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CrossRoads
The document discusses transforming health care delivery through informatics using Massachusetts General Hospital as an example. It describes MGH's large primary care network and existing IT infrastructure. It then discusses challenges like lack of time and flawed care processes. Several tools are presented, including clinical decision support systems and same-day communication, to help close gaps outside of visits. Results show these tools improved preventative screening and disease metrics for connected patients. The document advocates for population-based, continuous approaches like ACCORD to strengthen fragile care loops through shared decision making and documentation.
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CrossRoads
- 1. Crossroads Transforming Health CareDelivery with Informatics: A perspective from the Massachusetts General Hospital (MGH) Henry C. Chueh, MD, MS
- 2. Coming up... Introduce theproblem Suggest a theme to solutions to the problem Provide a brief description of MGH Describe our path through stories about tools Revisit the theme
- 3. One Day inthe 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. “Computerized clinical informationsystems 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 the job...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)
- 6. supply Lack of time Flawed process demand
- 8.
- 10. 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 NECHC MDs = 178 • FTEs = 101 • Practices = 15 • Patients = 155,590
- 11. IT infrastructure atMGH Online registration and scheduling Outpatient electronic health records and e-prescribing Clinical data repository for results and reports Inpatient provider order entry Patient portal
- 13. Information “push” Decision supportin 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
- 14. Patients don’t alwayscome in for clinic visits. Clinic visits are busy. Providers are good at deciding, but bad at doing.
- 15. Getting there fromhere Loyalty cohort: Connectedness FastTrack: Enhanced CDSS/SSCD outside visits ACCORD: Involving patients
- 16. Who are mypatients? Visit to registered PCP Repeated visits to a specific practice Age and home address as variables
- 17. Connection Status PCP connected Practice connected Not connected 6% 34% 59% n = 155,590
- 18. 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)
- 19. 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)
- 21. A patient-tailored informationletter A hard copy Rx, to be signed Automatic electronic documentation A 6-week reminder timer
- 22.
- 23. Breast cancer screening PCP/screened Practice/screened Practice/overdue PCP/overdue 11% 9% 15% 64%
- 24. Mammography FastTrack Decision supportin breast cancer prevention population info patients primary care physician Outside the Visit action care delegate
- 25. Mammography FastTrack: 6-month results Intervention Control 30.0 P = 0.01 Completion rate (%) P = 0.01 22.5 P = 0.02 15.0 7.5 0 All Patients MD-Linked Practice-Linked
- 27. A Fragile Loop Awareness of Issue Risk assessment Follow-up ? Plan for care Complete care
- 28. Follow-up 1/3 have nosystem, <1/3 satisfied with system Patients want communication Lack of documentation Lack of patient understanding
- 29. ACCORD Ambulatory Care Compactto Organize Risk and Decision-making
- 33. ACCORD characteristics Patient-Provider preferences Explicitagreement with documentation Fail-safe monitoring High visibility
- 34.
- 35. challenges. tools. Continuous, not visit-based Population-based Patient-provider preferences