Lessons in Using Clinical Decision Support for Chronic Disease Management Brian Dixon, MPA Regenstrief Institute, Inc. Jac...
Overview <ul><li>The Chronic Disease Problem </li></ul><ul><li>Agency for Healthcare Research and Quality </li></ul><ul><u...
The Chronic Disease Problem <ul><li>Chronic Diseases </li></ul><ul><ul><li>… afflict 90 million Americans </li></ul></ul><...
The Agency for Healthcare Research and Quality (AHRQ) <ul><li>AHRQ Mission </li></ul><ul><ul><li>To improve the quality, s...
<ul><li>Over 125  projects  and  demonstrations  to better understand how health IT can improve the safety, quality and ef...
AHRQ Health IT Portfolio http://healthit.ahrq.gov State and Regional Demonstrations of HIE 5 yr Current issues:  eRx stand...
The AHRQ Health IT Portfolio: Breadth of Technologies Used Source: Dixon BE, “The Landscape of the AHRQ Health Information...
A Report on IT Innovations in Chronic Disease Management (CDM)
Report Background <ul><li>Source: AHRQ-funded projects that target chronic diseases via health IT interventions </li></ul>...
Today’s Focus: CDSS <ul><li>Subset of AHRQ-funded projects that implemented clinical decision support systems (CDSS) </li>...
CDSS Technologies <ul><li>Dashboards / Quality Reports </li></ul><ul><ul><li>Aggregation of data across the EHR </li></ul>...
Key Lessons
Project Management <ul><li>What is project management? </li></ul><ul><ul><li>Ability to organize and manage project resour...
Project Management <ul><li>Commercial systems require significant customization, especially for CDM </li></ul><ul><ul><li>...
Alert Fatigue <ul><li>What is alert fatigue? </li></ul><ul><ul><li>Overwhelming or non-essential alerts that lead provider...
Alert Fatigue <ul><li>Process Redesign </li></ul><ul><ul><li>Alert prioritization </li></ul></ul><ul><li>“Middle” ware </l...
The Human Element <ul><li>What is the human element? </li></ul><ul><ul><li>The other 2/3 of IT implementations </li></ul><...
The Human Element <ul><li>Securing trust and buy-in </li></ul><ul><ul><li>HIE v. referral system </li></ul></ul><ul><li>So...
Conclusion
What’s Next? <ul><li>Expansion </li></ul><ul><ul><li>From 1-2 diseases to N diseases </li></ul></ul><ul><ul><li>From local...
Questions? <ul><li>AHRQ National Resource Center </li></ul><ul><li>URL:  http://healthit.ahrq.gov </li></ul><ul><li>Email:...
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CDS Innovations for Chronic Disease Management

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This is a presentation I gave at the 2007 AMIA Spring Congress. The presentation focuses on innovative projects in the AHRQ Health IT Portfolio focused on improving health care through the use of clinical decision support. In particular, these projects targeted chronically ill patients.

