Implementing EHR Modifications to Support Self-Care to Patients with Chronic Conditions
Chris SheaPracticum Presentation 12-14-2012
The Problem Patients with chronic conditions often must undergo substantial behavior change to perform self-care activities effectively National efforts aim to improve care for patients by supporting their self-care activities Patient Centered Medical Home (PCMH)
Scope and Goals of the Practicum Setting: Carolina Advanced Health (CAH) Overall Goal: To achieve PCMH recognition Requires use of EHR to document the following for 50% of patients in diabetes, hypertension, or depression registry: Goal setting with patients Patient education materials Self-management tools Counseling (i.e., nutritional and behavioral). My goal was to engage staff who are involved with completion of the PCMH-related activities to participate in planning for the change and to adopt new workflows
Carolina Advanced Health A partnership between UNC Health Care System (HCS) and Blue Cross Blue Shield of North Carolina An innovative patient-centered primary care model longer patient visits (i.e., 40 minutes) onsite pharmacy, nutrition, and behavior specialists
Approach The PCMH change effort was embedded within the CAH’s quality-improvement (QI) approach The QI team dedicated to this effort consisted of representatives from each role directly involved with the care processes The CAH QI specialist worked with developers to modify the EHR The aims were to 1. Modify the EHR to capture necessary data for PCMH 2. Optimize EHR usability and workflows related to the PCMH activities 3. Monitor the performance of the clinic in these areas.
Methods for Change Management Initial interviews and follow-up discussions with 6 CAH representatives to identify current and desired future processes for PCMH-required activities Weekly QI meetings to 1. Make decisions about EHR design modifications 2. Formalize related workflows 3. Review data on the clinic’s performance on PCMH- related care processes
Initial Results Denominator Numerator % of DenominatorPCMH Requirement August November August November August NovemberEducation Provided 154 168 49 106 31.82% 63.10%Has Goal or Plan 154 168 54 85 35.06% 50.60%Self-Mgt Tool Provided 154 168 21 76 13.64% 45.24%Counseling Provided 154 168 14 112 9.09% 66.67%Note:Denominator = patients verified in diabetes, hypertension or depression registryNumerator = patients who received education, set goal/plan, received self-monitoring tool or received counseling
Lessons Learned Embedding this type of change within a QI framework helps ensure successful completion As with most process-oriented requirements, there is a need to assess whether the “spirit” of the requirement is being achieved over time. Are patients receiving educational materials that are appropriate? Are patients being overloaded with information? Do they use each source of information provided (e.g., educational materials and self-monitoring tools)? For what purposes?