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Improving Patient Health Outcomes using an EHR

Improving Patient Health Outcomes using an EHR

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Published by jackshafferjr
Improving Patient Health Outcomes at Primary Care Systems in Clay, WV Using an Electronic Health Management System
Improving Patient Health Outcomes at Primary Care Systems in Clay, WV Using an Electronic Health Management System

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Categories:Types, Research
Published by: jackshafferjr on Mar 02, 2013
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Improving Patient Health Outcomesat Primary Care Systems in Clay, WVUsing an Electronic HealthManagement System
Version 2.0:
Prepared by:
Sarah Chouinard, MD. and Jack L. Shaffer, Jr.
Case Study for Primary Care Systems
Improving Patient Care Using an EHRBackground
A number of studies strongly suggest that health care services delivered in the United Statesoften do not meet patient needs. One of these studies indicates that only 50 percent of theindividuals studied received recommended preventive care and only 60 percent receivedrecommended chronic care. Equally troubling was the finding that, of those studied, twentypercent received chronic care that was contraindicated. See: Mark A. Schuster, Elizabeth A.McGlynn, Robert H. Brook (1998), “How Good Is the Quality of Health Care in the United States?” The Milbank Quarterly 76 (4), 517–563. These results were confirmed by a RAND Corporation study that found American adults receivedonly about half (54.9 percent) of recommended medical care in compliance with evidenced-basedguidelines. This study added to the mounting evidence of deficiencies in the U.S. health caresystem, which was highlighted in a 2001 Institute of Medicine report, “Crossing the QualityChasm”, documenting the chasm between the care Americans receive and the care Americansshould expect. There is emerging evidence that electronic health information systems (referred to genericallyherein as “EHR” for “Electronic Health Record”) can have a profound impact on quality of serviceand patient outcomes if implemented in concert with recommended health improvementprocesses. The use of EHR systems permits participants to measure and report externally on anumber of quality indicators and more importantly, to use these results internally to continuallyimprove care delivery by more readily conforming to evidence-based clinical best practices.Use of an EHR system facilitates measurement of outcomes and evaluation of interventions inreal-time rather than a retrospective environment, facilitating continuous improvement of theworkflow and processes of clinical activities. It also facilitates communication and coordination of care among care team participants and allows tracking of patient health indicators over time(facilitating health indicator trending through charts and graphs). This case study reviews how the implementation of a population-based EHR along with thechronic care model of care delivery and coordination (referred to herein as the “Care Model”indicating a system of care for chronic conditions based upon a model developed by Ed Wagner,MD, MPH, Director of the MacColl Institute for Healthcare Innovation and employed bycommunity health centers through the Health Disparities Collaborative efforts coordinated byHRSA, see: http://www.improvingchroniccare.org/) is improving the health outcomes for patientsof Primary Care Systems in the rural community of Clay, West Virginia.
Primary Care Systems
Primary Care Systems, Inc., is a Federally Qualified community health center (FQHC) serving theresidents of Clay County, West Virginia, and surrounding areas. Primary Care Systems has twoprimary clinical locations in Clay and Big Otter within Clay County, and three school-based healthcenters at Clay Elementary, Clay Middle and Clay High Schools (with a fourth center planned forthe new Big Otter Elementary School in 2008). Primary Care Systems serves approximately7,200 patients with approximately 30,000 patient encounters annually. Of the patients served,over seventy percent are covered by Medicare or Medicaid or are uninsured. The staff of PrimaryCare Systems currently includes 4 FTE physicians and 4 FTE mid-levels providing a range of primary care services, including laboratory, radiology, behavioral health and maternity and well-child services.
(Note: FQHC is a federal designation from the Bureau of Primary Health Care (BPHC) within theHealth
Resources and Services Administration (HRSA) of the US Department of Health andHuman Services and the Center for Medicare and Medicaid Services (CMS) that is assigned toprivate non-profit or public health care organizations that serve predominantly uninsured ormedically underserved populations. FQHCs are located in or serve a Federally-designatedMedically Underserved Area/Population (MUA or MUP). FQHCs must operate under a consumerBoard of Directors governance structure, and provide comprehensive primary health, oral, andmental health/substance abuse services to persons in all stages of the life cycle. FQHCs providetheir services to all persons regardless of ability to pay, and charge for services on a Boardapproved sliding-fee scale that is based on patients’ family income and size. FQHCs must complywith Section 330 (of the Public Health Service Act) program expectations/requirements and allapplicable federal and state regulations. FQHCs are also called Community/Migrant HealthCenters (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics.)In 2005, Primary Care Systems began to prepare for the implementation of an EHR system as amember of the Community Health Network of West Virginia (the “Network’) and as a pilot site totest concepts of personal health management and care coordination for the West VirginiaMedicaid program. This preparation involved implementation of the Care Model clinicalprocesses and realignment of clinicians within care teams. Care managers and coordinatorswere trained on disease management processes and patient self-management techniques. These processes were refined over a period of eighteen months and were used to guide theconfiguration of the electronic health information system clinical reminders, health factor reportsand patient education material. In 2006, Primary Care Systems began implementation of anelectronic health management system, starting with care managers and clinical support teammembers and then expanding to physicians. One of the aspects of the project that makesPrimary Care Systems truly unique is that it is the first community health center organization inthe country to successfully implement an adapted version of the Resource and PatientManagement System (“RPMS) clinical information system developed and used by Indian HealthService. This adapted version of RPMS has been branded as MedLynks™ by the Network. The Medlynks system is a health centered configured version of the RPMS software platform (asoftware platform that is largely in the public domain with a limited number of modules that areproprietary) that has been used by the Indian Health Service to dramatically improve healthoutcomes for tribal populations in a number of ambulatory care settings. MedLynks hastemplates and tools adapted for use in community health centers and can serve as an alternativeto commercial applications to rapidly accelerate the adoption of population-based, patient-centered electronic health information technology.
Clinical Outcome Measures
Primary Care System, like most FQHC grant recipients, is required to undergo periodic Office of Performance Review (“OPR”, formerly called the Primary Care Effectiveness Reviews (“PCER”))which may be combined with Joint Commission on Accreditation of Healthcare Organizations(JCAHO) reviews) to evaluate clinical outcomes and performance. The OPR process requiresthat an FQHC select at least two quality measures from a list of fourteen possible measures andperform a data analysis on those measures for the last three years. To prepare for its periodicOPR evaluation, Primary Care Systems selected two measurements to analyze over the pastthree years:1. Diabetic patients whose HgBA1c lab results are under control”. The accepted, standardHgBA1c lab result of seven or less indicates that the patient has their condition undercontrol; anything above seven indicates that the diabetes condition is not being controlledeffectively.2. The percentages of children and adolescents ages 2 thru 19 that have been identified asclinically obese based upon their respective body mass index (BMI) score that have alsobeen referred to weight management counseling.

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