quality improvement using the va electronic health record
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Quality Improvement using the VA Electronic Health Record. Matthew Bidwell Goetz, MD Chief, Infectious Diseases VA Greater Los Angeles HCS. VHA and quality of care. VA is now recognized nationally for quality - PowerPoint PPT PresentationTRANSCRIPT
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VETERANS HEALTH ADMINISTRATION
Quality Improvement using the VA Electronic Health RecordMatthew Bidwell Goetz, MDChief, Infectious DiseasesVA Greater Los Angeles HCS
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VETERANS HEALTH ADMINISTRATION
VHA and quality of care
• VA is now recognized nationally for quality
• Transformation into a quality institution occurred in conjunction with other changes
– Reorganization to a primary care-focused system
– Quality measurement and accountability
– Independent data gathering programs
– Public availability of performance data
– Institution of an integrated, comprehensive EHR
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VETERANS HEALTH ADMINISTRATION
How did the EHR help improve quality?
• 100% access to records
• Availability of remote data (other VAs) and DoD data
• Ability to identify patients by disease or other characteristics (coding, use of data elements)
• Ability to use data to create reports, provide feedback
• Decision support tools at point of care including reminders to providers
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VETERANS HEALTH ADMINISTRATION
Examples of Summary Reports
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VETERANS HEALTH ADMINISTRATION
Secure, web-based national registries for use by all VA primary care providers
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VETERANS HEALTH ADMINISTRATION
Group comparisons
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VETERANS HEALTH ADMINISTRATION
Care Managers can produce customized, team-level reports
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VETERANS HEALTH ADMINISTRATION
Provider access to information on patients not meeting indicators
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VETERANS HEALTH ADMINISTRATION
Quality Measures in the VA
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VETERANS HEALTH ADMINISTRATION
Use of the Computerized Patient Record System (CPRS) for Management of Individual Patients
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VETERANS HEALTH ADMINISTRATION
Selected views of CPRSCover Page
Imaging and Procedure Reports Laboratory Reports
Clinician Notes
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VETERANS HEALTH ADMINISTRATION
CRPS: customized patient-specific reports
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VETERANS HEALTH ADMINISTRATION
GLA HIV Viral Loads, Includes patients not on treatment
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515
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515
0tan16
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516
0tan16
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0tan17
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0tan17
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0tan18
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0tan18
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0tan19
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519
0tan19
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0tan20
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0tan20
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0tan21
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0tan21
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0tan22
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0tan22
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0tan23
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0tan23
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0tan24
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0tan24
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0tan25
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0tan25
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0tan26
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0tan26
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0tan27
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0tan27
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0tan28
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0tan29
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0tan30
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0%10%20%30%40%50%60%70%80%90%
100%
<50 50 - 400 400 - < 1,000 1,000 - <100,000 >100,000
Viral Load
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VETERANS HEALTH ADMINISTRATION
System-Wide Quality Improvement in HIV - Testing
Facilitation by the VA Electronic Health Record (EHR) and the Functionality of CPRS
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VETERANS HEALTH ADMINISTRATION
How did the VA EHR and CPRS help HIV testing initiatives?
• Able to identify patients not previously tested and avoid repeatedly offering tests the previously tested
• Able to use data to create reports, provide feedback
• Decision support tools at point of care
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VETERANS HEALTH ADMINISTRATION
Using CPRS – based decision support (Clinical Reminders)
• Used for a wide variety of purposes in the VA– Screening for depression, traumatic brain injury– Screening for Tobacco & alcohol use– Hypertension identification and management– Diabetes monitoring– Vaccination rates– Etc.
• Contributes to attainment of performance standards
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VETERANS HEALTH ADMINISTRATION
Examples of Clinical Reminders
• Sample reminders for an HIV-infected patient• OI prophylaxis
• Hepatitis screening
• Primary care indicators
• Reminders can be determined by the status of the patient
• Reminders can be customized at each facility
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VETERANS HEALTH ADMINISTRATION
Provider – specific reminder completion rates
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VETERANS HEALTH ADMINISTRATION
Relative Increase in Testing50% 390% 556%
Pre- vs Post-Intervention Routine HIV TestingMulti- VISN QI Project – Adjusted Rates
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0tan6a56606
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0tan6a566060%
5%
10%
15%
20%
25%
30%
Pre-Intervention Post-Intervention
HHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHHH
HIV
Testi
ng R
ate
Control Sites Local CentralNo Implementation Implementation Implementation
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VETERANS HEALTH ADMINISTRATION0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
HIV
Tes
ts (t
hous
ands
)
VA-Wide Changes in HIV Testing vs Use of HIV Testing Clinical Reminder
Sites without Clinical Reminder Sites with Clinical Reminder
2009 2010
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VETERANS HEALTH ADMINISTRATION
Acknowledgements
• VA HSR&D: QUERI core funds, SDP 06-001, SDP 08-002
• VA Clinical Public Health: moral, financial and logistical support
• QUERI-HIV/HEP colleagues: Steve Asch, Allen Gifford, Jane Burgess, Tuyen Hoang, Hersch Knapp, Henry Anaya and many, many others
• Slides on the development of clinical dashboards – Caroline Goldzweig