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Quality Improvement using the VA Electronic Health Record

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

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Quality Improvement using the VA Electronic Health Record

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  1. Quality Improvement using the VA Electronic Health Record Matthew Bidwell Goetz, MD Chief, Infectious Diseases VA Greater Los Angeles HCS

  2. 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

  3. 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

  4. Examples of Summary Reports

  5. Secure, web-based national registries for use by all VA primary care providers

  6. Group comparisons

  7. Care Managers can produce customized, team-level reports

  8. Provider access to information on patients not meeting indicators

  9. Quality Measures in the VA

  10. Use of the Computerized Patient Record System (CPRS) for Management of Individual Patients

  11. Selected views of CPRS Clinician Notes Cover Page Laboratory Reports Imaging and Procedure Reports

  12. CRPS: customized patient-specific reports

  13. GLA HIV Viral Loads, Includes patients not on treatment Viral Load

  14. System-Wide Quality Improvement in HIV - TestingFacilitation by the VA Electronic Health Record (EHR) and the Functionality of CPRS

  15. 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

  16. 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

  17. 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

  18. Provider – specific reminder completion rates

  19. Pre- vs Post-Intervention Routine HIV TestingMulti- VISN QI Project – Adjusted Rates Relative Increase in Testing 50% 390% 556% Control Sites Local Central No Implementation Implementation Implementation

  20. VA-Wide Changes in HIV Testing vs Use of HIV Testing Clinical Reminder Sites without Clinical Reminder Sites with Clinical Reminder 2009 2010

  21. 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

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