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Brad Doebbeling Slides for AHRQ Kick-Off Event


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Brad Doebbeling Slides for AHRQ Kick-Off Event

  1. 1. Project Overview: “Improving the Integration of Decision Support into Outpatient Clinical Workflow” January 8 th , 2008 LEADERS SYMPOSIUM “ Strategic Planning to Inform a Funded Project on how to Achieve Workflow Integration in Developing and Implementing CDS for CRC Screening”
  2. 2. Goals for Today <ul><li>Bring together thought leaders to advise and foster potential collaboration </li></ul><ul><li>Strategize about improving the quality of our research & implementation plans </li></ul><ul><li>Discuss uptake, dissemination and next steps </li></ul>
  3. 3. Who We Are <ul><li>IU Center for Health Services & Outcomes Research (IU CHSOR), Regenstrief Institute, Inc. </li></ul><ul><li>VA HSR&D Center of Excellence in Implementing Evidence- based Practice (CIEBP) </li></ul><ul><li>Websites: </li></ul><ul><ul><li> </li></ul></ul><ul><ul><li>- / </li></ul></ul>
  4. 4. Mission, Vision and Focus Mission: Advance the science of transforming healthcare delivery. Vision: Become the leading national resource for promoting and studying health system transformation. Focus: Implementation of health informatics, system redesign.
  5. 5. VISN 11 Roudebush VAMC Regenstrief Institute, Inc . Medical Informatics Aging Research Health Services Research Regenstrief Center for Healthcare Engineering Indiana University School of Medicine School of Nursing Cancer Center IUPUI School of Engineering & Tech. School of Science School of Informatics Purdue College of Liberal Arts College of Engineering College of Pharmacy College of Technology Cancer Center System Redesign Office of Quality & Performance Patient Care Services Academic & Research Partners Other VISN’S & VAMC’S VA Partners RESEARCH PARTNERS Community Partners Indiana Health Information Exchange Indiana Patient Safety Center Indiana Hospital & Health Assoc. Indianapolis Health Systems (Clarian, Community, St. Francis, St. Vincent’s, & Wishard Hospitals) Rehab Hospital of Indiana Office of Research & Development HSR&D HSR&D & QuERI Programs Other Centers of Excellence Office of Information Research Indiana University Center for Health Services & Outcomes Research ACT Center of Indiana IU CAMMP VA Stroke QuERI Informatics System Redesign VA Center of Excellence for Implementing Evidence-based Practice
  6. 6. Core Investigators <ul><li>Doebbeling, Brad - Implementation, Informatics, Pt Safety, System Change </li></ul><ul><li>Bair, Matt - Chronic Pain, Implementation </li></ul><ul><li>Bravata, Dawn - Stroke, Implementation, Sleep Apnea </li></ul><ul><li>Carney-Doebbeling, Caroline - Cancer Care, Mental Illness, Implementation </li></ul><ul><li>Cook, Cynthia - Nursing, Implementation </li></ul><ul><li>Damush, Teresa - Stroke, Implementation </li></ul><ul><li>Frankel, Richard - Safety, Comm, Education, Qualitative </li></ul><ul><li>Haggstrom, David - Cancer Care, Implementation </li></ul><ul><li>Imperiale, Tom - Cancer Care, Implementation </li></ul><ul><li>Inui, Tom - Communication, Education, System Change </li></ul><ul><li>Krebs, Erin - Chronic Pain and Implementation </li></ul><ul><li>Kroenke, Kurt - Chronic Pain, Depression, Cancer Care, Implementation </li></ul><ul><li>Saleem, Jason - Safety, Informatics, HCI </li></ul><ul><li>Salyers, Michelle - SMI, Implementation, Community Treatment </li></ul><ul><li>Williams, Linda - Stroke, QI, Implementation, Post-Stroke Depression </li></ul><ul><li>Woodward-Hagg, Heather - Systems Engineering, QI, Implementation </li></ul><ul><li>Zillich, Alan - Implementation, Pharmacy </li></ul>
  7. 7. AHRQ ACTION Collaborative <ul><li>TASK ORDER #8: Improving Quality Through Health IT: Testing the feasibility and assessing the impact of using existing health IT infrastructure for better care delivery </li></ul><ul><li>Title: “Improving the Integration of Decision Support into Outpatient Clinical Workflow” </li></ul><ul><li>Dates: 10/07 – 09/09 </li></ul>
  8. 8. AHRQ Grant – Improving Integration of CDS into Workflow <ul><li>Research Team: </li></ul><ul><ul><li>Brad Doebbeling, MD, MSc (PI) </li></ul></ul><ul><ul><li>David Haggstrom, MD, MAS </li></ul></ul><ul><ul><li>Jason Saleem, PhD </li></ul></ul><ul><ul><li>Laura Militello, MA </li></ul></ul><ul><ul><li>Heather Hagg, MS </li></ul></ul><ul><ul><li>And representatives from West Haven VA, Columbia, South Carolina VA, Partners Healthcare, & Regenstrief </li></ul></ul><ul><ul><li>Project managers: Shawn Hoke and Lori Losee </li></ul></ul>
