What CIS Can do for the Practice Team

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The Role of Clinical Information Systems in
Improving Care to those with Chronic Conditions
Jerry Langley IHI Dr. Anne Camp Fair Haven
Health Center Health Disparities
Collaboratives May, 2005
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The Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
You are here
Prepared, Proactive Practice Team
Informed, Empowered Patient
Productive Interactions
Improved Outcomes
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What is the Difference Between a CIS and Other
Health Care Information Systems
The main purpose of most health care related
information systems is to support billing and
documentation. The main purpose of a CIS is to
support the improvement of health care. What are
the implications of this?
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Clinical Information System

• Include clinically useful and timely information
  on all patients.
• Provide reminders and feedback for providers and
  patients.
• Identify relevant patient subgroups and provide
  proactive care.
• Facilitate individual patient care planning.

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If a productive patient-clinician interaction is
at the heart of a good visit, then information
is the life blood flowing throughout that
interaction
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Currently Information Available During the
Interaction Tends to Be

• focused on the paper record
• disorganized
• disease/procedure-centered versus
  patient-centered
• responsive to the past interaction versus
  forward looking

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• Our Goal for This Session
• Answer The Questions
• How Do You Get Started (Populating the CIS)?
• How Do You Use the CIS for Population-Based
  Planned Care?

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Getting Started
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Making the CIS Work in The Practice Setting The
Clinical Information System Manager

• Identify best person on team to manage the
  Clinical Information System.
• Choose person with computer skills and interest.
• Define roles and responsibilities for manager.
• Secure training for manager as needed.
• Highlight Clinical Information Systems
  importance to rest of team.
• Train a Clinical Information System manager
  back-up.

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Making the CIS Work in The Practice
Setting Populating the Clinical Information System

• Use billing data and ICD9 codes to identify
  specific populations or build prospectively.
• Download names and contact information into
  Clinical Information System.
• Establish process for regular population
  updates.

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Making the CIS Work in The Practice
Setting Gathering Clinical Data

• Define the relevant clinical data needs.
• Use the visit for collecting non-automated data.
• Develop and test data capture process.
• Develop and test data entry process.

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Population-Based Planned Care
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Population-Based Planned Care

• Goal Maximize the health outcomes of a defined
  population (all patients for one clinic, a
  provider panel, patients at risk)
• Efforts are made to assure that all relevant
  members of a population receive needed services
• Use registries, planning, and outreach

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Individual Care Planning

• Having the right information readily available at
  the time of the encounter
• Having the right tools to create and track
  treatment plans both clinical and self-management
• Ensuring the all routine care is delivered at the
  appropriate time

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Reminders

• Prompts to deliver evidence-based care. They can
  be delivered
• At the time of visit
• Through population reports
• Via exception reports

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Clinical Summaries at Visit

• The summary is a tool that ensures all the
  appropriate information is readily available at
  the time of the encounter.
• It saves time!
• It can be used to provide reminders!
• It facilitates a productive interaction!

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Performance Feedback

• The Clinical Information System is a clinical
  tool, but it can also provide data on how the
  practice team is doing with respect to the
  populations care. It can be used to
• Create population-specific reports
• Facilitate external reporting requirements

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Specific Ideas to Make Population-Based Planned
Care Work for You and Your Patients
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Making the CIS Work in The Practice Setting Using
Data at Point of Care

• Establish process for producing patient summary
  data for use at time of visit. (acute or
  planned)
• Make sure summary is replacing other data
  capture processes to avoid double entry.
• Ensure summary is on chart or in the exam room.
• Does the summary work for various patient types?
• Ensure new data is captured on the summary.
• Develop process for new summary data to be
  entered into Clinical Information System.

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Making the CIS Work in The Practice Setting Using
Data for Care Reminders

• Establish what you want reminding about.
• Determine how you want to be reminded. (i.e,
  exception reports or individual patient prompts)
• Identify team member responsible for monitoring
  reminders.
• Create process for responding to reminders.
  (i.e., who calls patient, when and for what
  purpose)
• Create process for updating/modifying
  reminders.

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Making the CIS Work in The Practice Setting Using
Data to Monitor Performance

• Determine what types of population reports
  are needed and reporting intervals.
• Establish process for creating customized
  reports.
• Who will generate reports?
• Who receives reports?
• Do the reports facilitate continued improvement?

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Keys to Success

• Committed team with responsibilities for data
  collection and review clearly defined
• Care management as a team approach
• Dedicated time each week for primary team
• Ongoing enthusiastic repetition and reinforcement
  to other clinical teams
• Make steady small changes regularly

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Common Issues to CIS Implementation

• Lack of onsite available computer expertise
• Inability to use other databases to generate CIS
  or download into CIS
• Integrating the use of the Clinical Information
  System
• Lack of consistency between providers
• Time data entry, monthly review
• Lack of perceived value added

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Understanding the Barriers in order to Implement

• Fear Why are we doing this?
• Fact Planned population-based care cannot be
  done without knowing your patient population and
  its key clinical data
• Fact Primary care teams that implement
  registries are more likely to improve processes
  of care for all chronic conditions
• Fact Teams with registries are less likely to
  lose patients to follow-up, and more likely to
  improve patient satisfaction as care improves

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Understanding the Barriers in order to Implement

• Fear Its just more work during our already
  hectic day!
• Fact Using a patient summary form from a
  Clinical Information System will actually reduce
  charting time and make the visit run more
  smoothly
• Fact The form gives a snapshot of past care,
  reminders of needed care and planning for future
  care all at the time of the visit
• Fact Teams with registries feel better prepared
  for visits since they have the patient
  information when and where they need it.

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Understanding the Barriers in order to Implement

• Fear This will cost me a fortune and theres no
  return on investment!
• Fact Implementing a Clinical Information System
  is simple, and there are economies of scale as
  you add more patients.
• Fact Registries facilitate populations-based
  care which improves outcomes and patient
  satisfaction
• Fact Planned care via the Clinical Information
  System generates visits that are typically of
  higher intensity while reducing unexpected visits
  for acute exacerbations

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Understanding the Barriers in order to Implement

• Fear So now I need Clinical Information System
  for every disease! Ill have 500 registries!!
  Where will it end?
• Fact Implementing a Clinical Information System
  using a single condition is an easier way to
  start.
• Fact As you move forward your Clinical
  Information System will be patient-based not
  disease-based.
• Fact Moving from paper to computer is very
  simple and more efficient.
• Fact There are 1000s of practice teams just like
  you using registries in Canada, UK, USA and other
  countries

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Understanding the Barriers in order to Implement

• Fear I dont need anyone telling me how to
  practice! Im doing just fine with my patients!
• Fact Surveys show that providers consistently
  under-estimate the numbers of patients with
  chronic disease in their practice
• Fact Surveys show that provider consistently
  over estimate their performance measures on
  process and clinical outcomes for chronically ill
  patients.
• Fact The two are interdependent.
• Fact Knowing you population of patients will
  help rectify this disparity.

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The Power of Data

• The act of collecting data can cause change to
  occur
• Data can help you recognize when useful
  information is being generated and when it is not
• Look at the information contained in the patterns
  of variation in data
• Health Center Example - CareSouth

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A Reality Check withDr. Anne CampQuestions and
Collaboration