Eric Herman, MDMedical Director, Population HealthFamily Physician, Kent ClinicMultiCare

Using the EMR to DriveImproved Patient Outcomes

Overview

•The EHR as a clinical tool

•EHR Clinical Improvement Checklist

•Example at MHS

•Conclusion & Questions

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The EHR as a Clinical Tool: X-ray Analogy

• Albeit extraordinarily powerful, it is a merely a software application

– Like an X-ray is directed radiation, EHRs is a directed database of information.

– Only as good as someone else programs it: “Garbage in -> Garbage Out”.

– Computers are NOT medical decision makers – People are!!

• Before you dive, learn the intended use, capacities, and limitations

– Radiologic competencies required time and training to understand the tool and

processes.

– EHR is also a tool, with risks and benefits. (See EHR Clinical Innovators Checklist)

• Insist on an excellent instructor / liaison

– Right IT liaison for a non-techy doc = Right doctor for a complex patient.

– Research your Organization: Is there a Clinical Informatics MD on your team?

– Don’t be afraid to push the envelope; Our patients deserve it.

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The EHR as a Clinical Tool: Framing the Right Questions

• Are You in Alignment with Your Organization’s Goals & Vision

– What are goals: More high level, 10,000 ft. view.

– What are your objectives: Measurable processes and/or outcomes.

– Triple AIM is a valuable litmus test. (Quality; Patient Experience; Cost)

– Critical for resources, overcoming barriers, delays, unmet expectations.

• Who will be the target audience

– What is the value of your effort and outcomes to them?

– Are you speaking their language and their culture?

– Will your approaches be easily adopted by all stakeholders?

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The EHR as a Clinical Tool:Form Follows Function – EHR Follows Operations

• Even if you had the most valuable data at your fingertips, do you know how to be successful with it!

– Like ordering a study, what will you do with the results afterwards.what will you do with the results afterwards.

– Your success depends on a healthy partnership with operations

• Collaboratively plan your steps with your operational team.team.

– Set the clinical stage to capture the right data.

– Support workflows necessary for targeted interventions.

– Perform invaluable work on behalf of clinicians.

– Analyze outcomes and variances.

– Training everyone to do the above correctly

– They will identify critical success factors unknown to you. 5 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

Readiness Assessment ChecklistComprehensive Considerations Critical To Success

See Referenced Handout

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CHF Example: Multicare Health Systems

• Goal = Improve Triple Aim for CHF Pts– Improve quality of care, patient experience of care,

and cost of care for patients at a pilot PCP office. (n=196; ~ 6.0 Provider FTEs [FP/IM]).

• Outcomes:

– Appropriate ACE/ARB & Beta Blocker Management.

– Decrease CHF Readmissions.

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CHF Example: Multicare Health Systems

• Stakeholders

– Clinicians (Primary Care & Specialists; IP/OP/ED)

– Clinical collaboratives; Hospice and palliative care

– Executive sponsors and administrators

– Clinical operations

– Clinical care coordinators and home health

– Patient’s and their families

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CHF Example: Multicare Health Systems

• Processes

– Establish the clinical best practices

– Determine the outcomes of interest

– Determine the interventions, resources, and workflows

to facilitate best practices

• Work extensively to research all IT/Operations processes

– Pilot the interventions (Plan, Do, Check, Adjust)

– Diffuse what was of value (Dashboards & Pop Health)

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CHF Example: CHF Dashboards – The New Workhorse

• Most relevant content immediately available.

• LEAN design with further detail dives.

• Valuable for clinicians, patients, and staff

• Focused on the content NOT than the EHRFocused on the content NOT than the EHR

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CHF Example: Outcomes

• Beta Blocker Chemoprophylaxis (LVEF < 40%)– 26 of 26 patients = 100%

• ACE/ARB Chemoprophylaxis (LVEF < 40%)– 25 of 27 patients = 93%

• Readmissions

– Internal = 0% in a recent rolling 12-month time frame– External = ? Pending further investigation

• Diffusion

– Dashboards now available in production– Best Practice Workflows being considered for system-wide

processes

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CHF Example: Challenges

• Data clean up (Problem List; CHF Stage / Class).

• IT Enhancement Requests (Discrete Stage / Class / EF).

• Pharmaceutical data dependent on third party.

• Availability of External Data.

• Keeping all stakeholders informed.

• Education of technical and operational innovations.

• Challenges isolating the effectiveness of a specific intervention.

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Next Steps For Dashboards

• Published dashboards for DM, HTN, Depression

• Prioritize new dashboards (CKD, Chronic Pain…)

• Consideration of a SuperDashboard (Life Care Plan)

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Conclusion

• Love the EHR, but…

– Understand what it can and can’t do

– Be careful what you ask for

– Be nice, oh so nice, to your operations team

– Be true to the triple aim and clinical best practices

– Think outside the EHR box to Think outside the EHR box to innovative systems of care innovative systems of care

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THANK YOU