The Bridge:Naval Hospital Oak Harbor’s Answer to Disparately Accessed Health Information

Points of Contact: Mr. Todd Reese, (360)257-9763, michael.reese@med.navy.mil

Groups Involved with the Project: Naval Hospital Oak Harbor’s Management Information Department, Public Health Services Department and The Bridge Working

Group

Submitted by LTJG Curtis Popp02 May 2014

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Effectively monitoring population health in the Military Health System requires access to data housed in multiple systems, databases, and applications that often do not interface. As a result, pulling data for an individual patient’s full range of preventative and primary health care needs is a complex and labor-intensive process. To enhance the effectiveness and efficiency of preventative health care efforts and to improve the reliability of information available to health care teams, Naval Hospital Oak Harbor created The Bridge. The Bridge is a computer-based application that links these databases and consolidates the health information in one easy to use application. The Bridge has improved the timeliness, reliability, and completeness of information available to all users within the hospital, significantly adding to the planning and decision-making at the core of the health care mission. The application of The Bridge into health promotion efforts has produced marked gains in the process of identifying patients that need screenings and overall HEDIS scores have risen dramatically. The use of the Bridge has shown to be 12 times faster than using the Military Health System Population Health Portal CarePoint program and generally easier to use. The Bridge has two different configurations that can accommodate any size Military Treatment Facility. NHOH staff successfully demonstrated its utility to the Air Force Medical Operations Agency’s Population Health Committee, the Military Health System PeriOp Community Advisory Committee, and Naval Hospital Lemoore’s Board of Directors. These demonstrations illustrate the tremendous potential this initiative has for the entire Military Health System.

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Objective of the Best Practice Naval Hospital Oak Harbor (NHOH) leadership commissioned an initiative to enhance the effectiveness and efficiency of preventative health care efforts and to improve the reliability of information available to their health care teams. NHOH needed a computer-based program that possessed the ability to compile information from the various systems, databases, and applications that those in the Military Health System (MHS) utilize to care for their beneficiaries.

Background Effectively monitoring population health in the MHS requires access to data housed in multiple systems, databases, and applications that often do not interface. As a result, pulling data for an individual patient’s full range of preventative and primary health care needs is complex and labor intensive process. Information systems such as the Military Health System Population Health Portal (MHSPHP) CarePoint are cumbersome to use and data requests in these systems routinely take two minutes, or more, to return the results of a single patient query. NHOH is doubly troubled for internet conductivity speed because of the set up their network. NHOH is downstream, as far as internet access, from both Naval Hospital Bremerton (NHB) and Madigan Army Medical Center (MAMC). Meaning, if either of those two locations bogs down the network for any reason, NHOH feels the downstream effects. The clinicians and data users in the hospital are desperate to remove the waste from their daily health care interactions and time spent waiting on computers is time not spent caring for the population. Literature Review A review of the patient satisfaction comments at NHOH revealed that most of the preventable complaints were in some way related to information technology (IT) deficiencies. Faster and more reliable access to information has the potential to quell those complaints going forward into the future. A review of staff satisfaction comments showed that, again, IT deficiencies dominated a majority of the complaints. Internet conductivity, outages, slow responsiveness, and inaccurate patient information topped the list. The Command, being unable to change much with the external IT situation, welcomed the idea of a program that possessed the ability to ease some of the constraints the staff are facing

Implementation Methods Mr. Todd Reese, a former active duty staff member and current Management Information Department (MID) Government Service (GS) employee, took the lead as chief developer of the program that eventually received the name The Bridge due to its ability to “bridge” multiple databases and information sources into one easy to use application. A working group developed around him with representatives from the family practice clinics, the health promotions department, and other areas that had an interest. The working group members proved vital in the construction and continued development/refinement of The Bridge, allowing it to meet the needs of the end-point users. The MHMPHP CarePoint provides the population health data utilized by The Bridge; and it displays patients on the breast cancer, colon cancer, cervical cancer, asthma, diabetes, cholesterol management, and well-child action lists on an easy to navigate webpage. The Composite Health Care System (CHCS) Cache supplies the patient demographic information that comprises the

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central database in The Bridge. Information from multiple electronic medical records (EMR) systems joins that central database and is stored in The Bridge. The total compliment of EMRs and data sources contained in The Bridge includes CHCS, Essentris, CarePoint, S3, United Healthcare Referral Reports, and Mammography Reporting System (MRS) Live. The Bridge specifically addresses a problem that plagues all Military Treatment Facilities (MTFs), the lack of common patient identifiers in these various EMRs. The Bridge pulls in multiple identifiers (SSN, DoD ID, sponsor SSN, DOB, and family member prefix), cross-references them, and flags potential incorrect patient identifiers. This process has the potential to prevent medical errors based on erroneous patient identifiers and helps avoid duplicate records. The Bridge will continue to develop as requests for data increase and as the number of new EMRs increases. The Bridge application is adaptable and currently utilized in multiple outpatient clinical setting at NHOH. The program can accommodate any MTF that has access to Department of Defense (DoD) standard electronic health record (EHR) systems. Two configurations are available based on the MTFs individual needs. The first, and more robust version, utilizes a Microsoft SQL backend connection to the CHCS Cache, which allows for near real-time data extraction. The second version utilizes a “flush and fill” system that requires CHCS file manager ad-hoc reports be written to provide the data that can then be placed into scheduled data transmissions, whether it be nightly or in smaller intervals (i.e. every six hours, every hour, etc. depending on how accurate/updated the staff needs the data to be). This option constrains the information available to a single snapshot in time and is therefore less desirable than the first option.

