Integrating PROs for Clinical Care & Research Rachel Hess, MD, - - PowerPoint PPT Presentation

@ r h e s s m d

Integrating PROs for Clinical Care & Research

Rachel Hess, MD, MS

@ r h e s s m d

EVERY PATIENT SHOULD HAVE ACCESS TO THE BEST CARE FOR THEM AND THAT CARE SHOULD BE….

• Timely
• Personalized
• Safe

@ r h e s s m d

A growing body of evidence demonstrates that patients who are more actively involved in their health care experience better health

• utcomes and incur lower costs.
• Robert Wood Johnson Foundation

@ r h e s s m d

STRATEGIC INITIATIVES / POPULATION MANAGEMENT

• Treatment determination based upon outcome for

demographic – Use of Predictive Analytics to Tailor Treatment Plan

• Cost Benefit Analysis
• Allow for more bundled payments

@ r h e s s m d

@ r h e s s m d

• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable

@ r h e s s m d

Implementation

@ r h e s s m d

PRINCIPLES FOR SETTING UP A HEALTH SYSTEM PRO COLLECTION SYSTEM

• Leadership needs to establish expectations
• Patient Care Focus –Not Research
• Decrease Burden of PRO collection on patients

– Short questionnaires – Collect only what is needed—Nothing More – Collect Remotely

• PRO results available at time of visit to provider

@ r h e s s m d

ENTERPRISE STANDARDIZATION

Core

• General Health Assessment (E-VG-G-F-P)
• Visual Analog Scale
• PROMIS Physical Function
• PROMIS Depression

Specialty Specific

• 1 Specialty Instrument (Can be CAT or legacy)

Minimize patient burden: 5-7 minutes (goal); no more than 10 minutes total (maximum) Set the “interval” by clinic for how often the questions are asked

@ r h e s s m d

BUT WHAT ABOUT MY LEGACY SCALE? PROMIS CROSS-WALKS

PROMIS Physical Function v1.2

HAQ- Disability Index Neuro-QoL Mobility Neuro-QoL Upper Extremity SF-36 Physical Function PHQ-2 PANAS Kessler 6 Mental Health Scale Neuro-QoL Depression PHQ-9 SF-36 CES-D Beck Depression Inventory-II

PROMIS DEPRESSION V1.0

@ r h e s s m d

CHANNEL YOUR INNER DUNSON

• I’m concerned that this data isn’t available in Epic because the “ortho model” didn’t

work well

• If you don’t think thru the “ownership” of these questions you are dead
• How are you going to get patients to do this?
• At 5 mins a patient this is going to kill clinic productivity and slow down the physician
• This isn’t physician workflow, this needs to be operationalized without breaking the

clinic workflow

• What, we barely have 60% of patients signed up on MyChart, how are you going to

get an 80% response rate?

• What about all my questions I already built in Epic?
• I don’t want to have to click to see any data
• How does mEVAL and Epic integrate?
• What is my liability for asking these questions?
• I don’t have time to deal with the answers!
• We are collaborating with the NCCN to identify outcome

measures for lung cancer. We're particularly interested in PROs.

• We plan to use the generic PROs that are currently in place

at HCH and to develop custom PROs for the Thoracic group.

• We have a number of projects theorizing that different

aspects of advanced NSCLC care impact outcomes, including PROs.

• The Breast & Melanoma Teams are either done or close to

being set up with similar projects.

@ r h e s s m d

HOW PATIENTS ENTER DATA DIRECTLY INTO EPIC

Two Ways

Epic Questionnaire

MyChart

Home

Workstation Welcome Tablet

(Windows Only)

Clinic

Tablet

(iPad or Windows)

Clinic

PRO

Epic

Home

@ r h e s s m d

CLINIC WORKFLOW

Patients check in with OSS OSS finds patient encounter within EPIC QR Code generated with MRN information embedded OSS scans QR Code with tablet Application (either Welcome or mEVAL) is launched Patient is handed tablet to complete all questionnaires After completion, patient is instructed to return tablet

@ r h e s s m d

CREATING VALUE FOR THE PATIENT

@ r h e s s m d

EPIC PRESENTATION OF RESULTS

@ r h e s s m d

• The report also

has a tab where the physician can see the patient’s answers for every specific question that they were asked in the surveys

