healthbridge – healthcare transformation conference scott callahan, md faap medical director...
TRANSCRIPT
HealthBridge – Healthcare Transformation ConferenceScott Callahan, MD FAAP
Medical Director
Children’s Health Care
Batesville, Indiana
Practice Site
• Children’s Health Care is a pediatric primary care office located in Batesville Indiana between Cincinnati and Indianapolis.
• It is a 6 physician (4 full time, 2 part-time) and 2 nurse practitioner group.
• Hospital employed by Cincinnati Children’s Hospital Medical Center for over 10 years.
Children’s Health Care EMR Journey
• Milestones
• 1. December, 2004- NextGen chosen as EMR.
• 2. September, 2005- NextGen contract signed.
• 3. October, 2005- NextGen installed.
Electronic Milestones
• 4. January, 2006- EPM goes live.
• 5. February, 2006-EMR goes live.
• 6. May, 2008-Margaret Mary live with HealthBridge
Electronic Milestones
• 7. September, 2008-HealthBridge EMR interface goes live.
• 8. October, 2009-IHIE to HealthBridge to EMR live.
• 9. August, 2009-Margaret Mary EMR transmits data to PHO for asthma collaborative.
Electronic Milestones
• 10. January, 2010-NextGen patient portal live.
• 11. Currently working on registry for Children with Special Health Care Needs collaborative.
Quality Improvement
• Participation in the Tristate PHO Asthma Collaborative.
PHO Network: Asthma Process Measures (as of May 16, 2011)
Population-Based Measures(Network all-payor asthma population = 12,668)
PHO Literature
% of asthma population with flu shot:2010-2011 flu season2009-2010 flu season 2008-2009 flu season2007-2008 flu season2006-2007 flu season (delayed vaccine delivery)2005-2006 flu season 2004-2005 flu season2003-2004 flu season (baseline)
67%66%66%60%54%62%40%22%
10-40%
% of asthma population with management plan 94% 50%
% of population with “persistent” asthma on controller medication* 96% 97%
% of asthma population with severity classified 96% 50%
% of asthma population receiving “perfect care”** 93% not available
* “Persistent” asthma defined per NHLBI severity classification criteria.
** “Perfect care”: composite measure of severity classification, written management plan, and controller medications (if patient has “persistent” asthma)
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
PHO vs. Comparison Group:Asthma Admission Rate
(monthly data)
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Ju
l-0
8
Au
g-0
8
Se
p-0
8
Oct-
08
No
v-0
8
De
c-0
8
Ja
n-0
9
Feb
-09
Ma
r-0
9
Ap
r-0
9
Ma
y-0
9
Ju
n-0
9
Ju
l-0
9
Au
g-0
9
Se
p-0
9
Oct-
09
No
v-0
9
De
c-0
9
Ja
n-1
0
Feb
-10
Ma
r-1
0
Ap
r-1
0
Ma
y-1
0
Ju
n-1
0
Ju
l-1
0
Au
g-1
0
Se
p-1
0
Oct-
10
No
v-1
0
De
c-1
0
Ja
n-1
1
Feb
-11
Nu
mb
er
of
Inp
ati
en
t a
nd
Sh
ort
Sta
y V
isit
s p
er
10
,00
0 P
ati
en
ts
Month
Rate of PHO and Non-PHO Inpatient/Short Stay Admissions(Total Number of Admissions/Total Number of Patients)
Population: Commercially Insured Patients, within 8 Cty PSA, age 2-17 yrsBEACON MEASURE ID: 6A
PHO Non-PHO PHO Rolling Non-PHO Rolling
Last Updated 5/3/2011 by Michael Lake, The James M. Anderson Center for Health Systems Excellence
7/2008: Began identifying PHO patients using PCP UPIR field.
Denominators: Jan-2009 to Present:PHO Commercial Pop, n=149,370
Non-PHO Commercial Pop, n=164,521
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
PHO vs. Comparison Group: % Difference in Asthma Admission Rate
(monthly data)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ju
l-0
8
Au
g-0
8
Se
p-0
8
Oct-
08
No
v-0
8
De
c-0
8
Ja
n-0
9
Feb
-09
Ma
r-0
9
Ap
r-0
9
Ma
y-0
9
Ju
n-0
9
Ju
l-0
9
Au
g-0
9
Se
p-0
9
Oct-
09
No
v-0
9
De
c-0
9
Ja
n-1
0
Feb
-10
Ma
r-1
0
Ap
r-1
0
Ma
y-1
0
Ju
n-1
0
Ju
l-1
0
Au
g-1
0
Se
p-1
0
Oct-
10
No
v-1
0
De
c-1
0
Ja
n-1
1
Feb
-11
% D
iffe
ren
ce
in
Vis
its
pe
r 1
0,0
00
Pa
tie
nts
Month
% Difference between PHO and Non-PHO Inpatient/Short Stay Admissions(Positive value means Non-PHO is a higher rate)
Population: Commercially Insured Patients, within 8 Cty PSA, age 2-17 yrsBEACON MEASURE ID: 6A
% Diff Median Beacon Goal (60%) Rolling % Diff
Last Updated 5/3/2011 by Michael Lake, The James M. Anderson Center for Health Systems Excellence
7/2008: Began identifying PHO patients using PCP UPIR field.