Results The hard work, innovative creativity, and intellectual genius of Mr. Todd Reese and his working group yielded The Bridge. The Bridge is a computer-based application that links databases from various areas that otherwise required separate attention. Its use ranges from patient check-in to Healthcare Effectiveness Data and Information Set (HEDIS) metric analysis. It is accessible to end users via a link on the NHOH Intranet Homepage as shown in Figure 1. Upon clicking the link, the end user receives direction the disclaimer and terms of agreement page where the user agrees by clicking the “click to enter button,” see Figure 2. The Main Page of the Bridge, as seen in Figure 3, has links to various areas of concentration including: Family Medicine, Operational Forces, Well Child, Obstetrics, Gynecology, Patient Check-in, Mental Health, Referral Management, Case Management, Uniform Billing Office (UBO), Surgery Center, Medical Staff Evaluation, Nursing Staff Evaluation, Quality Management & Medical Review Board, and a feedback link. The Family Medicine Page, shown in Figure 4, and the other pages available from The Bridge Home Page have imbedded links such as HEDIS metric links, patient education links, pharmacy links, clinical practice guideline links, self-management tools links, network referral data links, billing links, etc. Each of the individual pages attains customization to the needs of those particular end users and modification to meet changing necessities as needed. When viewing a patient’s information in The Bridge, the patient’s demographic information, last known screening date for each of the HEDIS measures, and pending appointments (in the next 14 days) are displayed in a single view. When the user selects a specific patient, a detailed description of the patient’s HEDIS information appears in the display. Furthermore, when the patient checks in for an appointment, the clerks can print a patient appointment sheet, shown in Figure 5, which displays important information for both the provider and patient; including

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name, current medications, open referrals, and upcoming appointments. Because of this application, the health care teams can proactively contact and schedule patients due for preventative health screenings or follow-up. As a disease prevention tool, The Bridge is helping to increase screenings for breast, colon, and cervical cancers. Health care providers are also able to manage chronic conditions such as diabetes, depression, and hyperlipidemia by tracking lab values, medication management, and patient appointments. With preventive health screenings and effective management of chronic conditions, health care teams are helping improve quality of life for all beneficiaries and support force health promotion. The man-hours saved by using The Bridge are extremely significant. As an example, using MHSPHP CarePoint to determine if a patient is due for breast cancer screening alone takes approximately two minutes. Using The Bridge, this same function takes 10 seconds, which is 12 times faster. For the first 20,000 searches completed using The Bridge, it saved significant man-hours as shown in the following example: Using MHSPHP CarePoint, 20,000 searches at two minutes each equates to 667 man-hours; those same 20,000 searches done using The Bridge at 10 seconds each actually only took 56 man-hours, a difference of 611 man-hours. Extrapolating these savings across the various queries, demonstrates the tremendous resource savings The Bridge creates. Most importantly, the health care providers realize the man-hour savings and are now spending less time pulling data and more time delivering excellent health care to their beneficiaries.

Conclusion The Bridge has effectively consolidated disparately accessed information from a variety of sources. This initiative has improved the timeliness, reliability, and completeness of information available to all users within NHOH, significantly improving planning and decision-making at the core of the health care mission. Improving accessibility to patient data allows the medical team to be more efficient and effective in managing the care of the population. Currently, the Bridge, with its two different configurations, can accommodate any size MTF. NHOH staff successfully demonstrated this program’s utility to the Air Force Medical Operations Agency’s (AFMOA) Population Health Committee, the Military health System PeriOp Community Advisory Committee, and Naval Hospital Lemoore’s Board of Directors. These demonstrations and the demonstrated gains to the productivity of the end users of this unique resource illustrate the tremendous potential this initiative has for the entire MHS.

References

Naval Hospital Oak Harbor. (n.d.). Retrieved April 30, 2014, from Naval Hospital Oak Harbor Intranet Site: http://nhohintranet/Pages/Default.aspx

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Appendix

Figure 1. NHOH Intranet Homepage (Naval Hospital Oak Harbor).

Figure 2. The Bridge User Agreement Page (Naval Hospital Oak Harbor).

Figure 3. The Bridge Main Navigation Page (Naval Hospital Oak Harbor).

Figure 4. The Bridge Family Medicine Screen (Naval Hospital Oak Harbor).

Figure 5. The Bridge Patient Appointment Sheet (Naval Hospital Oak Harbor).

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