Information for OHIT Information for OHIT conferenceconference

Priscilla Moschella, BS, CSWPriscilla Moschella, BS, CSW

St. Mary’s Hospital in Passaic - St. Mary’s Hospital in Passaic - Specialty Clinics– Early Specialty Clinics– Early Intervention ProgramIntervention Program

Clinic started in Clinic started in 19931993 RW Part A Funded for primary medical care, RW Part A Funded for primary medical care,

medical case management, and mental health. medical case management, and mental health. 150 clients annually with primary diagnosis of 150 clients annually with primary diagnosis of

HIV/AIDSHIV/AIDS Staffing: Staffing:

– physician (ID specialist), nurse, medical case physician (ID specialist), nurse, medical case manager, part time mental health clinician, medical manager, part time mental health clinician, medical assistant, medical office assistant.assistant, medical office assistant.

Secure Internet access in patient rooms and Secure Internet access in patient rooms and clinic area for staff to use. clinic area for staff to use. – Dedicated computer with internet access for patients Dedicated computer with internet access for patients

to complete online surveys or needs assessment.to complete online surveys or needs assessment.

Benefits of HITBenefits of HIT Ability to do Project Improvements (PI) more easily and track results.Ability to do Project Improvements (PI) more easily and track results.

Using Plan-Do-Study-Act for Tuberculosis Skin Test (TST). Electronic Using Plan-Do-Study-Act for Tuberculosis Skin Test (TST). Electronic system is used to document when TST’s are placed and read. Systems system is used to document when TST’s are placed and read. Systems provides the ability to:provides the ability to:– View increased results View increased results of administering and reading TST results in a timely of administering and reading TST results in a timely

manner. manner. – View whether or not the View whether or not the task was completed task was completed accurately. accurately.

Expansion of HIT includes DRILL down on results. Expansion of HIT includes DRILL down on results. – View of patient list of TST’s that were View of patient list of TST’s that were not read not read and and drill down drill down to see the to see the

individual client report. We can then assess data accuracy. Early identification individual client report. We can then assess data accuracy. Early identification of data mistakes and error, and/or data omission can be more carefully of data mistakes and error, and/or data omission can be more carefully monitored and viewed for case conferencing.monitored and viewed for case conferencing.

– HIT provides a change method of how and when to administer or read test. 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 Project Improvement activity included cross training of nursing staff from other

clinics, including Emergency Room (ER). This allowed for the clinic to see clinics, including Emergency Room (ER). This allowed for the clinic to see improved outcomes for those clients who have difficulties returning for reading improved outcomes for those clients who have difficulties returning for reading of the TST during office hours. of the TST during office hours.

Similar concepts to document and measure other tests completed, such Similar concepts to document and measure other tests completed, such as Syphilis & STI Screening, Immunizations have been an initiated to as Syphilis & STI Screening, Immunizations have been an initiated to improve rate of testing and quality of care. improve rate of testing and quality of care.

Other Benefits of HITOther Benefits of HIT Clinical HIT data at a glance. Last lab test dates, CD4 and Clinical HIT data at a glance. Last lab test dates, CD4 and

Viral Load. This data tool allows the clinic staff to view lab Viral Load. This data tool allows the clinic staff to view lab information more quickly. As the system is web-based it information more quickly. As the system is web-based it allows more flexibility in where it can be obtained and allows more flexibility in where it can be obtained and multiple users can view info simultaneously if needed. multiple users can view info simultaneously if needed. – The doctor or nurse can view the data in the room with the client, The doctor or nurse can view the data in the room with the client,

while simultaneously, the medical case manager can be while simultaneously, the medical case manager can be reviewing the same record with another HIV Care provider in reviewing the same record with another HIV Care provider in order to coordinate care and increase patient outcome.order to coordinate care and increase patient outcome.

Clinical HIT data reminders of upcoming test, data, or missing Clinical HIT data reminders of upcoming test, data, or missing data. This tool provides the clinical staff with important data. This tool provides the clinical staff with important discussions points that support and promote treatment discussions points that support and promote treatment adherence. adherence. – During case coordination meeting with a support service HIV Care During case coordination meeting with a support service HIV Care

Provider Individual reports had been prepared in advance and Provider Individual reports had been prepared in advance and brought to the session. We were able to gain access to the brought to the session. We were able to gain access to the secure web-based HIT program, enter in the unique client secure web-based HIT program, enter in the unique client identifier and pull up medical records instantaneously. This identifier and pull up medical records instantaneously. This resulted in enhanced timely coordination of services and improve resulted in enhanced timely coordination of services and improve quality of care with the use of HIT.quality of care with the use of HIT.

Other Benefits of HITOther Benefits of HIT Patient Access to Data. Patient Access to Data.

– HIT systems allows the clinic to review medical information HIT systems allows the clinic to review medical information and results with patients. Specifically, patients can view their and results with patients. Specifically, patients can view their CD4’s and Viral Loads in list form (most recent on top) and CD4’s and Viral Loads in list form (most recent on top) and view user friendly graphs and to then pinpoint success and view user friendly graphs and to then pinpoint success and problems with their medical status.problems with their medical status.

