Queens Medical Professional Association (QMPA)
Core Assessment Review Evaluation Program (CARE Program)
Healthcare professionals have
struggled to effectively utilize Electronic Health Records (EHR) into the
workflow of their private practices for the treatment of chronic diseases. This
ineffective use of EHR software wastes a significant amount of time and
resources possibly leaving patients vulnerable during the gaps between health
services. QMPA aims to help health
professionals integrate EHR software more effectively into their clinical
routines with an eye towards possible alternative payment models.
Inputs
QMPA will be using our present
headquarters in Corona, Queens for meetings and workshops. The program funding
will come from the contributions of our members (in kind donations of at least
$10,000) and grant funding. The funds will be used for other inputs such as to pay
our staff, maintain a third party consultant, and gain access to multiple EHR
software troubleshooting services.
Our Core Assessment Review
Evaluation (CARE) program requires staff skilled or at least knowledgeable
about the various EHR software programs used in private practices. For human
resources we will require a minimum of three program managers, an EHR
specialist, an IT assistant, an executive assistant, and a president. A variety
of skills will be required to reach optimum efficiency. Since the program
managers will be performing most of the interactive work, they are expected to
have excellent communication skills. Their discussions with health care
providers on the field will be vital to quick adjustments to designed models. The
EHR specialist must be familiar with at least ten of the top leading EHR
software, “Familiar” meaning at least three months of experience using the
software. Some well known EHR software are Allscripts, Aetnahealth, Cerner,
eClinicalworks, eMDs, Epic, Healthfusion, Kareo, McKesson, MDland, Meditech,
Praxis, Care 360, SOAPware, and WEBeDoctor. The executive assistant is expected
to have exceptional time management skills, as they will be in charge of
organizing the data gathered by the program managers as well as arranging meetings
and paperwork. The president, Dr. Amigon, will oversee the program and make
priority decisions regarding basic objectives and core assessments. However,
most of the time his intervention in policy will be minimal.
Outputs
The first month consists of each
project manager visiting his or her 10 different medical practices. The three
project managers are laying the foundation for further QMPA interactions and
suggestions. Thus, project managers must become acquainted with all the staff. It
is during this first month that project managers will compile all patient data
regarding nine health-related conditions prior and status post treatment. The
nine health-related conditions are cholesterol, cancer, hypertension, diabetes,
obesity, mental health, gastro-intestinal health, smoking, and drinking. At the
basic level two fraction numbers are produced, patients with said condition and
patients without the condition. More specific details such as level of obesity
through BMI and stage of cancer will be included on further quarterly reports
after the third month. In addition, the project managers will compile a preliminary
report each practice regarding number of staff, average patient load, doctor’s
basic procedure, and practice workflow. The reports are rough drafts containing
just basic information and not much else.
On the second month, there will be
a QMPA meeting with all QMPA members of project CARE to validate collected
patient data (scrubbed free of identifying information to avoid violating the
Health Insurance Portability and Accountability Act). A randomized 10% of each
practice will be pulled from the patient groups with one of the nine
health-related conditions as well as 10% from the patient group without the
conditions. The randomly selected groups will be analyzed for health history
and to determine if the necessary conditions exist or that the patient’s health
falls into the parameters of listed health condition. Patient records that do
not pass the test are placed on a list for later reference to discuss with the
health professionals. All the while the project managers will continue to visit
the medical practices to build up on their preliminary report.
On the third month, the first
report on all 30 primary care practices will be completed. There will be a
group meeting at the QMPA headquarters to discuss the results. The unique
aspects of each practice’s workflow will be analyzed in depth. Environmental
and community factors surrounding each practice will also be discussed. The executive
assistant will produce minutes of meeting.
After the third month of analysis
of the practice, QMPA will start to host weekly workshops regarding EHRs as
well as meetings for improved workflow designs. The weekly workshops will be
held on a weekday or weekend depending on medical professional availability. Each
workshop will feature three EHR software programs and their order sequences for
analyzing core health assessments. Also will include specific troubleshooting
questions and possible efficiency improvements. Finalized workflow charts of
each practice are devised after the project manager believes he or she has sufficient
understanding of the practice’s ins and outs. A second report regarding staff
utilization of workshops and any changes or new details to note about practice
workflow will be published at the end of the month. After the second report, a
report is expected every quarterly regarding workflow changes and challenges.
