Blog by Richard Howe, PhD
Last month, I discussed the return on investment (ROI) of using physician data analytics for population health. This month I want to cover some of the basic things you can do to enhance your electronic health record (EHR) for population health. The idea is to setup and use your EHR for improving patient care in a way that allows the system to collect the data for population health just as a by-product of the normal patient care process.
Basic Rules of the Road
A recent article in Healthcare IT News (01/15/15) discussed some ideas for better EHR usability. I call these “basic rules of the road.” By improving EHR usability, you will enhance the ability of your system to support population health analytics. Some basic rules of the road for improving your EHR include:
• Physician leaders in your practice should define the professional standards for clinical documentation. These “agreed to” standards must be established before installing an EHR and are basically independent of the EHR vendor system. These documentation standards will have an impact on how the EHR is setup, including screen workflows, required fields, order sets, documentation templates, presentation of summary and/or historical information, etc.
• Setup your clinical documentation process to support patient care and enhance communication. It is important for all staff in your practice to follow the same documentation process, so that a continuity of care can exist across your entire care team and communication is enhanced at the same time. A key success factor is to require a sufficient amount of recurring training to make sure all functions and features are being used correctly by your entire office staff.
• The clinical record should also include the “patient’s story.” This may be a short section of “free text” that comes directly from the patient. Even though structured text is preferred (to be discussed next month), this may be one place in the electronic record where free text adds value. This is especially true if your EHR allows the patient remote electronic access to their record so the patient can add their own “story.”
• Implement the use of “templates” to improve the efficiency of documentation for clinical procedures and results. This falls into what I call the “80-20 Rule,” where 80 percent of the time the standard templates work just fine. In general, templates greatly speed up the documentation process and improve accuracy of the data.
• EHR should present past patient history in a quick and easy way. Past history should show only the most relevant information and not be overloaded with so much detail the process is slowed and/or key relevant information may be overlooked. Even though you may have a large amount of data on a patient, make sure the first historical view is straight forward, simplified and relevant.
Next month I will present some additional ideas (Part 2) on how to improve your EHR for both patient care and population health.
Blog by Richard Howe, PhD
The DFW Hospital Council Foundation’s own Patti Taylor was highlighted in a news broadcast on local TV station CW 33 last night. The segment details the dangers of C-diff (Clostridium difficile bacteria), highlighted in a study released by The Centers for Disease Control on Thursday. Taylor, the director of quality and patient safety services, coordinated the recent Foundation public awareness campaign “Stop C-diff Now!” The website combined with videos won multiple national awards.
You can view the video here or click the graphic below.
In the Winter 2014 edition of the Journal of Health Disparities Research and Practice, the DFW Hospital Council (DFWHC) Foundation published “Environmental Disparities Present a Challenge for Diabetes Prevention and Management Efforts in Dallas County.” The paper rendered Dallas County transparent and exposed specific zip codes displaying unusually high prevalence of diabetes.
Authors included Sushma Sharma, Theresa Mendoza, Crystee Cooper, Kristin Jenkins, Pamela Doughty and Carol Young of the DFWHC Foundation and Larry Tubb of Cook Children’s Health Care System.
As noted in the paper, Texas is home to nearly two million men, women and children with diabetes, with more than 500,000 residing in the Dallas-Fort Worth area. Recognizing the need to implement diabetes prevention efforts while providing education to crisis areas in Dallas, the DFW Hospital Council Foundation utilized the Geographic Information System (GIS) to analyze regional zip codes.
Utilizing the DFWHC Foundation’s extensive database, the report revealed zip codes with the highest prevalence of diabetes and the disparities influencing the high numbers. Results showed zip codes with high numbers of diabetics had limited access to fresh food and supermarkets. Food banks, parks, sidewalks, hospitals and medical clinics were also limited, providing promising clues for reducing diabetes in Dallas County.
“With identification of the disparities in the high diabetes zip codes in Dallas County, public health efforts and resources can be more efficiently targeted for prevention and management,” said Dr. Sushma Sharma of the DFWHC Foundation and lead author of the study.
You can read the study here.
We hope you have the opportunity to attend the Fourth Annual UT Southwestern (UTSW) Office of Global Health Conference, January 30-31 at the T. Boone Pickens Biomedical Building Auditorium on the UTSW campus. The busy symposium brings together faculty, students, administrators and healthcare professionals.
The goal of the event is to discuss the evolution of global health education and research and the role for academic medical centers in global health.
A great line-up of speakers will include Dr. Jide Idris, the commissioner of health for Lagos State, Nigeria. Dr. Idris will discuss “Public Health Strengthening: The Story of Ebola.” Dr. Michael Cappello, director of the Yale World Fellows program, will discuss “The Yale Partnership Approach to Building Global Health Capacity.” Dr. Cappello is the founder of the Yale Program in International Child Health, which develops international initiatives in pediatric research, clinical care and education.
I am personally looking forward to this symposium as it covers the many healthcare challenges of public health in underserved countries. Global health experts will share fascinating experiences on tuberculosis and malaria issues to trauma care and the necessary surgical training for developing countries.
Registration for this conference is free. Times on Jan. 30 are 9:00 a.m. to 4:15 p.m. and on Jan. 31 from 8:45 a.m. to 4:30 p.m. For event information, please click here.
For more information, please contact Lillian Niwagaba, PhD, director of education programs for UTSW Office of Global Health, at Lillian.Niwagaba@UTSouthwestern.edu.
Last month, I discussed some ideas of how physician analytics can impact your future in 2015. This month I would like to discuss the return on investment of using physician data analytics for population health.
What is the payoff time period?
A recent poll by KPMG (In Healthcare Informatics, 01/15/15) revealed the following response to the question of how long it would take to recoup your investment in healthcare analytics:
• 20% = Pay off in 1-2 years
• 36% = Pay off in 3-4 years
• 29% = Pay off in 5 or more years
• 14% = No payoff.
Survey respondents indicated the biggest benefit from population health management is “to reduce avoidable medical costs and variability in care.” For a physician in private practice, the increase in physician efficiency and improvement of overall practice operations can also have a very positive impact on improving the “bottom line” (see my November blog for a case study example).
What is the benefit?
When asked what the biggest clinical benefit derived from using data analytics and population health management was, the survey indicated:
• 36% = Increasing preventive care
• 23% = Developing evidence-based protocols
• 21% = Managing chronic diseases.
Where is your organization?
When asked where your organization’s population health management capabilities were, the respondents indicated:
• 24% = Mature
• 38% = Elementary
• 23% = Infancy
• 15% = Non-existent.
As I have mentioned in my earlier blogs, the key point is not analytics itself, but whether or not your practice is on the “data analytics journey.” This may seem like a daunting task, but my recommendation is to start small, think simple and begin the process. The overall long-term benefit will be great and will position your practice not only for survival in the future, but move it into a “thriving” organization – one that you can be proud of and truly enjoy doing what you do every day – treating patients! The time is NOW to get on board!