Reporting:Reporting:– Clinical Cross collaborative reports incorporated into the HIT Clinical Cross collaborative reports incorporated into the HIT

has allowed the clinic to gauge clinical outcomes quickly and has allowed the clinic to gauge clinical outcomes quickly and compare the data to other regional and state norms. Quality compare the data to other regional and state norms. Quality data checks also allow for drill down of aggregate data to data checks also allow for drill down of aggregate data to client level data to ensure integrity of data.client level data to ensure integrity of data.

– Prompt discussion of case between disciplines internally and Prompt discussion of case between disciplines internally and externally, leading to quality delivery of care.externally, leading to quality delivery of care.

– Ease of completing federal reports through HIT system, Ease of completing federal reports through HIT system, reducing considerable amount of time of staff in paperwork. reducing considerable amount of time of staff in paperwork. Process of completing reports is quicker and more efficient – Process of completing reports is quicker and more efficient – more accurate.more accurate.

Other Benefits of HITOther Benefits of HIT– Patient satisfaction surveys (confidential) have been online Patient satisfaction surveys (confidential) have been online

to ensure real time data review. to ensure real time data review. Patients can complete surveys anywhere since it is web-based. Patients can complete surveys anywhere since it is web-based.

The HIT provides data outputs to compare findings across The HIT provides data outputs to compare findings across agencies. This allows the HIV Care Provider to view how they agencies. This allows the HIV Care Provider to view how they are doing compared to others in the IT Network of Care.are doing compared to others in the IT Network of Care.

– Provider outcomes and surveys using HIT have allowed the Provider outcomes and surveys using HIT have allowed the clinic to promptly document and evaluate their patients clinic to promptly document and evaluate their patients needs resulting in policy and programming changes:needs resulting in policy and programming changes:

Several years ago the EIP clinic changed hours of operations Several years ago the EIP clinic changed hours of operations based on their patient surveys findings. Some of the patients based on their patient surveys findings. Some of the patients had been relying heavily on van/program transportation that had been relying heavily on van/program transportation that did not run in the evening hours.did not run in the evening hours.

Provider outcomes revealed that patients needed support in Provider outcomes revealed that patients needed support in self-sufficiency of telephone skills, so we made a point to self-sufficiency of telephone skills, so we made a point to review this information with some patients.review this information with some patients.

Client Needs Assessment findings have help to shape Client Needs Assessment findings have help to shape educational programs that are provided by the clinic.educational programs that are provided by the clinic.

Other Benefits of HITOther Benefits of HIT

– Real Time Data. Real Time Data. The ability to enter data in real time allows other The ability to enter data in real time allows other

agencies to view information that is up-to-date, agencies to view information that is up-to-date, instead of out-dated. This helps our agency with instead of out-dated. This helps our agency with coordination of care.coordination of care.

– Grant Writing Grant Writing Survey completed by clients and providers further Survey completed by clients and providers further

assist our clinic with grant writing, assists the planning assist our clinic with grant writing, assists the planning council with priority setting and assists other council or council with priority setting and assists other council or quality teams to shape the way care is delivered and quality teams to shape the way care is delivered and ultimately improve quality of care. ultimately improve quality of care.

There are so many benefits to having an HIT system There are so many benefits to having an HIT system …. From the client to the provider to the council to …. From the client to the provider to the council to the government … the government …

Critical Thinking Questions for Critical Thinking Questions for PreparationPreparation

1.      In broad terms, what are the outcomes that define success for you? 1.      In broad terms, what are the outcomes that define success for you? (In order to achieve it, it helps to define it) (In order to achieve it, it helps to define it) Quality care, adherence to Quality care, adherence to treatment, ability to connect client with other disciplines or coordinate treatment, ability to connect client with other disciplines or coordinate care with other agencies.care with other agencies.

2.      What are some ideas for how stakeholders should go about a 2.      What are some ideas for how stakeholders should go about a process of defining success for their own purposes? process of defining success for their own purposes? One step at a One step at a time …. It’s a lengthy process, but ultimately one with limitless time …. It’s a lengthy process, but ultimately one with limitless opportunities to improve quality of care.opportunities to improve quality of care.

3.      What are common barriers and limiting realities to success with HIT 3.      What are common barriers and limiting realities to success with HIT implementation and adoption? implementation and adoption? TIME .. Time for data entry and quality. TIME .. Time for data entry and quality. Continuous training to reinforce systems benefits.Continuous training to reinforce systems benefits.

4.      What bodies of knowledge and disciplines have you found 4.      What bodies of knowledge and disciplines have you found applicable to successful HIT planning and adoption? applicable to successful HIT planning and adoption? From data entry From data entry to computer programmers, from clients to staff to grantee to quality 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 management teams. In our area, it is nice to know that our input is valuable in improving the way the information is collected, organized valuable in improving the way the information is collected, organized and viewed.and viewed.

5.      What are the costs and problems of getting HIT wrong?  (i.e., 5.      What are the costs and problems of getting HIT wrong?  (i.e., motivation to get it done right)motivation to get it done right) Quality of care can decrease with Quality of care can decrease with getting HIT wrong. Our strive to see healthier clients, longer surviving getting HIT wrong. Our strive to see healthier clients, longer surviving clients helps us to succeed and be the best in improving quality of 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, 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 especially when we see the successes in our treatments and care that we give our clients. we give our clients.