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Marilyn Moon American Institutes for Research

Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs? AHRQ Annual Conference September 28, 2010. Marilyn Moon American Institutes for Research. Acknowledgement of team members & funders. Project team

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Marilyn Moon American Institutes for Research

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  1. Implementing IT to Capture Functional Status in Rheumatology:Are there Efficiency and Quality Tradeoffs?AHRQ Annual ConferenceSeptember 28, 2010 Marilyn Moon American Institutes for Research

  2. Acknowledgement of team members & funders • Project team • AIR: Kristin Carman (Project Director), Marilyn Moon (Senior Advisor), CallanBlough, Lauren Smeeding • Urban Institute: Kelly Devers • Geisinger Health System: Walter Stewart, Eric Newman, Virginia Lerch • Michael Harrison, Project Officer, AHRQ • Funding: Agency for Healthcare Research and Quality, ACTION Network, #290200600019, Task Order #2 Contract

  3. Project overview • Timeline: August 200 7 – October 2010 • Objectives • Aim 1: Develop, refine, and implement PACER-Rheum • Aim 2: Evaluate whether PACER-Rheum improves efficiency, productivity, quality and safety, adherence, and patient-centeredness • Aim 3: Determine which elements explain the observed effects • Aim 4: Disseminate findings

  4. What is PACER-Rheum? • PACER-Rheum is an HIT tool that... • Begins with a touch screen questionnaire to collect patient reported data • Pulls data from EHR • Presents trend data in tabular dashboard format • Includes an After Visit Summary • Redesign of office workflow • Was designed by outside firm in conjunction with GHS research staff • Web application that exists outside of EHR

  5. Methods: data collection Quantitative data to assess outcomes at the physician, encounter, and patient level From EHR, patient surveys, and workflow collected manually Qualitative data to describe and monitor implementation in real time at the system and practice level assess factors and conditions necessary for successful implementation in different settings detailed guidelines for implementation and decision-making digital diaries, telephone interviews, site visits

  6. Efficiency and Quality Issues • Information Collection • EHR vs. Patient Reported and EHR • Information Assembly • Mental dashboard vs. screen dashboard • Information review • Sorting through papers vs. trends over time • Provider documentation

  7. Findings: Early Implementation • GHS culture encourages and fosters clinical innovation • Many revisions and updates necessary • Clinic staff expected increase in quality of care and efficiency, but impact unclear • Patients had mixed reactions to PACER-Rheum • Physicians noted need to change documentation note in PACER-Rheum

  8. Findings: Post-Implementation • Staff are more comfortable with use of PACER-Rheum, but efficiency burdens are shifting • Conversations with patients are changing • Patients still have mixed reactions to PACER-Rheum • Documentation still needs to be improved • Long learning curve

  9. Findings: Facilitators and Barriers

  10. Findings: Lessons Learned • IT/IS culture and priorities can be a major hindrance to innovation and research • Getting clinicians and office staff on board is major task • Key features of PACER-Rheum are database interaction and combining data into one screen • PACER-Rheum may not be applicable for all patients • Questions about transferability of PACER-Rheum to external organizations

  11. Discussion questions • Has enough time passed to realize all benefits? • Are there tradeoffs between efficiency and quality? • What are the implications from burden shifts ? • On patients ? • On support staff and nurses ? • Away from physicians ? • What are the policy implications for use of EHRs?

  12. Resources Key contacts Kristin L. Carman, PhD Managing Director, Health Policy & Research American Institutes for Research 1000 Thomas Jefferson St., NW Washington, DC 20007 ph. 202.403-5090 email: kcarman@air.org Marilyn Moon, PhD Vice President, Health Program American Institutes for Research 10720 Columbia Pike Silver Spring, MD 20901 ph. 301.592.2101 email: mmoon@air.org http://www.air.org

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