Good Afternoon. Today I will make a presentation on the ID-Web Project.
Delivery of high quality primary care depends on institutional support for providers. In particular, the availability of information, technology, and organizational systems that work efficiently are necessary to support health care delivery. New health care technologies, medications, treatments, and procedures are being developed rapidly, and physicians are expected to incorporate them into their clinical practice. Meeting these expectations can be challenging. Today I will be talking about an information technology that has great potential for supporting providers in delivering high quality primary care. In particular, I will be talking about an approach that provides periodic information on quality of care indicators, and engages providers in using this information to improve systems of care.
The potential for strengthening quality of care through feedback of information to and from providers is just beginning to be explored.
There are many published papers supporting the use of feedback to improve quality of care…a recent paper that is particularly relevant is a report of a system implemented at Kaiser-Permanente in Calif. Feedback in the form of quality of care indicators allowed the medical staff there to identify system problems & brainstorm system solutions. For example, chlamydia screening was increased by 40%.
AI/AN have the second highest rates of chlamydia, gonorrhea, and syphilis, among racial/ethnic groups in the U.S. Three actions came to mind to address this public health problem in the clinical setting: to provide information about the high STD prevalence in the patient population, provide training on STD testing and treatment guidelines, and identify and resolve system issues related to STD testing and treatment. The ID Web project came about as an innovative tool to support these actions.
This is how it works: ID-Web provides information on caseload and quality of care indicators related to Human Immunodeficiency Virus (HIV), Sexually Transmitted Diseases (STDs), and hepatitis B. It also provides links to training on national guidelines, for which CME credit can be earned. The project is operating at five pilot sites, which have access to this information through a secured website. In a few minutes we will walk through the web site screens to show you what they look like.
The five pilot sites are: Albuquerque PHS Indian Hospital (Albuquerque, New Mexico), Ignacio PHS Indian Health Center (Ignacio, Colorado), Phoenix Indian Medical Center (Phoenix, Arizona), Rapid City PHS Indian Health Service Hospital (Rapid City, South Dakota), and W.W. Hasting Indian Hospital (Tahlequah, Oklahoma) I would like to thank Dr. Bill Gloyd (Albuquerque), Joan MacEachen (Ignacio), Erica Avery (Phoenix), Mike Crutcher (Rapid City), and Rod Copely (Tahlequah). The project is benefiting greatly from the active involvement of these folks, who have agreed to be advocates of the project in their facilities.
ID-Web provides quality of care information to healthcare providers in the form of 13 clinical indicators, including the following: women seen for prenatal care who have been tested for syphilis, HIV, chlamydia, hepatitis B; patients with chlamydia receiving CDC recommended treatment and Azithromycin for their sex partner; patients with chlamydia, syphilis or gonorrhea who were tested for HIV and Hepatitis B; patients with HIV or AIDS receiving highly active antiretroviral therapy; and patients with a new STD/HIV who received documented risk-reduction counseling.
IHS’ electronic medical record system provides the source of data for ID Web. Use of laboratory and clinical data on the diseases of interest from data fields already present in the Resource Patient Management System (RPMS), assures that ID Web accurately reflects medical records. All privacy and confidentiality standards are met for the website by excluding patient identifiers--like name, chart number, date of birth, and social security number. These identifiers are excluded from any posted data. Only summary data are posted to the website.
This is the screenshot of the actual ID-Web website. The website is developed and maintained by an IHS contractor, Cereplex, Inc. The ID-Web website is a secure point of access for health care providers and administrators. Only registered users have access to the data presented, which is protected by banking level security.
The website provides an interactive query tool to display information on thirteen clinical care indicators.
The analysis can be run on monthly, quarterly, or yearly basis using this query tool.
This page is a demo only (not real data) showing comparison between facilities on a given indicator—in this case, percent of women seen for prenatal care who have been screened for chlamydia. Again, this is not real data. As you can see, the indicator is shown for two facilities. The colors indicate high, medium and low values of the indicator. In this case, the first facility has a very low score and the second facility has a medium score. Neither one has a score in the range that we would like to see (above 80%). One way to use this information is to print it and then distribute and discuss it at staff meetings. A discussion about why the % of STD patients tested for HIV is not as high as expected can identify system issues and solutions that may need to be addressed. An example: At one of the pilot facilities, the % of STD patients tested was not as high as it should be, so a solution has been implemented. When STD patients go to the pharmacy to get their medications to treat their STD, the pharmacist gives them HIV counseling and encouraged them to go to the lab for testing.
And if providers want to look at their own testing rates, they can go on the web. Each of the rows in this chart shows a specific clinicians values on the indicator (in this case, percent of patients with new STD/HIV diagnosis who have had documented risk-reduction counseling) . Note again that we are not showing real data here—this is just a demo for the purpose of the presentation. Only registered users can access the real data. The users will only be able to see their own user specific information. All the personal information of their peers is masked. At the bottom of the page, where it says View CME Topic, there is a link to the training module for CME credit.
