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

April 30, 2007

Immunization reminders update

Filed under: Immunizations — admin @ 3:35 pm

On Friday, the group affectionately called “Teammunizations” by Rob Piston, MD, got together to look at the state of immunization reminders in EpicCare, and the news is very good.

John Dunn, MD, Jean Soderquist, RN, and Rob are our clinical experts in this area, and they’ve looked at cases of patients under their care and compared the Epic functioning for identifying patients with correct immunizations.

In a general sense, Epic works well. In a specific sense, it is working too well, and correctly identifying children that are clinically “unimmunized,” for example, children that have MMR or Hep A or Varicella before 12 months of age. By CDC guidelines, these children might need to be considered for re-immunization, so it would be correct for an electonic system to not count this immunization. In reality, however, a child may present a few days before their first birthday, and we wouldn’t reimmunize in these cases.

In other examples, a child may have an immunization that is spaced too closely to count clinically. Epic will call this out.

In all of these situations, the child is actually unimmunized because their immune systems are not properly prepared for the antigen.

What we’re doing is joining the clinical recommendation with clinical practice and Epic functionality to make this work as best as possible. So, some of the changes that will happen in the next week include:

  1. Creating a grace period before and after recommended intervals, and reducing minimum spacing in Epic in some cases
  2. Having reminders fire on the day they are due, rather than 2 weeks before, to recognize that we want to immunize children as part of well visit care
  3. Simplifying criteria for complex algorithms, like PCV and Hib, whose requirements change as children age and their immune systems mature.

What you’ll see in the next week or so is Epic running overnight with these changes and reminders in the snapshot view becoming more in line with what Group Health wants. We’ll be surveilling this over the next week and then get together and see where we are at.

The alerts that go with these are designed to facilitate ordering by flowstaff – that is the only purpose they serve.

I think that with these improvements, we will be where we want to be to support accurate immunization reminders in EpicCare. All of us left our discussion (Jean, Ted, John, and Epic team project manager Russ Telling, manager Emily Hull) feeling very confident with this direction.

Comments and questions welcome. Let us know what you’re seeing on snapshots…..

Perceptions of EHR’s by Physicians

Filed under: Informatics Team — admin @ 7:26 am

Simon SR, Kaushal R, Cleary PD, et al. Physicians and Electronic Health Records: A Statewide Survey. Arch Intern Med 2007;167(5):507-12.

This paper was recently published by our colleagues at the Harvard Departments of Ambulatory Care and Prevention and Harvard Pilgrim Health Care, on the impact of electronic health records in physicians’ lives. A significant amount of the care provided in the HPHC system is done using EpicCare. At the same time, this study is interesting because it’s a cross sectional survey of all of the physicians in Massachussetts, who both use electronic health records of all kinds, and paper. Our team visited the Harvard Vanguard Medical Associates Group recently and found that they are similar in maturity to us in terms of EpicCare use.

This study sought to find out what functions are used in electronic health records after adoption, and how physicians felt about computers in medicine after adoption. They compared EHR adopters (high use and low use of various functions) to EHR nonadopters. They did not find any demographic differences between high use and low use EHR adopters. There were differences between EHR adopters and non-adopters, though. Adopters had fewer years since medical school completion (20.6 vs. 24.3 years), had been in current practice for less years (8.4 vs 12.0), and were more likely to be from multispecialty groups.

The significant findings were that physicians who had adopted an EHR reported more positive views of the potential effect of computers on health care.

More interesting, though, was the finding around perceptions of practice in these groups:

There was no difference between nonadopters, high users, and low users in reported levels of isolation from colleagues, professional or personal stress, and having to work long hours. However, physicians who had not adopted an EHR were more likely to report feeling demoralized about the state of medical practice in general compared with physicians who had already adopted one.

If you look at the numbers across all of the groups, they are concerning in terms of their magnitude. Our experience and the experience of this survey doesn’t tell us that an EHR is the solution or the cause of these issues, but we have a duty to manage the use of our EHR as a profession just as we manage the delivery of care.

I welcome your thoughts and feedback.

Group Health Featured on iTunes / LeanBlog Podcast

James Hereford, our Executive Vice President of Strategic Services and Quality, Lee Fried, our Manager of Strategic Consulting, and myself are published today on iTunes, via the LeanBlog podcast. We talk about the transformation of our organization and the roles of our clinical delivery system and health plan administration. It was a lot of fun to do.

You can access it here, with directions to download to your iPod or download to your computer

Podcast interview with Mark Graban, Lean Manufacturing Blog: Group Health Cooperative

April 27, 2007

Schedule Display Changes to Support Appointments in MyGroupHealth

Filed under: MyGroupHealth — admin @ 11:18 am

Recently a number of patients raised concerns about not seeing all of their scheduled appointments in MyGroupHealth. The Epic team has responded to this concern and will be rolling out a change so that patients can see all their appointments even the ones that are designated as overbooked. In the past the overbooked appointment were not seen and this was confusion for our members.

The root cause of this is the MyChart functionality that does not recognize overbooked appointments Only appointments with a status of ‘scheduled’ were displayed. CIS implemented custom code in order to create the status of “Overbooked” to display on the provider schedules and that was not recognized in MyGroupHealth

To allow patients to see all of their appointments in MyGroupHealth, this CIS team has removed this “overbooked” function in Epic. In this way, patients will have a complete record of all their appointments. LastWord will still designate certain appointments as overbooked. But, they will appear on the provider’s schedule as “Scheduled”.

The Lastword appointment process remains unchanged, staff will follow current protocols for overbooking a patient on the provider’s schedule.

The only impact will be on the Epic display of the schedule. In that the patient will show as “Scheduled” instead of “Overbooked”. Once the Practice Management suite is rolled out later this year, providers will be able to quickly look in Cadence (the new scheduling application) to see which appointments were overbooked. This modification is scheduled to occur on May 3rd.

April 26, 2007

A simple, usable care plan, Kaiser Permanente, Colorado

Filed under: Quality / Affordability — admin @ 1:46 pm
Care Plan Screen Shots 08Mar2007

Screen shots, simple, usable care plan in EpicCare

The attached screen shots demonstrate a simple care plan, using existing functions within EpicCare. What do you think?

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