Utilizing Epic to Meet Health Care Standards

Larissa L. Davids, RNClinical Nurse Manager

Community Group Family Medicine and Residency

Indianapolis, INNCQA PCMH Level 3

Purpose

Significance Establishing a process to efficiently

elevate the level of patient care will improve patient outcomes and prevent gaps in care.

Background January 2013 98% of our patients with a diagnosis of

diabetes had not had a diabetic filament test charted

April 2013 our patients with +STD tests were inconsistently reported to the Health Department

April 2013 Asthma Control Tests (ACT) were not completed regularly by Asthma patients at office visits

April 2013 COPD and Asthma patients did not have an SPO2 performed regularly

July 2013 32.6% of our pediatric patients 0-13 had overdue state mandated immunizations

Description/Methods

View of Report in EpicFMC patients that have not had a

diabetic foot exam done in the last year.

Working the Report MA/LPN runs the report three days a week (M, W, F)

Report is run prior to the patients’ appointments MA/LPN makes a comment on the appointment note that the patient

needs a foot exam, SPO2, ACT or immunizations based on the report.

When an MA/LPN rooms a patient, the information is available on the schedule, preventing timely research in the chart during the visit and the MA/LPN is prepared to room the patient.

Patients’ charts are audited weekly to ensure continuance of care and sustain the process.

Results

STD labs ordered in office are identified, followed-up by MA/LPN, provider notified of result if not already reviewed, and Health Department is notified of 100% of positive results with a treatment plan.

Asthma patients are identified, SPO2 and ACT are performed at every visit despite the chief complaint. Assessments are reviewed by a provider to determine Asthma control and prevent ED and hospital admissions.

COPD patients are pinpointed, SPO2 is performed at every office visit to provide optimal care.

Pediatric patients, with overdue immunizations are detected and provided vaccines at every office visit, in addition to Well Child Exams.

In Addition:

Qualitative Feedback MAs’feedback

More efficient utilization of time “Do not have to research patient’s chart to provide care.”

Providers’ feedback Foot exams are consistently performed before provider

sees the patient Not doing minimal tasks; filling out paperwork for Health

Department Detecting and treating Asthma patients outside of the green

zone before an exacerbation occurs

Patients’ feedback “Never had a foot exam done before.” Voiced appreciation clinical staff was providing the foot exams Parents voiced appreciation for less trips to the office for

immunization catch-up.

Conclusions/Implications for Practice

FMC elevated its level of patient care by utilizing Epic to identify patients with unmet health care needs.

Patients’ standards of care are met while maximizing efficiency during clinic hours.

Clinical staff is empowered to take pro-active measures to prevent gaps in patient care.

Ownership of Epic reports has promoted clinical staff to perform at the top of their licensure.

Improvement of CGCAHPS scores exemplifies patient satisfaction.

Process improvement propelled FMC to obtain NCQA PCMH Level 3 Recognition.

References Aring, MD, Ann M., Jones, MD, DPM, David E., Falko, MD, James M. (June 1, 2005).

Evaluation and Prevention of Diabetic Neuropathy. Retrieved from www.aafp.org/afp/2005/0601/p2123.html

Centers for Disease Control and Prevention. (March 20, 2013). 2013 Recommended Immunizations for Children (Birth to 6 years). Retrieved from http://www.cdc.gov/vaccines/parents/downloads/parent-ver-sch-0-6yrs.pdfhttp

Centers for Disease Control and Prevention. (January 16, 2013). 2013 Recommended Immunizations for Children from 7 through 18 Years. Retrieved from http://www.cdc.gov/vaccines/who/teens/downloads/parent-version-schedule-7-18yrs.pdf

Lang, MD, David M. (September 2008). New asthma guidelines emphasize control, regular monitoring. Cleveland Clinic Journal of Medicine. Retrieved from www.ccjm.org/content/75/9/651.full

National Institutes of Health. (November 2000). Feet Can Last a Lifetime. Retrieved from http://nedep.nih.gov/media/feet_hcguide.pdf