Connected Primary Care Preventive care and chronic disease management at Mayo Clinic Rajeev Chaudhry...
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Transcript of Connected Primary Care Preventive care and chronic disease management at Mayo Clinic Rajeev Chaudhry...
Connected Primary Care
Preventive care and chronic disease management at Mayo Clinic
Rajeev Chaudhry MBBS MPHConsultant Primary Care Internal Medicine
Leader, Health Information Management Systems
Leader, Mayo Clinic Connection Platform, Center for Innovation
Employee and Community Health( Mayo Clinic’s Primary Care )
• 105 Physicians
• 154 Nurses ( 12 new case managers)
• 182 Allied Health employees
• 6 Practice locations
• 2 Divisions, 1 Department ( Internal Medicine, Family Medicine and Pediatrics)
Mayo’s Primary care’s Connected Care needs
• Systems must be designed to enable longitudinal care compared to “usual” episodic care :
• Know who our patients are• Know what our patients need in a proactive manner• Alert patients and provide them “coordinated”
access• We must “care for” the patient at all times, not just
when they request our care for a symptom related illness
• When we see them we need to provide all the care they need
Who we need to provide “connected” care for…
• All preventive services for 140,000 patients ( cancer screenings, immunizations, metabolic screenings and wellness counseling)
• Chronic disease management • 20,000 Hypertension patients• 10,000 Depression patients • 8,000 Diabetes patients• 7,000 Asthma patients• 7,000 Coronary Artery Disease patients• 3,000 Congestive Heart Failure patients• And many other chronic conditions
• Acute Illness management for all 140,000 patients
So what we needed…
• Information systems to know needs of all of our patients needs for care
• Utilizing our allied health staff to offload responsibilities from MD’s both at population level and for patients being physically seen ( GDMS-Vitalhealth Software) for preventive care and care for chronic conditions so that our MD’s can spend their valuable time caring for patients and not spending their time searching for the information
Health Information Management Systems at Mayo
• Point of care –Generic Disease Management System ( GDMS, 2007)
• Population Management and Quality Reporting (Microsoft Amalga, 2009)
• Cost and utilization Reporting
( Currently physician portal)
GDMS Application StructureMayo ClinicEMR Data
Mayo ClinicEMR Data
Web Services
Web Services
Labs, VitalsPreventive services
Problem listImmunizations
Allergies
Labs, VitalsPreventive services
Problem listImmunizations
Allergies
Vital HealthGDMS
Vital HealthGDMS
DemographicsDemographics
ColonoscopyFlex Sig
ColonoscopyFlex Sig
Tobacco useTobacco use
Web interfaceWeb interface
GDMSapplication
GDMSapplication
GDMSdatabase
MICSCl. Notes
CRD
GI
PPICP1309217-13
GDMS ECH User Satisfaction SurveyApril 2008, All staff n=122
Time saved per patient for preventive services, diabetes and CAD care
• 3.9 minutes per patient for MD's
• 2.7 minutes per patient for LPN's
• 2.17 minutes per patient for CA's/ appointment coordinators
Time saved per patient for preventive services, diabetes and CAD care
• 3.9 minutes per patient for MD's
• 2.7 minutes per patient for LPN's
• 2.17 minutes per patient for CA's/ appointment coordinators
CP1309217-8
GDMS ECH Zoster Vaccine Volumes
CP1309217-4
0
100
200
300
400
500
600
Jan
Feb Mar Apr
May Ju
nJu
lAug
Sept
Oct
NovDec Ja
nFeb
PCIMPCIM
FMFM
2008200820072007
376%increase
ECHECH
Percent of People that Received AAA Screening after their Appointment and had not Received the Screening in the past 5 years in 2007and 2008
0.00% 0.00%
20.00%
21.84%
15.75%
4.05%3.80% 3.22%
25.29%
18.24%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Mayo Family ClinicNorthwest
Mayo Family ClinicNortheast
Family Medicine-Baldwin
Primary Care InternalMedicine
Total
Mayo Locations
Per
cen
tag
es 2007
2008
Response Frequency %Strongly agree 24 62.3Somewhat agree 12 31.6Neither agree nor disagree 2 5.3Somewhat disagree 0 0.0Strongly disagree 0 0.0
Response Frequency %Strongly agree 24 62.3Somewhat agree 12 31.6Neither agree nor disagree 2 5.3Somewhat disagree 0 0.0Strongly disagree 0 0.0
Response Frequency %Strongly agree 24 64.9Somewhat agree 11 29.7Neither agree nor disagree 2 5.4Somewhat disagree 0 0.0Strongly disagree 0 0.0
