Information for OHIT conference Priscilla Moschella, BS, CSW
Clinic started in 1993 RW Part A Funded for primary medical care, medical case management, and mental health. 150 clients annually with primary diagnosis of HIV/AIDS Staffing: physician (ID specialist), nurse, medical case manager, part time mental health clinician, medical assistant, medical office assistant. Secure Internet access in patient rooms and clinic area for staff to use. Dedicated computer with internet access for patients to complete online surveys or needs assessment. St. Mary’s Hospital in Passaic - Specialty Clinics– Early Intervention Program
Benefits of HIT • Ability to do Project Improvements (PI) more easily and track results. • Using Plan-Do-Study-Act for Tuberculosis Skin Test (TST). Electronic system is used to document when TST’s are placed and read. Systems provides the ability to: • View increased results of administering and reading TST results in a timely manner. • View whether or not the task was completed accurately. • Expansion of HIT includes DRILL down on results. • View of patient list of TST’s that were not read and drill down to see the individual client report. We can then assess data accuracy. Early identification of data mistakes and error, and/or data omission can be more carefully monitored and viewed for case conferencing. • HIT provides a change method of how and when to administer or read test. • Project Improvement activity included cross training of nursing staff from other clinics, including Emergency Room (ER). This allowed for the clinic to see improved outcomes for those clients who have difficulties returning for reading of the TST during office hours. • Similar concepts to document and measure other tests completed, such as Syphilis & STI Screening, Immunizations have been an initiated to improve rate of testing and quality of care.
Other Benefits of HIT • Clinical HIT data at a glance. Last lab test dates, CD4 and Viral Load. This data tool allows the clinic staff to view lab information more quickly. As the system is web-based it allows more flexibility in where it can be obtained and multiple users can view info simultaneously if needed. • The doctor or nurse can view the data in the room with the client, while simultaneously, the medical case manager can be reviewing the same record with another HIV Care provider in order to coordinate care and increase patient outcome. • Clinical HIT data reminders of upcoming test, data, or missing data. This tool provides the clinical staff with important discussions points that support and promote treatment adherence. • During case coordination meeting with a support service HIV Care Provider Individual reports had been prepared in advance and brought to the session. We were able to gain access to the secure web-based HIT program, enter in the unique client identifier and pull up medical records instantaneously. This resulted in enhanced timely coordination of services and improve quality of care with the use of HIT.
Other Benefits of HIT • Patient Access to Data. • HIT systems allows the clinic to review medical information and results with patients. Specifically, patients can view their CD4’s and Viral Loads in list form (most recent on top) and view user friendly graphs and to then pinpoint success and problems with their medical status. • Reporting: • Clinical Cross collaborative reports incorporated into the HIT has allowed the clinic to gauge clinical outcomes quickly and compare the data to other regional and state norms. Quality data checks also allow for drill down of aggregate data to client level data to ensure integrity of data. • Prompt discussion of case between disciplines internally and externally, leading to quality delivery of care. • Ease of completing federal reports through HIT system, reducing considerable amount of time of staff in paperwork. Process of completing reports is quicker and more efficient – more accurate.
Other Benefits of HIT • Patient satisfaction surveys (confidential) have been online to ensure real time data review. • Patients can complete surveys anywhere since it is web-based. The HIT provides data outputs to compare findings across agencies. This allows the HIV Care Provider to view how they are doing compared to others in the IT Network of Care. • Provider outcomes and surveys using HIT have allowed the clinic to promptly document and evaluate their patients needs resulting in policy and programming changes: • Several years ago the EIP clinic changed hours of operations based on their patient surveys findings. Some of the patients had been relying heavily on van/program transportation that did not run in the evening hours. • Provider outcomes revealed that patients needed support in self-sufficiency of telephone skills, so we made a point to review this information with some patients. • Client Needs Assessment findings have help to shape educational programs that are provided by the clinic.
Other Benefits of HIT • Real Time Data. • The ability to enter data in real time allows other agencies to view information that is up-to-date, instead of out-dated. This helps our agency with coordination of care. • Grant Writing • Survey completed by clients and providers further assist our clinic with grant writing, assists the planning council with priority setting and assists other council or quality teams to shape the way care is delivered and ultimately improve quality of care. There are so many benefits to having an HIT system …. From the client to the provider to the council to the government …
Critical Thinking Questions for Preparation 1. In broad terms, what are the outcomes that define success for you? (In order to achieve it, it helps to define it) Quality care, adherence to treatment, ability to connect client with other disciplines or coordinate care with other agencies. 2. What are some ideas for how stakeholders should go about a process of defining success for their own purposes? One step at a time …. It’s a lengthy process, but ultimately one with limitless opportunities to improve quality of care. 3. What are common barriers and limiting realities to success with HIT implementation and adoption? TIME .. Time for data entry and quality. Continuous training to reinforce systems benefits. 4. What bodies of knowledge and disciplines have you found applicable to successful HIT planning and adoption? From data entry to computer programmers, from clients to staff to grantee to quality management teams. In our area, it is nice to know that our input is valuable in improving the way the information is collected, organized and viewed. 5. What are the costs and problems of getting HIT wrong? (i.e., motivation to get it done right) Quality of care can decrease with getting HIT wrong. Our strive to see healthier clients, longer surviving clients helps us to succeed and be the best in improving quality of care in our agency. It is a great motivator to getting it right, especially when we see the successes in our treatments and care that we give our clients.