Improved Documentation of Preventative Screening with the Implementation of an Electronic Health Record

Superior Health Information Management
Now and for the Future

Christopher C. Lamer, PharmD, BCPS, CDE
Medical Informaticist

(image: RPMS EHR logo)

• Provides a comprehensive health services delivery system for:
  • 1.8 Million American Indian/Alaska Natives
  • 550 Federally Recognized Tribes
  • 36 States
• Opportunity for maximal tribal involvement in developing and managing programs to meet their health care needs.

(image: photos of Native Americans)

• IHS Headquarters - Rockville Maryland
  • Aberdeen
  • Alaska
  • Albuquerque
  • Bemidji
  • Billings
  • California
  • Nashville
  • Navajo
  • Oklahoma
  • Phoenix
  • Portland
  • Tucson
• Medical Centers
• Hospitals
• Ambulatory Clinics

• Indian Health
• Tribal
• Urban Center

(image: IHS Organization Chart)

• Strategic Plan Goals for 2010
• Annual Performance
• Government Performance Results Act (GPRA)

(image: image titled "Performance Audits = Accountability")

• Build healthy communities
• Achieve parity in access by 2010
• Provide compassionate quality health care
• Embrace innovation

(image: Healthy People 2010 logo)

• Annual Performance Plan
  • Performance goals or indicators for the fiscal year
  • Description of resources needed to meet the goals
  • How data to be reported is verified and validated
• Annual Performance Report
  • What was actually accomplished in comparison to goals in Plan
  • If goals were not met, why not
  • Plan for achieving unmet goals or reasons why goal is impractical or infeasible

The Government Performance and Results Act

• Federal law
• Requires a data-supported audit trail

" (image: images titled "Appropriated Dollars" > "Activities Consistent with Agency Goals" > "Customer benefits or outcomes/Return on Investment")

Headquarters
Agency performance on GPRA is intimately tied to the budget submissions

Area Directors
SES Bonuses tied to GPRA outcomes

Service Unit Director/ CEOs
Performance assessments are based on GPRA measures

Providers
GPRA measures included in performance evaluations

(image: photos for Headquarters, Area Directors and Service Unit Director/CEOs, and Providers)

2006 GPRA Measures

• 21 focus on treatment
• 12 focus on Prevention

Resource & Patient Management System (RPMS)

• Evolving since the 1970s
• Over 50 software applications
• Used at all IHS health care facilities and 95% of Tribal

(image: photo of laptop keyboard)

Integrated solution for the management of clinical, business practice and administrative information.

(image: diagram of various components of RPMS and relation to PCC Patient Database)

(image: diagram of RPMS and the process of manual chart reviews, data entry and billing of paper records)

(image: diagram showing relationship between laboratory, RPMS' HER, pharmacy and PCC Patient Database, and immunizations, RPMS' ICare and PCC Patient Database")

• Assess the impact on documentation of preventive screening when transitioning from a paper-based system to an electronic format.
• Clinical Reporting System (CRS)
  • Produces on demand from local RPMS databases a printed or electronic report for any or all of over 300+ clinical performance measures, representing 50 clinical topics designed for national reporting as well as local and Area monitoring of clinical performance measures.

• Documentation of information in the RPMS database is highly standardized.
  • One way to do it in the EHR…many (wrong) ways on paper
• Electronic system provides clinical reminders

(image: screenshot of window titled "Available Reminders")

(image: photo of fox leap-frogging over sheep)

(image: bar graph titled "Blood Pressure")

(image: bar graph titled "BMI Measured" showing BMI calculated results for 2005 exceeding 2005 goal)

(image: bar graph titled "Intimate Partner Violence" showing IPV screening results exceeding 2005 and 2010 goals)

(image: bar graph titled "Tobacco" showing Tobacco Assessment level for 2005 exceeding goal and an increase in Tobacco Cessation over 2004 results)

(image: bar graph titled "Fetal Alcohol Screening" showing 2005 FAS screening results exceeding 2005 and 2010 goals)

(image: bar graph titled "Pneumovax 65+" showing 2005 Pneumovax results exceeding goal and fast approaching 2010 goal)

(image: bar graph titled "Depression Screening" showing an increase in 2005 results over 2004 as well as fast approaching 2010 goal)

• Uses of health information technology, including an Electronic Health Record that offers:
  • Clinical reminders
  • Standardization of documentation
  • Evaluation of the services provided
• Can increase provision and documentation of preventive screening