NC AHEC`s Practice Support.pptx

Partnering with Rural Hospitals and
Primary Care Practices to Adopt
HIT & Improve Patient Care
May 17, 2011
Ann Lefebvre
Associate Director, NC AHEC
[email protected]
Jeff Spade
Vice President, NCHA
[email protected]
Lynn Harron
PM HER Sys. Admin, Transylvania Physician Services
[email protected]
CSC Proprietary and Confidential
North Carolina Hospital Association
Partnering with Rural Hospitals and
Primary Care Practices to Adopt
HIT & Improve Patient Care
May 17, 2011
Ann Lefebvre
Jeff Spade
Associate Director, NC AHEC
Vice President, NCHA
Lynn Harron
PM HER Sys. Admin, Transylvania Physician Services
CSC Proprietary and Confidential
North Carolina Hospital Association
NC AHEC’S PRACTICE SUPPORT
Ann Lefebvre MSW, CPHQ
Associate Director
NC AHEC Program
NORTH CAROLINA AHEC’S PRACTICE SUPPORT
PROGRAM
Mission:
To provide primary care practices with the
systems and support to provide
high quality care to improve patient health.
2
2007-2009 SERVICES PROVIDED BY AHEC’S
PRACTICE SUPPORT CONSULTANTS
Improved
Clinical
Outcomes
QI
Consultants
Learn how
to:
Produce
population –
based
reporting to
test the
efficacy of
your care
Use proven
methods
and
techniques
to improve
the
outcomes of
your
patients
3
Model for Improvement
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Act
Plan
Systems within Ambulatory Care
Front End
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4
EXAMPLES OF PRACTICE RESULTS
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100
100
80
80
5
60
60
40
40
0%
New flow sheet
Baseline
Reviewed documentation guidelines/flowsheet
-1
-1
Jul-09 - 1
May-09 - 1
-1
-1
Mar-09 - 1
Nov-08
Sep-08
Jul-08
May-08
Mar-08
Jan-08
Aug-09 - 1
Jul-09 - 1
Jun-09 - 1
May-09 - 1
Flu vaccine clinics
60%
20%
Apr-09 - 1
Reminders to patients
80%
40%
Mar-09 - 1
Feb-09 - 1
Jan-09 - 1
Dec-08
Oct-08
Nov-08
Sep-08
Aug-08
Jul-08
Jun-08
May-08
Apr-08
Mar-08
Feb-08
100%
0
Percent of Asthma Patients with Flu Vaccine
%
Jan-08
0
Jan-09 - 1
20
20
Table 2. Quality of Care Measures for Diabetes in Wave 1 at baseline (time
1), 9 months (time 2) and 2 years (time 3) !
Diabetes Practices (n=11)!
Time 1 Mean%!
Time 2 Mean%!
Time 3 Mean%!
a1c >9 !
a1c <=7 !
15!
48!
10!
54!
9!
49!
on aspirin!
51!
55!
67!
BP <=130/80!
43!
41!
52!
BP <=140/90!
65!
61!
68!
Dilated eye exam!
37!
38!
26!
Flu vaccine!
32!
46!
46!
Foot exam!
36!
66!
64!
LDL<=100!
33!
41!
44!
LDL<= 130!
51!
60!
60!
Nephropathy screen!
43!
65!
59!
Smoking cessation counseling!
31!
78!
79!
>=1 LDL!
66!
74!
76!
P = 0.001!
P = 0.001!
(T1 vs T2)!
(T1 vs T3)!
Newton, et al (2010). JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS, 30(2):106–113
BASELINE (BLUE) TO 12 MONTHS (RED)
PRACTICES WORKING ON DIABETES
CHALLENGES OF QI IN PRIMARY CARE
!  2009:
Nine QI consultants and 183 practices
!  Practices
are overworked and don’t have time to do
redundant systems to collect data to evaluate care.
!  EHRs
are good for documentation and improving some
efficiencies, but were not built to produce data on
clinical care.
!  QI
Consultants were spending an enormous amount of
time trying to help practice get data out of EHR
systems.
!  Obtaining
the data becomes the focus of the QI
process instead of improving office systems.
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NC AHEC AND HITECH ACT
!  2010
HIT
! 
became the Regional Extension Center for
Assist practices with selection, implementation,
and optimization of EHRs so to achieve
Meaningful use
!  GOAL:
3465 priority primary care providers
!  Current:
2894 providers in 794 priority practices
PRIORITY PRIMARY CARE=
SMALL, RURAL AND/OR UNDERSERVED
Practice
Practice
support
Support
Coordinator
Coordinator
QI
Consultant
QI
s
Consultants
Technical
Assistance
Specialist
11
TRAINING
!  All
NC AHEC Consulting staff are required to complete
additional training:
28 hours on EHR implementation and
meaningful use
! 10 hours on QI techniques and primary care
focused initiatives
! 8 hours of effective consulting skills
! 5 Additional hours on finances, HIE,
FQHCs, etc
! Tandem visits with experienced consultants
to start
! 
12
Primary Care Practice Support Program
Clinical Quality
Improvement
On-site
Practice
Support
Practice Redesign,
Patient Centered
Medical Home,
EHR Implementation
SERVICES PROVIDED BY AHEC’S
PRACTICE-BASED CONSULTANTS
Paper
Charts
Electronic
Health
Records
Learn how
to:
Learn how
to:
Learn how
to:
• Assess the
needs of
your
practice in
an EHR
system.
• Select a
certified
EHR that
meets your
needs
• Redesign
your paper
practice to
ready for an
EHR.
Meaningful
use of HIT
• Implement
an EHR for
optimal use
in your
practice
• Use your
EHR to
meet the
federal
requirement
s for the
HITECH
Act
Meaningful
Use
Incentive
Payments
from
Medicare or
Medicaid
Improved
Clinical
Outcomes
Learn how
to:
Produce
population –
based
reporting to
test the
efficacy of
your care
Use proven
methods
and
techniques
to improve
the
outcomes of
your
patients
Patient
Centered
Medical
Home
Learn how
to:
•  Meet the
requirements
of the NCQA
Recognition
program for
PCMH
• Approach
the PCMH
application
process with
improvement
techniques
14
HOW CAN HOSPITALS HELP?
!  Lynn
Harron
PM/EHR Systems Administrator
Transylvania Regional Hospital
NC AHEC STATEWIDE MAP
Mountain AHEC
Nina Vinson
[email protected]
Eastern AHEC
Northwest AHEC
Donna Stevenson
[email protected]
[email protected]
Charlotte AHEC
Chris Jones
Greensboro AHEC
Jill Smith
[email protected]
Wake AHEC
Gary Stambaugh
[email protected]
Area L AHEC
Mary Webster
[email protected]
Southern Regional AHEC
Jennifer Borton
[email protected]
SouthEast AHEC
Monique Mackey
Melissa Odom
[email protected] [email protected]
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Thank You!
Contact: Ann Lefebvre
[email protected]
919-966-0815
Jeff Spade
[email protected]
919-677-4223
NC AHEC
IT Assessment and Roadmap Development
Hospital
©/2010 North
ComputerCarolina
Sciences Corporation
Association
4/16/10
BE09_0521
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