It’s Not About The Box Improving Care at Group Health with People, Process and Technology

February 28, 2007

Consumers See Electronic Health Records as Important Factor when Choosing a Physician and Are Willing to Pay for the Service

Filed under: e-health news — admin @ 6:16 am

This survey research was recently published. It tracks some of the findings we are seeing/hearing about, namely that patients are more willing to switch physicians than has been commonly believed, in the interest of better service.

Accenture Newsroom: Consumers See Electronic Health Records as Important Factor when Choosing a Physician and Are Willing to Pay for the Service, Accenture Research Finds

With regard to the willing to pay issue, a recent study done at my alma mater, University of Arizona, arrived at $10/year in terms of what patients were willing to pay, with the conclusion that $11,775 for a physician practice/year in a panel of 2500 makes this a viable option for physician practices.

I think on a large scale this could be true. However, I have a bit of a hard time understanding how a solo practice would be able to maintain an online personal health record system for $11,775 a year in the absence of other reimbursement for services provided in this medium, given a fee for service financing model.

February 27, 2007

Case review: Best Practice Alerts

Filed under: Quality / Affordability — admin @ 4:47 pm

Greetings from the Factoria Medical Center QIST!

I was asked by two of our medical centers’ staff to review a few patient cases and the triggering of alerts. I thought it would be useful to post those reviews here, to generate discussion.

We have potentially found a problem with the triggering of eye care alerts. We need to do some diagnostics on that, and those are under way. We should have more information soon. In the meantime, I welcome any comments or insights on the cases presented below.

There are 5 cases total.

Case 1 : Had Diabetic HM alerts fire due to Metformin being on Med list, but med not for diabetes.  No dx of Diabetes indicated on the problem list.

This is a patient with polycystic ovary syndrome being treated with Metformin.

Patient had the GHC.04 (CIS Care Coordination: Diabetes) on their problem list. Is has not been deleted. Now that it is deleted, these reminders will not fire. If the practitioner does not want this to come back at all, they should “Resolve” the problem with a date, instead of deleting it. Otherwise, it will come back next month when we relook at the data.

We are double checking to make sure that if a problem is “resolved” that it does not come back onto the problem list.

The GHC.04 made it onto the problem list because the algorithm currently does not filter out Metformin for PCO. The same issue existed with the old registry system. It is a well characterized issue. Resolution time is unknown, given other work under way to manage our overall data warehouse.

Case 2: Diabetic eye care alert appeared even though the patient has recent visit to optometry with diabetic retina code.

We checked the base dates in the system and it appears there are older base dates loaded after newer base dates. Epic looks at the most recent one added to the list, so in this patient’s case, it looked to February, 2006, instead of October, 2006 as the last eye exam.This was due to the interaction of an automated algorithm that adds dates from other GH system.
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February 22, 2007

Center for Health Studies QIST

Filed under: Center for Health Studies — admin @ 6:06 am

The team is at Center for Health Studies this week. I realize that I hadn’t posted the information about this QIST. It’s below.

The goal is to bring the Center for Health Studies into the care community of Group Health, in a privacy protected way. This is a bit more complex than it seems, since there are different governing bodies when it comes to protecting member information.

The outcome we would like to see if appropriate notification of significant clinical events to treating physician teams, and notification of studies that require a different care approach in the treating physician setting. Most studies do not require this; this is just for studies like immunization studies, where routine vaccination might be contraindicated. Having information in EpicCare about this prevents confusion.

Many people may not realize that Center for Health Studies actually has a functional clinic. As part of this week, exam room workstations have been installed. This opens the door to many opportunities for Group Health collaboration with the Center for the future.
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February 21, 2007

EpicCare Update to Consutative Specialty Services

Filed under: Informatics Team — admin @ 4:10 pm

Yesterday I had the opportunity to update Service Line Chiefs on EpicCare. The presentation I gave is attached:

Presentation: EpicCare update to Consultative Specialty Services

February 20, 2007

Protecting member information in the exam room; point of care device time-outs

Filed under: Safety — admin @ 7:09 am

As John Kaschko described well previously (click here to read) we have been looking at changing the security settings for computers in exam rooms and other patient care areas, otherwise known as Point of Care (POC) devices.

Before the end of this month, POC devices will go from a current 4 hour logout of EpicCare to 30 minutes. This is longer than the 15 minutes recommended by the Security and Confidentiality Committee. The 30 minutes and is based on the need to balance the need to do this quickly and not negatively impact staff workflow, which could pose safety risks itself. A timeout closer to the one recommended by Security and Confidentiality may be pursued, but with a more thorough analysis or workflow and other factors. In the meantime, our CIO and myself are obligated to support a system that does not contribute to privacy problems – a 4 hour timeout for these devices is not defensible moving forward.

This is still part of the ongoing project described by John to look at protection of member information holistically, so timeouts and other aspects of the system will change, in some cases to allow longer sessions, some cases not. John will present that information to the staff before it is implemented. This change will go into effect now, however.

The reality is that computer lockouts are a backup mechanism and not the primary way our members expect that Group Health will protect their member information. The primary mechanism are the habits we use in practice. Even a few seconds of exposure to your daily schedule in an exam room can have an unintended consequence – an automated timeout will not prevent that. The other reality is that in some situations, our members/patients may be more concerned about their privacy than they indicate or that we’re aware of in the midst of an encounter. It’s difficult to know which situations these are, so a standard approach for each patient prevents misunderstandings. Here’s mine:

  • I always turn the screen away from the patient when logging in (or returning to the room) and say the following, “I’m logging in and making sure this is you.” I look at the LastWord label and match name to Epic name.
  • Whenever I leave the room, even for a second, I secure the Epic screen and say the following, “I’m locking the system so no one else can see your stuff.”
  • When I conclude a visit, I turn the screen away from the patient, exit the workspace, secure it, and say the same thing above, “I’m locking the system so no one else can see your stuff.” In my practice, it’s preferred that the screen be secured on the schedule and not on the last patient seen, for safety.  (There’s a trick that Joy Osaki, my MA, showed me, where if you hit ‘exit workspace’ and then ‘secure screen’ quickly, the Epic Schedule will never show because the system won’t have time to display it.)
  • After the screen is secured, I turn it back toward the patient so they can see that it is locked.

Now that this is habit for me, it doesn’t take any extra time. It’s been really important for me to have a defined script and say the words described above. I want the patient to leave remembering that I was including this in the care process.
As we do QISTs and other activities where our team shadows providers, we’ll be working with practitioners around this issue to answer questions and learn other best practices out there. We know that you’re expert at protecting member privacy. It is one of the most important aspect of care that we provide. In the era of the computerized electronic medical record, the work is to apply the awareness we already have to the tool.

Comments are open for questions, feedback, or your best practices.

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