On the fifth and sixth months, as
the weekly workshops continue, the first round of low tier suggestions will be
brought up for possible implementation. Care will be made to see if the program
has support of medical staff present at the health practices. If possible
attempts should be made to elicit suggestions for improvements from the staff
themselves. Suggestions with support will be implemented and kept in place for
duration of three months.
On the ninth month, analysis of
implementation of the first round of suggestion will to done to see if there is
any room for improvement. Following the analysis of the first round of
suggestions will be a second round of suggestions, this time any tier would be
possible.
By the 12th month, there
will be an annual review of the events of the past year as well as a review of
the first and second round of suggestions. A look into any possible changes to
the nine core assessments will also occur at this time. With improvements or
changes in play, the next major step would be to introduce a top tier health
insurance reimbursement model. This top tier suggestion in addition with
maintaining already existing policy changes will be the focus until the next
quarterly meeting.
Healthcare professionals and
coordinators for those with chronic or terminal diseases are the primary
participants in the patient compilation process. It is from these individuals
that we will be able to eek out the nuances in each patient’s case. Chronic
diseases (such as diabetes and arthritis) and are expected to be bulk of
patient base and improvements to chronic care management will be expected to increase
patient outcomes.
With 30 health care practices of
varying sizes the staff participation percentages will be hard to estimate.
However, we aim for at least one senior staff member (over five years of
experience) from each practice to participate in the weekly meetings. From
those 30 participants every week, we will obtain a survey from each of them
about their level of satisfaction at the health practice’s current workflow.
Outcomes
Increasing the awareness of each
EHRs strengths and weaknesses will help staff members in each practice to
recognize the possible expansions and limits of the software. From this
baseline of recognition, staff will be able to pursue policies that can
mitigate their systems shortcomings or improve their workflow efficiency. Suggestions
of possible improvements will be take from the staff. There is an expectation
that there will be at least 30 suggestions from the medical professionals. This
increase in staff input is combined by an increase motivation in both patients
and staff to achieve higher or more efficient health goals.
Review of these new motivations and
inputs will be evaluated by studying any changes in the patient portal
statistics as well as changes to the nine core health-related conditions. By
increasing use of EHR data, adding in additional methods of communication and
by streamlining the workflow, the goal is to have a decrease of 10% in the time
and or number of office visits for those suffering from chronic ailments. This
decrease in visits is to be combined with an increase in patient portal use and
pre-clinical screenings.
All of these improvements and
changes amount to better health outcomes through focused efforts on specific
health-related conditions as well as increases in health efficiency through
less paperwork searching, pre-visit screenings, mixed media utilization, and expedited
extraneous procedure removal.
Evaluation
Evaluation of the entire operation
will be broken into chunks of audits and meetings. Each quarter will be
evaluated through its action process. Since the earlier months are spent
setting up the suggestions and systems, focus will be on the reports produced
by the project managers. These reports will be cross-examined with patient data
and health professional accounts of their clinical operations through a
one-on-one discussion with the health professionals. Of the first three
quartiles all the reports must be accurate to set a strong foundation for later
suggestions. The information must be at least 90% accurate to verify for a
solid foundation.
Later quarterlies will focus more
on workshop and suggestion implementation. A survey of the workshops will
provide QMPA staff with overall morale of the healthcare professionals from
each practice. It is expected that some of the practices will have health
professionals with little to no motivation to change policies or workflows.
Hope is to have the possible benefits of new EHR procedures dangled in front of
the health professionals to act an incentive to already existing problems.
Suggestions that are implemented should be evaluated on a before versus after basis.
If at least 50% of the suggestions are successfully implemented, then the later
quarterlies can be considered effective.
To evaluate final long-term
outcomes, we will examine the change in the data connected to the nine core
assessments. Changes regarding practice workflow comparison will be made from
past program manager reports to current conditions. If there is a marked
improvement on at least 50% of suggestions, the program will be considered a
success.
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