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  • CDS Innovations for Chronic Disease Management

    1. 1. Lessons in Using Clinical Decision Support for Chronic Disease Management Brian Dixon, MPA Regenstrief Institute, Inc. Jack Starmer, MD Vanderbilt University Medical Center Anita Samarth ASTECH Consulting
    2. 2. Overview <ul><li>The Chronic Disease Problem </li></ul><ul><li>Agency for Healthcare Research and Quality </li></ul><ul><ul><li>AHRQ Health IT Portfolio </li></ul></ul><ul><ul><li>AHRQ National Resource Center for HIT </li></ul></ul><ul><li>Innovations in Chronic Disease Management </li></ul><ul><li>Key Lessons </li></ul><ul><ul><li>Project Management </li></ul></ul><ul><ul><li>Alert Fatigue </li></ul></ul><ul><ul><li>Human Element </li></ul></ul><ul><li>Conclusion </li></ul>Page ©2007 AHRQ National Resource Center
    3. 3. The Chronic Disease Problem <ul><li>Chronic Diseases </li></ul><ul><ul><li>… afflict 90 million Americans </li></ul></ul><ul><ul><li>… account for 7 of every 10 deaths </li></ul></ul><ul><ul><li>… consume 2/3 of national health care expenditures </li></ul></ul><ul><ul><li>… many are preventable and manageable </li></ul></ul><ul><li>Sources: CDC (2004, 2006); Bodenheimer, Wagner, and Grumbach (2002) </li></ul>Page ©2007 AHRQ National Resource Center
    4. 4. The Agency for Healthcare Research and Quality (AHRQ) <ul><li>AHRQ Mission </li></ul><ul><ul><li>To improve the quality, safety, efficiency, and effectiveness of health care for all Americans </li></ul></ul><ul><li>AHRQ-Funded Research </li></ul><ul><ul><li>Patient-centered </li></ul></ul><ul><ul><li>Services + Delivery </li></ul></ul><ul><ul><ul><li>Systems effectiveness research focuses on actual daily practice, not ideal situations </li></ul></ul></ul><ul><ul><li>AHRQ mission includes production and use of evidence-based information </li></ul></ul>Page ©2007 AHRQ National Resource Center
    5. 5. <ul><li>Over 125 projects and demonstrations to better understand how health IT can improve the safety, quality and efficiency of health care </li></ul><ul><li>Projects in 43 states </li></ul><ul><li>Emphasis on best practices that can improve quality of care in rural, small, safety net, and community health center care settings </li></ul>Health IT Research Funding AHRQ HIT Investment: $166 Million Page ©2007 AHRQ National Resource Center
    6. 6. AHRQ Health IT Portfolio http://healthit.ahrq.gov State and Regional Demonstrations of HIE 5 yr Current issues: eRx standards pilots Privacy, security, business practices National Resource Center for Health IT Planning 1 yr Implementation 3 yr Demonstrating Value 3 yr
    7. 7. The AHRQ Health IT Portfolio: Breadth of Technologies Used Source: Dixon BE, “The Landscape of the AHRQ Health Information Technology Portfolio.” AMIA 2006 Symposium . Distribution of health information technologies across the AHRQ portfolio Page ©2007 AHRQ National Resource Center
    8. 8. A Report on IT Innovations in Chronic Disease Management (CDM)
    9. 9. Report Background <ul><li>Source: AHRQ-funded projects that target chronic diseases via health IT interventions </li></ul><ul><li>Methods: document review, phone interviews </li></ul><ul><li>Results: Best practices and lessons across 14 CDM projects </li></ul><ul><ul><li>Implementation </li></ul></ul><ul><ul><li>Demonstrating value </li></ul></ul><ul><ul><li>Challenges </li></ul></ul>Page ©2007 AHRQ National Resource Center
    10. 10. Today’s Focus: CDSS <ul><li>Subset of AHRQ-funded projects that implemented clinical decision support systems (CDSS) </li></ul><ul><li>6 of the 14 CDM projects </li></ul><ul><li>Demographics </li></ul><ul><ul><li>Medium and large urban hospitals </li></ul></ul><ul><ul><li>Most an academic medical center or affiliated with one </li></ul></ul><ul><ul><li>Geographically diverse </li></ul></ul>Page ©2007 AHRQ National Resource Center
