Implementing IT to Capture Functional States in Rheumatology: Are there Efficiency and Quality Tradeoffs? (Text Version)
On September 28, 2010, Marilyn Moon made this presentation at the 2010 Annual Conference. Select to access the PowerPoint® presentation (206 KB).
Implementing IT to Capture Functional Status in Rheumatology: Are there Efficiency and Quality Tradeoffs?
AHRQ Annual Conference
September 28, 2010
American Institutes for Research
Acknowledgement of team members & funders
- Project team:
- AIR: Kristin Carman (Project Director), Marilyn Moon (Senior Advisor), Callan Blough, 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
- Timeline: August 2007—October 2010
- 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.
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.
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.
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
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.
- 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.
Findings: Facilitators and Barriers
|Supportive culture / environment||Conservative IT environment|
|Resources to support innovation and technology||Physical layout|
|Physician champion||Patient resistance to technology|
|Alignment of incentives|
|Familiarity with EPIC|
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.
- 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?
Kristin L. Carman, PhD
Managing Director, Health Policy & Research
American Institutes for Research
1000 Thomas Jefferson St., NW
Washington, DC 20007