0.0001 68 Percentage (%) 51 34 17 0 Mammography Pap Test CRC Screening (n=35,865) (n=65,860) (n=37,605)
  15. 15. MGH Disease Metrics PCP Linked Practice Linked 90 P<0.0001 P<0.0001 P<0.0001 72 Percentage (%) 54 36 18 0 Diabetes A1C Diabetes LDL CAD LDL (n=9,632) (n=9,632) (n=6,612)
  16. 16. A patient-tailored information letterA hard copy Rx, to be signedAutomatic electronic documentationA 6-week reminder timer
  17. 17. Results
  18. 18. Breast cancer screening PCP/screened Practice/screened Practice/overdue PCP/overdue 11% 9% 15% 64%
  19. 19. Mammography FastTrackDecision support in breast cancer prevention population info patients primary care physician Outside the Visit action care delegate
  20. 20. Mammography FastTrack:6-month results Intervention Control 30.0 P = 0.01Completion rate (%) P = 0.01 22.5 P = 0.02 15.0 7.5 0 All Patients MD-Linked Practice-Linked
  21. 21. A Fragile Loop Awareness of Issue Risk assessment Follow-up ? Plan for care Complete care
  22. 22. Follow-up1/3 have no system, <1/3 satisfied with systemPatients want communicationLack of documentationLack of patient understanding
  23. 23. ACCORDAmbulatory Care Compact to Organize Risk and Decision-making
  24. 24. ACCORD characteristicsPatient-Provider preferencesExplicit agreement with documentationFail-safe monitoringHigh visibility
  25. 25. CDSSSSCD
  26. 26. challenges. tools. Continuous, not visit-based Population-basedPatient-provider preferences

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