Kwame A. Kitson, MD

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THE IMPACT OF HEALTH INFORMATION TECHNOLOGY ON
QUALITY IMPROVEMENT THE INSTITUTE FOR FAMILY
HEALTH
Kwame A. Kitson, MD VP of Quality
Improvement Institute for Family Health 16 East
16th St New York, NY 10003 kkitson_at_
institute2000.org 212-633-0815 www.
institute2000.org
HIT Workshop New York, NY July 9, 2009
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LEARNING OBJECTIVES

• NOW THAT YOUR ORGANIZATION HAS ACCESS TO DATA,
  HOW DO YOU TRANSLATE THAT INTO MEANINGFUL USE ?
• HOW CAN THE USE OF DATA AND REPORTING IMPACT
  PATIENT SAFETY ?
• HOW CAN THE USE OF DATA AND REPORTING IMPROVE
  QUALITY MEASURES PERFORMANCE ?

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MEANINGFUL USE OF HIT DATA

• MORE DATA MORE PROBLEMS

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MEANINGFUL USE OF HIT DATA

• A mountainful of data yet a finite amount of
  resources to handle it.

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MEANINGFUL USE OF HIT DATA

• Beware lest you lose the substance by grasping
  at the shadow . Aesop
• Solution- Target measures and target resources in
  the most efficient ways possible.

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MEANINGFUL USE OF HIT DATA

• Electronic Patient Outreach Team Created

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PATIENT SAFETY

• DRUG RECALLS

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THE IFH RESPONSE TO THE VIOXX RECALL
FDA SENDS AN ALERT BY EMAIL
INTERNAL VIOXX REPORT GENERATED
664 PATIENTS IDENTIFIED VIA REPORTING WITHIN 35
MINUTES OF RECEIVING FDA EMAIL
ALL BUT SIX PATIENTS CONTACTED BY TELEPHONE OR
MAIL WITHIN 10 DAYS
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PATIENT SAFETY

• DRUG INTERACTIONS
• AND CONTRAINDICATIONS
• INTERNAL EHR VENDOR LINKED DRUG- DRUG
  INTERACTION WARNINGS
• CUSTOM REPORTING
• ASTHMA PATIENTS ON BETA BLOCKERS
• PREGNANT PATIENTS ON CLASS D OR X MEDICATIONS
• BEERS CLASSIFIED MEDICATIONS IN THE ELDERLY

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PATIENT SAFETY

• IDENTIFYING AND PREVENTING
• INAPPROPRIATE MEDICATION PRESCRIBING
• CUSTOM REPORTING
• NARCOTIC ANALGESICS
• METFORMIN IN PATIENTS WITH RENAL DISEASE

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PATIENT SAFETY

• IDENTIFYING AND PREVENTING INAPPROPRIATE CODING
• CUSTOM REPORTING
• PROBLEM LIST AUDIT REPORTS IDENTIFIED MISCODING
  OF PATIENTS (HIV, DIABETES).
• THIS LED TO ENHANCEMENTS IN DECISION SUPPORT
  WHICH PREVENTED FURTHER REOCCURENCES.

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PERFORMANCE IMPROVEMENT IN QUALITY MEASURES
MACROSOLUTIONS (i.e. DECISION SUPPORT, GLOBAL
WORKFLOW CHANGES)
ACCESS TO DATA ALLOWS FOR GREATER ABILITY TO
PINPOINT PROBLEMS
MICROSOLUTIONS (i.e. INDIVIDUAL PROVIDER
ATTENTION)
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PERFORMANCE IMPROVEMENT IN QUALITY MEASURES

• CQI INTERVENTIONS ARE APPLIED WITH CONTINUED
  REASSESSMENT
• DECISION SUPPORT ALERTS ACCOMPANIED BY WORKFLOW
  CHANGES.
• IFH AGGRESSIVE IMPLEMENTATION OF BEST PRACTICE
  ALERTS 9 MONTHS AFTER GO-LIVE

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IFH BEST PRACTICE ALERTS

• PRIMARILY BASED ON HEDIS CRITERIA
• PneumoVax
• Seasonal FluVax
• Breast Cancer Screening
• Cervical Cancer Screening
• Lead Screening
• HGBA1C Testing Control

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IFH BEST PRACTICE ALERTS

• Ophthalmology consults for diabetics.
• Peak Flow measurements for all asthmatics
• Nephrology consults for patients with greater
  than 1.8 serum creatinine.
• LDL Screening
• Annual RPR Screening in HIV

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PNEUMOVAX
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COLORECTAL CANCER SCREENING
All sites listed were fully on the EHR as of Jan
2003
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• The greatest danger for most of us is not that
  our aim is too high and we miss it, but that it
  is too low and we reach it.
• Michelangelo