Response Frequency %Strongly agree 24 64.9Somewhat agree 11 29.7Neither agree nor disagree 2 5.4Somewhat disagree 0 0.0Strongly disagree 0 0.0
Response Frequency %Strongly agree 26 70.3Somewhat agree 11 29.7Neither agree nor disagree 0 0.0Somewhat disagree 0 0.0Strongly disagree 0 0.0
Response Frequency %Strongly agree 26 70.3Somewhat agree 11 29.7Neither agree nor disagree 0 0.0Somewhat disagree 0 0.0Strongly disagree 0 0.0
ECH Satisfaction Survey for GDMS – April 2008Physicians n=38
CP1309895-1
4. The GDMS recommended action for patient age and sex-specific average risk preventive services help me with identifying the services that need to be scheduled
4. The GDMS recommended action for patient age and sex-specific average risk preventive services help me with identifying the services that need to be scheduled
0 20 40 60 80 100
5. The GDMS recommended action for patient tests needed for diabetes mellitus (DM) help me with identifying the tests that need to be scheduled
5. The GDMS recommended action for patient tests needed for diabetes mellitus (DM) help me with identifying the tests that need to be scheduled
0 20 40 60 80 100
6. GDMS supports my work flow and improves efficiency in providing average risk preventive services and testing for diabetes patients
6. GDMS supports my work flow and improves efficiency in providing average risk preventive services and testing for diabetes patients
0 20 40 60 80 100
Data BaseMSS/GPAS
MICS Lastword
Dept.Systems
ClinicalNotes
EOP SIRS
DSS
PPI
Patient AppointmentsProvider Panels
ImmunizationsAllergies
Problem List
Vitals
Preventive Services
Tobacco UseExternal Services
Medications MastectomyHysterectomy
Views/Queries/Reports
Rules/Applications
Patient VisitsCost
EMR Interfaces Overview for HIMS at Mayo
RegLabs
Amalga UIS Applications at Mayo
Parsing of data for application
Data from Clinical Systems
Systems for end users
Systems are designed to lead to Standardized care
Registry view to get “real time” information of all the Diabetic patients
List of all the Diabetic patients to be contacted in “next 30 days” with “real time” data
List of all the patients that “care manager” needs to contact in next 7 days for “optimal care”
Patient “detail view” enabling navigating from all the patients to one patient in “real time”
“Plan of care” module to record patient’s preferences and “goal setting”
Result to MD
Consumer
Past processes of care
Report received
Preventive Services
Call patient
MD to RN
Appointment Office takes message
Mammogram done
Message to RN
OK to RN
Call PatientRetrieve
Message
Mammogram ordered
Call MD Office for Mammogram
MD reviews message
RN to Appt. Office
Not Home
Call back appt. office
Clinic
Consumer
Population Management (Prevention and Diseases) New Process
MayoPopulation
Management
Pull data of all 140,000 patients
Clinic
ECH130,000 patients
Identify who is due (Evidence based)
Schedule services due( visit or non visit based) Communication to
patients
Services performed
Call PAC
Will population management help Primary Care
•Population-based systems to improved breast cancer screening by 33% in a randomized controlled trial for 12,000 patients.
•Only 0.5 FTE appointment secretary needed to manage the needs of all patients
Chaudhry R, Scheitel S, McMurtry E, et al. Web-Based Proactive System to Improve Breast Cancer Screening: A Randomized Controlled Trial. Arch Intern Med 2007; 167:606-
611.
Will population management help Primary Care-Contd.
• Diabetic patients managed with a single contact based on information systems had significant improvement in low-density lipoprotein control (35.4% vs 13.3%; P=.004). The intervention group also had a greater percentage of patients who also showed better control of hemoglobin A1c
• Chaudhry R, Tulledge-Scheitel SM, Thomas MR, Hunt VL, Liesinger JT, Rahman AS, Naessens JM, Davis LA, Stroebel RJ, Clinical Informatics to Improve Quality of Care: A Population-Based System for Patients With Diabetes Mellitus, Primary Care Informatics, 2009 ; 17: 95-102
33
Population informatics-based system to improve osteoporosis screening in women in a primary care
practice.
• 25% of the 689 patients responded to the letter and completed osteoporosis screening. Patients who had osteoporosis screening received appropriate treatment.
J Am Med Inform Assoc. 2010 Mar-Apr;17(2):212-6.
Kesman RL, Rahman AS, Lin EY, Barnitt EA, Chaudhry R.
Thanks !
Needs of Patients Come First— Dr. Mayo
Questions?