Rhode Island Prevention Connection
Your resource for optimizing the use of your electronic health record (EHR) system to improve the quality and frequency of preventive health care services |
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Doctor's Corner
by Christopher Campanile, MD, PhD
IT-Driven Redesign of the Medical Practice
 There is a movement afoot, at least in primary care that a fairly extensive transformation in the delivery of medical care at the practice level needs to occur. The impetus for this comes from extensive quality and safety data, most famously compiled in two Institute of Medicine reports, The Quality Chasm, and To Err is Human. We, as primary care providers, are not meeting the expectation of quality based on the most recent evidence, and, we are harming patients at a rate that belies that most important maxim delivered to us on the first day of medical school: Primum non nocere. This is not to say that the vast majority of medical providers are not well-meaning in their daily work as clinicians. But it does speak to a certain level of unawareness if not misplaced professional pride. I believe the three basic components of efficient, high quality health care delivery at the primary care level can be distilled down to three components:
1. space,
2. use of personnel (teamwork), and
3. information technology (IT) support.
In this article, I am going to begin to lay out some thoughts regarding the many ways IT can support this needed practice redesign.
In one of the earliest inquiries into what components should comprise a well designed model for delivering care to patients with chronic illness, Dr. Ed Wagner and his colleagues, in 1993, arrived at six key components as part of their Chronic Care Model. One of them was what they called Computer Information Systems. They recognized, at a time when the role of computers in ambulatory medicine was barely in its infancy, that IT was crucial if clinicians were to deliver consistent, quality care to patients with chronic illness. I am going to touch on a host of applications of IT in the delivery of primary medical care, many of which occur 'behind or between the scenes', i.e., not in real time during a provider-patient visit.
The first level I am going to focus on, though, is the function of an EHR in the ontext of a provider-patient encounter.... Click here to read this article in its entirety. |
Prevention Update
BENCHMARKED DATA ACROSS PROJECT
Quarter 7 Data (February, March, April) is now available to share with your practices. This data will be de-identified and benchmarked across the Power Up for Prevention project. How is your practice doing at capturing your data? Contact us to find out. |
In The News
Preparing for Meaningful Use
As a participant in the Power Up for Prevention project, practices have laid the foundation on the road to "Meaningful Use". As discussed in last month's article, there are 25 Stage 1 proposed criteria. Of those 25 criteria, 17 must be accompanied by measurements including numerators and denominators; 8 will require a "yes" or "no" attestation. Here is a list of the measurable objectives:
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Implement drug-drug, drug-allergy, and drug-formulary checks
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Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT ®
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Maintain active medication list
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Maintain active medication allergy list
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Record selected demographics
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Record and chart changes in selected vital signs
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Record smoking status for patients 13 years old or older
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Incorporate clinical lab-test results into EHR as structured data
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Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research and outreach
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Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
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Insurance eligibility electronically from public and private payers
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Submit claims electronically to public and private payers
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Perform medication reconciliation at relevant encounters and each transition of care
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Provide summary care record for each transition of care and referral
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Capability to submit electronic data to immunization registries and actual submission where required and accepted
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Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice
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Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities
Next month we will review the remaining 8 ojectives. |
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Tip of the Month
Standardized Processes
Consistency in documentation methods will produce accurate, clear patient records and save time for all staff members. When your EHR offers choices regarding where certain items are documented, it is most important that everyone is "on board" with the standardized process chosen by the practice. For example, if all immunizations, whether given in the office or reported by the patient, are documented in the same screen or template, you will only need to look there to obtain accurate patient information. Having to search mulitple screens will utilize a large chunk of staff time, leaves room for errors in patient care, and does not support an accurate reporting process. |
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This material was prepared by Quality Partners of Rhode Island, the Quality Improvement Organization for Rhode Island, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. |
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Quote of the Month
The eye sees only what the mind is prepared to comprehend.
- Henri Bergson |
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