Topic: Team Delivery of Care
Title: Clinical Decision Support (CDS) Case Study: Southeast Texas Medical Associates, LLP (SETMA)
Date Posted: October 15, 2010
Submitter's Name: Evelyn Gallego, MBA
Organization: EgH Consulting
Objective: To present a high level summary of how a multi-specialty clinic uses its EHR CDC functionality to improve care quality and patient health and thereby meet one of the criteria for meaningful use of an EHR.
Keywords: clinical decision support (CDS), meaningful use, quality reporting

Practice Profile

Multi-specialty clinic located in southeast Texas across 3 clinical locations; 24 Physicians, 12 Nurse Practitioners, and 260 additional staff; 263,000 annual patient encounters including clinic, hospital, nursing home, physical therapy, hospice, and home health.¹

EHR Objectives

Transition to electronic patient management; ability to measure provider performance and outcomes of medical-decision-making processes; establish a true "continuum of care" health-care delivery model; integration of patient-encounter data; decrease costs associated with managing paper records and transcription; optimize revenue recovery for services; instantaneously infuse national standards of care in complex treatment conditions; increase practice revenue through efficiencies; and enforce patient safety through clinical decision support and patient education.

Implementation Process

SETMA selected a multi-functional EHR system and Enterprise Practice Management system. The systems were implemented by clinic where each clinic went 'live' separate from the other two in less than two months. SETMA redesigned their clinical workflow and for the first six months post deployment worked with both the EHR and the paper record during the patient encounter. Eventually the paper chart became redundant and all records became electronic.
Staff was trained through tutorials and each clinic was assigned a 'super-user' to help staff with questions and provide additional support to the IT staff.

Meaningful Use Functionality

SETMA's EHR provides a series of critical functionality including CDS, document generation, disease management and patient education. The CDS in routine use is organized by special care settings to increase the quality of health care as per the following:
Pediatrics: The childhood weight management program is modeled after SETMA's adult weight management program. The EHR has built-in age specific benchmarks like 'anticipatory guidance' and 'the Denver Scale' to alert providers and help them give consistent and quality counsel about patient care and child development.
Women's Health: the EHR's built-in template and order sets provide excellent process analysis of care in areas including cardiac screening, office gynecology, bone density and treadmill exercise testing.
Pulmonology and Critical Care: Disease-specific templates for asthma and COPD and hospital order sets for pneumonia and asthma are built into the EHR to enable decision-making by all SETMA providers at all levels of training.
The Congestive Heart Failure (CHF) Clinic: through the EHR, providers can create a preventative treatment and educational plan to help patients avoid CHF, manage CHF and/or help patients regain cardiac function through a medical-managed cardiopulmonary rehabilitation program. SETMA's EHR allows providers to correctly designate systolic or diastolic CHF and guides providers towards the right treatment.
Diabetes Disease Management: through the implementation of this tool, SETMA achieved a .36% improvement in HgbA1C after the first year of its use. An American Diabetes Association accredited Diabetes Self-Management Education program, which is EHR based, has added to that improvement. This EHR function has not only resulted in SETMA's recognition by the NCQA Diabetes Recognition Program but also by SEMTA becoming an affiliate of Diabetes Center of Excellence in Boston, Massachusetts.

Results

The EHR CDS capabilities integrate evaluation, treatment, and specialty consultations thereby maximizing quality, safety and cost effectiveness. The ability to manage patient data electronically has resulted in improved quality of patient care, increased physician and patient satisfaction, quantifiable financial return on investment and increased operational efficiencies. SETMA can now identify deficiencies in preventative care and notify patients immediately. The EHR has led to improvements in quality of care, patient satisfaction and outcomes.
Through their EHR, SETMA has launched a comprehensive electronic disease management effort called the LESS Initiative-Lose weight, Exercise and Stop Smoking. The program enables providers to evaluate patients' risk for diabetes, assess patient weight management, provide an exercise 'prescription' and educate patients on smoking cessation. This program assesses 5,000 patients per month.
CDS capabilities have also increased reporting efficiencies for patient management and outcomes management. The EHR easily validates how well providers are utilizing 'best practices' and meeting performance expectations. Patients are also provided with a physician report card so the patient can evaluate the physician level of care.

Implications for Stage 1 Meaningful Use Requirements

SETMA acknowledges they currently meet and are demonstrating the 24 functions required for a practice to demonstrate "Stage 1 Meaningful Use".² Clinical Decision Support is one of the core objectives SETMA will report on beginning in April 2011 under the CMS EHR Incentive Program. SETMA also reports on more than 200 quality standards for the CMS Physician Quality Improvement Initiative (PQRI) Program.

References:
Holly, J. L. (2005). SETMA Application for Ambulatory Care Davies Award. Retrieved 2010, from HIMSS Davies Awards: http://www.himss.org/content/files/davies/2005/STMA.pdf