Denominators: Jan-2009 to Present:PHO Commercial Pop, n=149,370
Non-PHO Commercial Pop, n=164,521
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
PHO vs. Comparison Group:Asthma ED/Urgent Care Visit Rate
(monthly data)
0.00
0.10
0.20
0.30
0.40
0.50
0.60
0.70
0.80
0.90
1.00
Ju
l-0
8
Au
g-0
8
Se
p-0
8
Oct-
08
Nov-0
8
Dec-0
8
Ja
n-0
9
Fe
b-0
9
Ma
r-09
Ap
r-09
Ma
y-0
9
Ju
n-0
9
Ju
l-0
9
Au
g-0
9
Se
p-0
9
Oct-
09
Nov-0
9
Dec-0
9
Ja
n-1
0
Fe
b-1
0
Ma
r-10
Ap
r-10
Ma
y-1
0
Ju
n-1
0
Ju
l-1
0
Au
g-1
0
Se
p-1
0
Oct-
10
Nov-1
0
Dec-1
0
Ja
n-1
1
Fe
b-1
1
Nu
mb
er
of
ED
/UC
Vis
its
pe
r 1
,00
0 P
ati
en
ts
Month
Rate of ED and Urgent Care Visits(Total Number of Visits/Total Number of Patients)
Population: Commercially Insured Patients, within 8 Cty PSA, age 2-17 yrsBEACON MEASURE ID: 6B
PHO Non-PHO PHO Rolling Non-PHO Rolling
Last Updated 5/3/2011 by Michael Lake, The James M. Anderson Center for Health Systems Excellence
7/2008: Began identifying PHO patients using PCP UPIR field.
Denominators: Jan-2009 to Present:PHO Commercial Pop, n=149,370
Non-PHO Commercial Pop, n=164,521
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
PHO vs. Comparison Group: % Difference in Asthma ED/Urgent Care Visit
Rate(monthly data)
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Ju
l-0
8
Au
g-0
8
Se
p-0
8
Oct-
08
No
v-0
8
De
c-0
8
Ja
n-0
9
Feb
-09
Ma
r-0
9
Ap
r-0
9
Ma
y-0
9
Ju
n-0
9
Ju
l-0
9
Au
g-0
9
Se
p-0
9
Oct-
09
No
v-0
9
De
c-0
9
Ja
n-1
0
Feb
-10
Ma
r-1
0
Ap
r-1
0
Ma
y-1
0
Ju
n-1
0
Ju
l-1
0
Au
g-1
0
Se
p-1
0
Oct-
10
No
v-1
0
De
c-1
0
Ja
n-1
1
Feb
-11
% D
iffe
ren
ce
in
Vis
its
pe
r 1
,00
0 P
ati
en
ts
Month
% Difference between PHO and Non-PHO ED/Urgent Care Visits(Positive value means Non-PHO is a higher rate)
Population: Commercially Insured Patients, within 8 Cty PSA, age 2-17 yrsBEACON MEASURE ID: 6B
% Diff Median Beacon Goal (45%) Rolling % Diff
Last Updated 5/3/2011 by Michael Lake, The James M. Anderson Center for Health Systems Excellence
7/2008: Began identifying PHO patients using PCP UPIR field.
Denominators: Jan-2009 to Present:PHO Commercial Pop, n=149,370
Non-PHO Commercial Pop, n=164,521
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
PHO Network: Asthma Outcome MeasuresPopulation-Based Measures(Network all-payor asthma population = 12,668)
Baseline
8/04 - 7/05Current
4/10 - 3/11%∆
% parents missing ≥ 2 work days due to child's asthma over prior 6 months
18.0% 10.2% 43% ↓
% parents rating confidence in managing child's asthma < 7/10
11.1% 5.8% 48% ↓
% asthma population missing ≥ 2 school days due to asthma over prior 6 months
26.5% 18.6% 30% ↓
% activity limitation reported as “not at all” or “a little of the time”
Not captured as these
questions were
initiated in June 2006
89.0%
n/a
% receiving oral steroids within prior 12 months 20.1%
% parents rating asthma as “well” controlled 93.7%
% physicians rating asthma as “well” controlled 90.2%
% parent and physician agreement on rating degree of asthma control
92.2%
Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.
Eligible Professonal Meaningful Use Menu Set (10)
• 1. Implement drug formulary checks.
• 2. Incorporate clinical lab tests results into EHR as structured data.
• 3. Generate lists of patientsby specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
• 4.Send reminders to patients per patient preference for preventative/follow up care.
• 5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP.
• 6. Use EHR technology to identify patient-specific education resources to the patient if appropriate.
• 7. The EP who receives a patient from another setting of care or provider of care should perform a medication reconciliation.
• 8. The EP who transitions their patient to another setting of care should provide a summary care record for each transition of care or referral.
• 9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.
• 10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission to applicable law and practice.