    11. 11. CDSS Technologies <ul><li>Dashboards / Quality Reports </li></ul><ul><ul><li>Aggregation of data across the EHR </li></ul></ul><ul><ul><li>Real-time feedback for clinicians </li></ul></ul><ul><ul><li>Timely feedback/notification based on billing/claims data </li></ul></ul><ul><ul><ul><li>1-7 days vs. 3-6 months </li></ul></ul></ul><ul><li>Clinical Documentation / Templates </li></ul><ul><ul><li>Integrated reminders </li></ul></ul><ul><li>Remote Monitoring </li></ul>Page ©2007 AHRQ National Resource Center
    12. 12. Key Lessons
    13. 13. Project Management <ul><li>What is project management? </li></ul><ul><ul><li>Ability to organize and manage project resources to complete project within scope, budget, time, and quality. </li></ul></ul><ul><li>Role of project management: </li></ul><ul><ul><li>Vendor management </li></ul></ul><ul><ul><li>Stakeholder engagement </li></ul></ul><ul><li>Potential Impacts </li></ul><ul><ul><li>Go live date, budget, adoption </li></ul></ul>Page ©2007 AHRQ National Resource Center
    14. 14. Project Management <ul><li>Commercial systems require significant customization, especially for CDM </li></ul><ul><ul><li>Alerts, prompts </li></ul></ul><ul><ul><li>Interfaces </li></ul></ul><ul><li>Project delays </li></ul><ul><ul><li>Vendor partnerships </li></ul></ul><ul><ul><li>Integration with legacy systems </li></ul></ul><ul><li>Projects in rural areas had a hard time finding experienced personnel </li></ul>Page ©2007 AHRQ National Resource Center
    15. 15. Alert Fatigue <ul><li>What is alert fatigue? </li></ul><ul><ul><li>Overwhelming or non-essential alerts that lead providers to ignore or stop using CDSS </li></ul></ul><ul><li>Where does alert fatigue present? </li></ul><ul><ul><li>CPOE: drug-drug interactions </li></ul></ul><ul><ul><li>EHR: guideline-driven templates </li></ul></ul><ul><li>Potential Impact </li></ul><ul><ul><li>Unintended patient safety consequences </li></ul></ul>Page ©2007 AHRQ National Resource Center
    16. 16. Alert Fatigue <ul><li>Process Redesign </li></ul><ul><ul><li>Alert prioritization </li></ul></ul><ul><li>“Middle” ware </li></ul><ul><ul><li>Custom inbox or routine to support workflow </li></ul></ul><ul><li>Human Resources </li></ul><ul><ul><li>Nurses </li></ul></ul><ul><ul><li>Medicaid workers </li></ul></ul><ul><ul><li>Other non-clinical personnel </li></ul></ul>Page ©2007 AHRQ National Resource Center
    17. 17. The Human Element <ul><li>What is the human element? </li></ul><ul><ul><li>The other 2/3 of IT implementations </li></ul></ul><ul><li>Where do human elements present? </li></ul><ul><ul><li>Everywhere! </li></ul></ul><ul><ul><li>Organizational, political, technical </li></ul></ul><ul><li>Potential Impact </li></ul><ul><ul><li>User acceptance / buy-in </li></ul></ul><ul><ul><li>Provider / Patient Satisfaction </li></ul></ul>Page ©2007 AHRQ National Resource Center
    18. 18. The Human Element <ul><li>Securing trust and buy-in </li></ul><ul><ul><li>HIE v. referral system </li></ul></ul><ul><li>Socio-technical factors </li></ul><ul><ul><li>Patient recruitment </li></ul></ul><ul><ul><li>Usability </li></ul></ul><ul><li>Patient-centered approaches </li></ul><ul><ul><li>Medication education “game” </li></ul></ul><ul><ul><li>Interactive voice response (IVR) </li></ul></ul>Page ©2007 AHRQ National Resource Center
    19. 19. Conclusion
    20. 20. What’s Next? <ul><li>Expansion </li></ul><ul><ul><li>From 1-2 diseases to N diseases </li></ul></ul><ul><ul><li>From local community to statewide </li></ul></ul><ul><li>Larger Projects </li></ul><ul><ul><li>Demonstrate greater value </li></ul></ul><ul><ul><li>Create sustainability </li></ul></ul><ul><li>More Public-Private Partnerships </li></ul><ul><ul><li>More commercial systems </li></ul></ul><ul><ul><li>Greater adoption </li></ul></ul>Page ©2007 AHRQ National Resource Center
    21. 21. Questions? <ul><li>AHRQ National Resource Center </li></ul><ul><li>URL: http://healthit.ahrq.gov </li></ul><ul><li>Email: NRC- [email_address] </li></ul><ul><li>Brian Dixon, MPA </li></ul><ul><li>Jack Starmer, MD </li></ul><ul><li>Anita Samarth </li></ul>Page ©2007 AHRQ National Resource Center

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