• This can be filtered by individual assessment or

by the visit date that corresponds to the assessment results

EPIC PRESENTATION OF RESULTS

@ r h e s s m d

HOW MUCH DATA HAS BEEN CAPTURED

17

Overall since October 2015 we have gather assessment data from over 65,000 unique patients and 120,000 encounters The more data we collect the better our ability will be to help patients make educated health care decisions by using this data of similar interventions

@ r h e s s m d

Technology

@ r h e s s m d

EPIC INTEGRATION

• Question/answer pairs stored in application tables
• Upon completion, stored algorithm is run and creates

rows in score table

• When scores are recorded, HL7 process runs and creates

HL7 messages

• HL7 engine picks up messages and sends them to Epic
• ETL to BOE for reporting embedded in Epic (Radar

dashboard link, custom programing point)

@ r h e s s m d

Application tables (EDW) Reports HL7 Epic-BOE Integration Administration Web App ETL PRO entry

@ r h e s s m d

EDW: Patient data, forms, scores, Q/As, status

BizTalk

PRO entry Informatica ETL (2 mins) HL7 Score Table HL7 Message Generation HL7 Queue HL7 BI Architecture

@ r h e s s m d

mEVAL Analytics

@ r h e s s m d

ADMINISTRATION WEB APP TOOL

Login to web app Filter patient list by selecting a provider and date. Use the date and MRN Search to find walk-in or same day appointments. Search Results Click on a patient name to display available assessments.

@ r h e s s m d

DISTRIBUTION OF SCORES SHOWN BY PROCEDURE

The Mean Age Adjusted Assessment Percentile can be tracked in any time interval from any range of days pre- surgery to post surgery Distribution is shown over time including standard deviations to show the shift over time

@ r h e s s m d

DISTRIBUTION OF SCORES SHOWN BY PROCEDURE

25

Count of responses that are included in the graphed data Adjustable “Days From Surgery” element, where the interval the user would like can be chosen Summary data broken out both by the percentile rankings as well as by standard deviations

@ r h e s s m d

The Physical Function percentile over the course of care

ABILITY TO TRACK INDIVIDUAL PATIENT’S CARE

Provider who saw the patient and visit date Cost of each visit

@ r h e s s m d

ABILITY TO TRACK INDIVIDUAL PATIENT’S CARE

Each visit number hyperlinks to a report with all the detail line item costs for that visit Clinical information such as site of service and diagnosis or surgical procedure and some outcomes measures are shown for each visit for the selected patient

@ r h e s s m d

DAILY CASE MANAGEMENT REPORTS

@ r h e s s m d

DEPRESSION SCREENING

PHQ 9 (only) PROMIS Depression (only) # total visits 408,926 94,488 # of surveys 11,814 (2.9%) 22,042 (23.3%) # of unique pts 7,289 16,046 # At “risk” 2,926 (0.7%) 1,297 (1.4%)

More information at Poster Session C, Monday 6:30-8:00

PaTH's experiences with EPIC/PRO development and implementation

Cecilia Dobi, MS, Project Manager, Temple University School of Medicine Diana Gumas, MS, Senior IT Director, Johns Hopkins Medicine Albert Wu, MD, MPH, Professor, Johns Hopkins Bloomberg School of Public Health Rachel Hess, MD, MS, PaTH Principal Investigator, UPMC, UUHC

@ r h e s s m d

THREE INITIAL USE CASES:

• Idiopathic Pulmonary

Fibrosis

• Atrial Fibrillation
• Obesity

@ r h e s s m d

CHOOSING PROS: TEAM WORK!

• Clinician
• Researcher
• Patient-partner
• Informatician
• System Analyst
• PRO experts

@ r h e s s m d

PRO COLLECTION (RESEARCH, CLINICIAN, STAFF)

• Epic MyChart
• RedCap

@ r h e s s m d

SENDING QUESTIONNAIRES Report Multi-patient messaging Series

@ r h e s s m d

Our hope is that, at the end of the day, we’ve enhanced each person’s health and quality of life

University of Utah Population Health Sciences

Booth 116