  9. 9. Motivation <ul><li>More effective use of IT is recommended in integrating point of care access to (e.g., Committee on Quality Health Care in America) : </li></ul><ul><ul><li>Health literature and evidence-based guidelines; </li></ul></ul><ul><ul><li>Computerized clinical data; </li></ul></ul><ul><ul><li>Computerized decision support (CDS) systems; </li></ul></ul><ul><ul><li>Automation of decisions to reduce errors; </li></ul></ul><ul><ul><li>Electronic communication among providers and patients into practice. </li></ul></ul><ul><li>Computerized CDS can improve clinician decision making and support adherence to evidence-based guidelines. </li></ul><ul><ul><li>(e.g., Reid et al., 2005; Doebbeling et al., JGIM, 2006; Bates et al. JAMIA 1999 & 2001) </li></ul></ul><ul><li>Colorectal cancer screening focus: high disease burden, relatively low screening rates, strong evidence for screening effectiveness </li></ul><ul><li>Failure to optimally integrate CDS into workflow has resulted in inconsistent and incomplete implementation strategies. </li></ul><ul><ul><li>(e.g., Doebbeling et al., JGIM 2006; Garg et al., JAMA, 2005) </li></ul></ul>
  10. 10. Conceptual Framework : Sociotechnical Systems Theory to guide identification of factors important in better understanding how to best develop and implement CDS Sociotechnical Framework
  11. 11. Study Aims <ul><li>Specific Aim 1: Identify key approaches to CDS development for colorectal cancer screening at two VAMC sites and two nationally recognized non-VA sites, for effective CDS integration into clinical workflow. </li></ul><ul><li>H1: Effective colorectal cancer screening CDS integration into workflow requires system redesign, human factors assessment, pilot testing, use at the bedside or patient room, and provider training and support. </li></ul><ul><li>Specific Aim 2: Develop and test CDS design alternatives for improved integration into clinical workflow through a controlled simulation study and subsequent implementation. </li></ul><ul><li>H2: Providers will experience improved efficiency and usability, and decreased workload when using design alternatives for colorectal cancer screening CDS compared to current CDS. </li></ul>
  12. 12. Key Informant Interviews of site-specific best-practices for integration of colorectal cancer screening CDS into workflow Direct Observation of colorectal cancer screening CDS for barriers and facilitators to workflow integration Implementation in primary care clinic after simulation study Rapid Prototyping of CDS design alternatives based on Phase 1 findings Simulation Study to test impact of CDS design alternatives on efficiency, usability, and workload Evaluation in primary care clinic after simulation study Figure. Project Overview Phase 1 Phase 2 Phase 3
  13. 13. Multi-Organizational Approach <ul><li>Proposal includes 3 of the top 4 leaders in demonstrating improved quality and efficiency using health IT: VA, Regenstrief, Partners Healthcare (Chaudhry et al., Annals of Internal Medicine, 2006) </li></ul><ul><li>Each of these 3 organizations use very different designs and approaches for CDS with the electronic medical record </li></ul><ul><li>These differences all impact workflow integration </li></ul><ul><ul><li>Unique context of each organization vs. generalizable design principles </li></ul></ul>
  14. 14. Timeline <ul><li>Project Activity </li></ul><ul><li>YEAR 1 </li></ul><ul><li>Data collection: West Haven VA Medical Center (target between months 2 and 5) </li></ul><ul><li>Data collection: * Columbia VA Medical Center (target between months 3 and 6) </li></ul><ul><li>Data collection: The Regenstrief Institute (target between months 4 and 7) </li></ul><ul><li>Data collection: Partners Healthcare System (target between months 5 and 10) </li></ul><ul><li>Continuous data reduction of observational and interview data through months 2-10 </li></ul><ul><li>Data analysis of observational and interview data between months 10-12 </li></ul><ul><li>YEAR 2 </li></ul><ul><li>Rapid prototyping of clinical decision support (CDS) design alternatives, months 13-14 </li></ul><ul><li>Initial pilot test of redesigned CDS, month 15 </li></ul><ul><li>Simulation study of CDS to demonstrate improved integration into workflow, months 15-16 </li></ul><ul><li>Evaluate impact / analyze measures: efficiency, usability, and workload, month 17 </li></ul><ul><li>Implementation of refined CDS in local VA primary care clinics, months 18-20 </li></ul><ul><li>Evaluate impact / analyze measures: efficiency, usability, and workload, months 20-21 </li></ul><ul><li>Create and disseminate implementation handbook, tools, manuscripts, months 22-24 </li></ul>*Columbia VA is initial test site for new OncWatch CRC Screening CDS