Clinical Information Systems

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Clinical Information Systems in Planned Care and
Improvement Transforming Care in the Indian
Health System CCI Readiness Call Series
8 November 19, 2008
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Session Aim and Objectives

• Aim
• To promote an understanding of the Key
  aspects of Clinical Information Systems (e.g.,
  RPMS), used daily by Providers and Care teams,
  that support the provision of high quality care
  and continuous improvement.
• Objectives
• Participants attending this session will
  be able to,
• - Describe CIS use in the improvement
  of
• individual patient care and
  population-based care
• - Give at least one example of how CIS
  can be used
• as a tool to drive quality
  improvement activities in
• their facility

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Agenda for Today

• General principles of using CIS for patient care
  quality improvement
• Whole patient proactive care planning
• Planning for population based care
• Improvement methods for care teams, PCPs, QI
• CIS as an integral component of each patients
  visit and each staff members role
• Examples from teams that illustrate how each of
  the key CIS capacities are used on a daily basis

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Patients coming in for visits
Patients in Microsystem
Successful Progression in Improving Care For
Populations
The Total Population
Microsystem small, interdependent groups of
people who work together regularly to provide
care for specific groups of patients
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Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Relationships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
10
Care Model CIS Change Ideas
Health System
Community
Health Care Organization
Resources and Policies

• Reminders used to inform Community Health
  Representatives to assist with needed treatment
  and screening
• iCare panels for CHRs
• Future Community Resource Guide in iCare

ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Relationships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
11
Care Model CIS Change Ideas
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
Self-Management Support
DeliverySystem Design
Decision Support

• Patient Wellness Handout
• Animations to share with patients to demonstrate
  how to collect FOBT

Relationships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Patient Wellness Handout
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Care Model CIS Change Ideas

• Increased use of FOBT
• Colorectal Screen -FOBT Patient List created in
  CIS (iCare and EHR)
• Mailing cards to people at home when due
• Patient mail cards to lab after collected
• Information used in previsit planning from iCare
• Nurse Assistants educate patients on use of FOBT
  cards

Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
Self-Management Support
DeliverySystem Design
Decision Support
Relationships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Pre-visit Planning The Huddle
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Care Model CIS Change Ideas
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support

• Use of Health Maintenance Reminders
• Use of EHR Reminders

Decision Support
Relationships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Care Model CIS Change Ideas
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems

• Use of iCare to track results of FOBT
• iCare registry to track returns
• Ensure accuracy of coding
• Enter refusals into CIS

DeliverySystem Design
Self-Management Support
Decision Support
Relatinships
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Tracking of Colorectal Screening in
iCareFollow-up on FOBT cards given to Patients
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Managing the Population

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Effective Data Display for ImprovementAnnotated
Time Series
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Real-world experiences from Indian Health
Service facilities using CIS (RPMS) in
planned care and improvement from
Warm Springs Forest County Potawatomi
Chinle IHS Service Unit