1 colorado associated community health information exchange lisa schilling, md, msph ahrq annual...
TRANSCRIPT
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Colorado Associated Community Health Information Exchange
Lisa Schilling, MD, MSPHAHRQ Annual ConferenceSept. 8, 2008
Creating a Shared Quality Improvement Reporting
System
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CACHIE Participants
• 14 Colorado federally qualified community health centers
• Colorado Community Managed Care Network
• Colorado Community Health Network
• Others
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Presentation Objectives
• Illustrate the use of business process analysis to inform user requirements
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CACHIE Goals
• To promote the use of information technology to support quality reporting and improvement across the CHC networks – To design, build, & implement a shared
system for quality reporting among 6 CHCs with 4 disparate EMR/PMS
– To assist CHC with EMR template implementation to improve care provision, documentation & measurement.
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Data <---> Information
Provide Care
Document CareMeasure Care
Template
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What is a business process?
Business process:
A “business process” describes a set of activities and tasks that logically group together to accomplish a goal or produce something of value for the benefit of the organization, stakeholder, or customer.
Dictionary
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Why Use Business Process Analysis?
• Everything is not as it appears to be: – Unintended internal and external consequences– It’s not just a “flip of the switch”– Technology must complement workflow
• Expectancy: – Exceeding capacities
• Fashion: – Unnecessary complexity – Remaining current
• Stakeholder interest: – Varying levels over time– Developing consensus
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Business Process Analysis
Business Process Redesign
RequirementsDefinition
THINKHow do we do our work now?
• Define goals and objectives
• Model context of work
• Identify business rules
• Describe tasks and workflows
• Identify common task sets
RETHINKHow should we do
our work?
• Examine tasks and workflows
• Identify inefficiencies• Identify efficiencies with repeatable processes
• Refine business processes and rules
• Remodel the context of work
• Restructure the tasks and workflow
DESCRIBEHow an information
system can support our work?
• Define tasks to be performed for optimized business processes
• Describe the implementation of business rules
• Describe in words and graphics how an information system is to be structured
• Determine scope of next phase of activities
Method
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BPA Example #1
•Outcome:Provide a “fast food” customer with their order efficiently and receive payment.
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Amount Due
Payment
Order Detail
Legend
Order taker
Greeting
Change
Order
Burger Station
Fry Station
Drink Station
Food inventory
Supplies (wrappers)
Food inventory
Supplies (oil)
Beverage inventory
Supplies (straws, cups)
Burge
r Ord
er
Fry Order
Drink Order
Burge
r
Drink
Fries
Transaction
Output
Outcome
Input
Reports, receipts
Restaurant Order Fulfillment ProcessContext Diagram
Customer
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CACHIE BPA Purpose
• Align the Information system (IS) with the organization’s mission, – need a clear model of the desired outcomes and
the business processes that result in those outcomes.
• IS should support and enhance business processes.
• Creating a shared system required that we understand CHC business process similarities and differences.
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CACHIE BPA Goals
• Develop a common definition of quality improvement reporting system
• Describe and visually document how quality improvement efforts are accomplished
• Describe how the quality improvement efforts will function with the quality IS
• Develop a list of functional requirements to drive information system design and implementation
On The Road
ClinicaClinica SunriseSunrise
ValleyValleyWideWide
Peak Peak VistaVista
High High PlainsPlains
MountainMountainFamilyFamily
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BPA Example #2
Outcome: Improve the provision and documentation of guideline concordant care in primary care clinic.
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Provide & Document DM Eye Care
• Goal: Provide DM pts guideline concordant care• Objective: Ensure DM pts receive eye exams• Business rules: Electronic referrals are not
possible, referrals to both internal and external providers.
• Trigger: DM pt presents for care (other?)• Task Set: Care for any acute needs, refer for
DM care• Outcome: Provide & document DM eye care
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Document Care
Legend
Provider
Enter Eye Referral
Internal Ophthalmologist
ExternalOphthalmologist
Med Records
Referral to
Referral to
Retina
l Exa
m
docu
men
ted
Scan
Transaction
Output
Outcome
Input
Quality Reports
Providing and Documenting GuidelineConcordant Care
EMR-Codified, text, scan
DiabeticPatient
Ophth note
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BPA- other topics
•Lab ordering & results handling, •Documentation of foot exams & self-management goals,•Incorporation of new or modified guidelines into their patient care processes, into their EMR templates, into their quality reporting,•Current methods of creating & using quality reports from EMR data, challenges and successes.
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What We Learned
• Templates– Not uniformly available,– Require costly professional support to develop/modify, – Require lots of CHC staff time,– When available, not always used,– Not automatically linked with “forms” -> double data
entry,– Desire for more & improved
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What We Learned- con’t
• Quality Reporting– Great variability among CHC capacity– Requires professional support ($$) to develop
reports – Reporting limited by $$$– Reporting limited by system– Desire for data (re-)use
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What We Learned- con’t
• Quality Reporting-2– Analyze at provider, pod, clinic site, CHC level– Analyze discrete specified time periods– Track trends for individual patients– Provide pre-built reports (UDS, etc) – Easily create reports for individual CHC needs– Save & share built reports – Run “huddle” reports based on scheduled
patients
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It Takes a Village…
CACHIE Steering CommitteeRoss Brooks, DirectorMolly Brown, ManagerArt Davidson, Co-Medical DirectorJason Greer, HIT DirectorMolly O’Fallon, Clinical Quality DirectorLisa Schilling, Co-Medical DirectorDan Tuteur, CCMCN Ex. Director
HIT CommitteeDavid Adamson, Mountain Family HCKitty Bailey, CCHNAndrew Bienstock, Salud Family HCDavid Fleurquin, Pueblo Community HCPete Gutierrez, Denver Health, Committee ChairAnnette Kowal, CCHN Pete Leibig, Clinica Family Health ServicesKonnie Martin, Valley-Wide Health Systems, Inc.Pam McManus, Peak Vista Community HC Mitzi Moran, Sunrise Community HealthPaul Olson, Peak Vista Community HCJohn Santistevan, Salud Family HCPat Tellez, Metro Community Provider Network
AHRQMarybeth Farquhar
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Contacts
CACHIE Project ManagerRoss Brooks [email protected]
CACHIE Medical DirectorsLisa Schilling [email protected] Davidson [email protected]