Each module is designed to provide information relevant to one of the indicators. Each modules takes about 15 minutes to complete, and is worth 0.25 credit. The CME modules also provide links to other resources for disease related guidelines and information. We received and are working on a suggestion that links be added for patient educational materials that providers could download.
Here are the questions at the end of the CME module. (Each has 3 questions).
In conclusion, this pilot project demonstrates a potentially powerful tool to assist providers in delivering high quality care for HIV, STDs, and Hepatitis B which could be expanded to include other infectious diseases. Larger scale implementation of this project will be dependent on its perceived value. Support of data entry is also important because the ID Web data can only be as accurate as the data entered into RPMS.
For further information about participating in ID-Web, please contact Laura Shelby by telephone at (505) 248-4395 or by e-mail at email@example.com. Demo of the system is available at www.webepi.com/index.jsp Jeanne Bertolli, PhD, Senior Epidemiologist, Prevention Support Office, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Rd. NE Mailstop E-07, Atlanta, Georgia, 30333. (404) 639-8500, fax (404) 639-8603, e-mail [email_address]
We are very grateful to ID-Web contacts supporting our project in each facility like Dr. Bill Gloyd (Albuquerque), Joan MacEachen (Ignacio), Erica Avery (Phoenix), Mike Crutcher (Rapid City), and Rod Copely (Tahlequah).
15th ihs id_web_presentation_final_may142003
The ID-Web Project: Improving Care and Surveillance <ul><li>Jeanne Bertolli, PhD </li></ul><ul><li>Agha Nabeel Khan, MD, MPH </li></ul><ul><li>Arnulfo C. Rosario, Jr., MD, MPH </li></ul><ul><li>Laura Shelby, BA </li></ul><ul><li>Peter Holck, PhD, MS, MPH </li></ul><ul><li>Steve Davis, MSEE </li></ul><ul><li>James E. Cheek, MD, MPH </li></ul><ul><li>15 th Annual IHS National Research Conference </li></ul><ul><li>Scottsdale, Arizona </li></ul><ul><li>May 14, 2003 </li></ul>
Delivery of high quality primary care … . is supported by: information technology efficient organizational systems.
Improving Quality of Care Feedback Systems Solution
Literature Review <ul><li>Effect of a clinical practice improvement intervention on Chlamydial screening among adolescent girls. Shafer MA, Tebb KP, Pantell RH, Wibbelsman CJ, Neuhaus JM, Tipton AC, et al. JAMA. 2002 Dec 11;288(22):2846-52. </li></ul>
Background <ul><li>AI/AN have the second highest rates of chlamydia, gonorrhea, and syphilis </li></ul><ul><li>How to address in the clinical setting? </li></ul><ul><ul><li>Provide information about the high STD prevalence in the patient population </li></ul></ul><ul><ul><li>Provide training on STD testing and treatment guidelines </li></ul></ul><ul><ul><li>Identify and resolve system issues related to STD testing and treatment </li></ul></ul>
Objective <ul><li>Feedback on HIV, STDs, and hepatitis B </li></ul><ul><ul><li>Caseload and Care </li></ul></ul><ul><li>Links to Training (for CME credit) on National Guidelines </li></ul>
<ul><li>Albuquerque PHS Indian Hospital (Albuquerque, New Mexico) </li></ul><ul><li>Rapid City PHS Indian Health Service Hospital (Rapid City, South Dakota) </li></ul><ul><li>Ignacio PHS Indian Health Center (Ignacio, Colorado) </li></ul><ul><li>Phoenix Indian Medical Center (Phoenix, Arizona) </li></ul><ul><li>W.W. Hasting Indian Hospital (Tahlequah, Oklahoma) </li></ul>5 Pilot Sites
Clinical Indicators <ul><li>Women seen for prenatal care who have been tested for syphilis, HIV, chlamydia, hepatitis B </li></ul><ul><li>Patients with chlamydia receiving CDC recommended treatment, azithromycin for sex partner </li></ul><ul><li>Patients with chlamydia, syphilis or gonorrhea who were tested for HIV and hepatitis B </li></ul><ul><li>Patients with HIV or AIDS receiving HAART </li></ul><ul><li>Patients with new STD/HIV who had documented risk-reduction counseling </li></ul>
Methods RPMS ID- Web Lab and clinical data 13 guidelines-based indicators of clinical care
Conclusions <ul><li>Demonstrates a potentially powerful tool to assist providers in delivering high quality care for HIV, STDs, and Hepatitis B </li></ul><ul><li>Could be expanded to include other infectious diseases </li></ul><ul><li>Larger scale implementation will be dependent on: </li></ul><ul><ul><ul><li>Perceived value </li></ul></ul></ul><ul><ul><ul><li>Support of data entry </li></ul></ul></ul>
Contact Information <ul><li>Participating in ID-Web </li></ul><ul><li>Please contact Laura Shelby </li></ul><ul><li>tel: (505) 248-4395 </li></ul><ul><li>e-mail: [email_address] </li></ul><ul><li>Demo of the system </li></ul><ul><li>http://www. webepi.com/index.jsp </li></ul>