Improving Patient Care Through Responsive Clinical Systems

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Improving Patient Care Through Responsive
Clinical Systems

• Jim Jirjis M.D.
• Vanderbilt Medical Group

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Vanderbilt Medical Center
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Objectives

• Review the Nature of our business
• Review some of the forces of the industry that
  enable excellent care.
• Review different arenas of care.
• Examples of responsive clinical systems improving
  care
• Conclusions

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What business are we in?

• The delivery of excellent patient care
• Core foci
• Research
• Patient Care
• Teaching
• Informatics supports each of these missions
• We focus on patient care for today

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When Do We Deliver Patient Care?

• Prior to the Visit
• If we could anticipate a patients need for care
  (risk)
• During the encounter
• Inpatient
• Outpatient
• Surgery
• ER
• Telephone
• Mail
• After the encounter
• Result reporting
• Follow up

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CommunicationThe neglected EMR need

• 60-70 of what we do is communicate
• Hard to fully implement paperless EMR without
  communication piece
• Electronic communication is becoming an
  expectation due to efficiency
• Privacy and security risk
• Options
• Regulate, monitor, enforce versus providing a
  system that is easier to use and preferred
• Make it easier to do the right thing.

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The World Has ChangedThe World is Flat

• PC
• Speed, portability, capacity
• Internet
• Wireless access
• Software/programming

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The Three Steps to Getting it Done.

• Who should be doing it?
• Traditional Doctor (Bottleneck)
• Next page

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The physician as the bottleneck
Yarnall, et. al., American Journal of Public
Health, April 2003, Vol. 93, 4
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The Three Steps to Getting it Done.

• Do they have the information and tools they need
  to get it done?
• Are they incentivized to align behavior to get it
  done?
• Internal or external

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Ingredients of a Satisfying Long-Term Job

• Importance
• Passion
• Can support a business model

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ExamplesReminders

• Hypertensive patient
• Began Blood pressure medicine

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Kidney Failure
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Example Point of CareBrain Imaging

• Problem
• The wrong test is often ordered.
• Next day the right test is ordered.
• Unnecessary testing, inconvenient for patient
• Solution
• Leverage EMR to assist with Brain imaging

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Example Point of CareBrain Imaging
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Implementation Ordering Page
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How can CPOE Help Improve Patient Safety and
Reduce Errors?

• Pediatric Dosing

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www.mederrors.com
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Example Population Management

• Offload the bottleneck
• Teams of nurses, techs assisting by
• Tracking to identify in a large population
  patients who
• Are not at target cholesterol, diabetes control
• Are in need of immunizations
• Are in need to foot or eye exams, etc.
• Providing Education

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Example Population Management

• Who? Team
• Offload the bottleneck (remain interactive)
• Do they have the information and the tools that
  they need to do this job?
• StarTracker
• Are they incentivized and supported?
• Insurance companies are going to incentivize

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Example Population Management
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Example Population Management
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Health Improvement Diabetes Collaboration with
BCBS TN

• 3000 diabetes in our primary care practice
• Hga1c semiannual monitoring improvement from 55
  (national average 45) to 60-65 in 1 year.
• 90 beta-blocker use after acute MI
• BCBS funding support if targets met in 1 year

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Results

• 100 of patients after Acute MI received
  beta-blockers (excluding 1/28 who had an absolute
  contraindication)
• 90 of diabetics in our entire practice have had
  2 hga1c values in the past year.
• Example patient

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Patient A.F.
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Librarian CommunicationUtilizing the messaging
system in new ways
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Librarian CommunicationUtilizing the messaging
system in new ways
Patient decided not to take this medicine based
on the librarians literature review.
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Example Interdepartmental MessagingImproving
communication across the medical center

• Mapping to existing triaging system
• Decouple local physician EMR adoption culture
  within each site
• Advertise and strategically encourage super users
  to begin using system
• Monitor to avoid unattended messages

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Interdepartmental MessagingClinical
Communication..
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Interdepartmental MessagingClinical
Communication..
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Interdepartmental MessagingMessage destination
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Example Patient MessagingSupporting the
Coaching Model of self care

• Patients find value in email (and find email
  addresses on the web!)
• Managing will at best be a probability
• Need to bundle so much additional value to having
  a secure web portal that it transcends email value

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Patient Web PortalMyHealthAtVanderbilt
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Patient MessagingImplementation strategy

• Intradepartmental
• Interdepartmental
• Web Portal
• Use one stage to advertise, introduce the model
  (in advance) and plan for the next

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Web PortalMyHealthAtVanderbilt

• Features
• Secure web portal tool
• Messaging
• Remote online sign-up
• Refills
• View lab results (with helpful links)
• Intake forms
• Ability to view appointments
• Ability to pay bills on-line
• Patient specific educational material

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Web PortalMyHealthAtVanderbilt
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Patient MessagingPatient end
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Patient MessagingPatient end
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Patient MessagingPatient end
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Patient MessagingPhysician/staff end
Patient messages Appear green
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Patient MessagingPhysician/staff end
Bounce back Time delay
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Patient Portal Value

• Providers and health care systems benefits..
• Decrease burden on phone system
• Optimizes staff resources by eliminating manual
  processes
• Electronic log of patients communications
• Secure electronic information exchange with
  patients
• Monitor patient conditions remotely

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Patient Portal Value

• Patients benefits..
• Patients will be involved in managing their own
  health
• Medical records can be readily accessed from
  anywhere
• Patients can communicate remotely across a
  secure portal

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Other Examples

• ChemoWiz ordering
• ED whiteboard
• Quill
• RX Star (prescription writer)
• Patient Letter Generator

• Starforms
• Bar Coding
• Discharge Wizard
• Horizon Expert Documentation
• Outpatient Whiteboard

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Conclusion

• Goal of improving care we need to be mindful of
• New models of team-based care
• (offloading the bottleneck)
• Payer movement towards incentivizing quality
  performance
• Leveraging information technology to improve the
  process of care through information

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Give me the information I want, when I want
itand nothing more, please
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