Obstetrical care and post partum care is not consistent

• • pregnancy date
  • pregnancy status outcomes
  • contraceptive counseling
• Even with the shift to electronic records has not always improved over paper; on paper, it was easy to scribble at the top of the form a reminder
• Some CHCs do full care through delivery, others refer out as soon as there is a positive pregnancy steps
• This project looked at the links to improve follow-up

Lisa - introductions for CDC guests

Turn mic over to Julia

Partner Report Out - Alliance Chicago 

Roxane Padilla

Dr. Lisa Masinter

Introductions of team and guests

Dr. Michele Whitt

Dr. AnneMarie Overholser

See transcript for 11:39 where there were not slides.

Development of EHR (Epic) tool turns out to be iterative.  There was a plan, but as users saw the build, they had new thoughts on how it would best work.  Each service area made recommendations.

It is possible in Epic to see if the Express Lane was being used - are they having to add an order all the time? Which things could be added, taken away because not used?

Champions who are experienced and take ownership at each site is really important.

Kim Cardoso contributed to the training, appreciated the ability to test and iterate. They had the ability to do Express Lane but were not maximizing its use because it seemed like a distraction, but once it could be customized for the users needed.

Great example of use of EHR optimization when users are able to express what they need and see it implemented.

temporal order of when DM - 

More pp visitors got LARC than non pp women

• Maybe this is because they get the prescription in the hospital, not the CHC
• Most of the LARCs would be given in the hospital
• If the hospital is a Catholic hospital, they will not get injectables there, patients will get them back in the office
• The practitioner who sees PP patients will be more comfortable with (counseling? LARC?) at 12:09

• Undocumented women will sometimes get a pp visit because their access to care ends after pregnancy.
• Some of the population may have shown up as pregnant but did not carry to term, others may have transferred care to another location - we might want to look at those lost to follow-up.  We will pull out the data from the two categories, we can look at patterns.

Kate - Temporal sequence in the contraception data?  Do we know that it is after the pregnancy episode or just during the year in which there was a pregnancy?

Pedro - about half the pregnancy sample has a valid delivery date.  We can use those cases to establish temporal order.  Some patients were identified through diagnosis codes, which might mean that they were diagnosed when they came for the pregnancy.

John - Anyone wants to predict when we will start seeing substantial exchange of patient data through implementation of systems that comply with Patient Rule?  Patient allows data to be pulled from claims system or other health care provider systems, SMART on FHIR API go into effect July 1, 2021.  

• AllianceChicago - These discussions maybe going on w/in certain departments, not known.  Partner hospitals - there is a mechanism to exchange data, specifics are not known.
• OCHIN - Not sure about the FHIR question. 
• MW: How clinically necessary is it for the patient to have all the data if you are not providing long term/ongoing care to the patient?  Great for data collection, but is how useful is it?  LM: It is useful if they come back - patient has a lapse or presents as new; gathering the background info is really challenging.  JS: If someone else is taking care of them, that works, well, but if they have a condition but do not return, how do we identify who they are and find them to help them?
• Nicole Ford - important to be able to track longer term outcomes.

Assist from John and Jayson

Ask if there are questions about the data

Slide from Menti Question 1

• AllianceChicago - Learning about possibility -  learning of pregnancy episode - critical for buliding data, an EMR-led mechanism for case management for patients

• Where should would you like to see these findings presented - OCHIN & Alliance conferences, CDC Conferences? Journal articles?

Julia facilitate - have people raise hands? 

Switch screen to Mentimeter

Slide 4 What did you hear that should be scaled and replicated?

Slide 5 Given the lessons learned, what would you suggest for next steps?

Go to Discussion Next Steps slide

Thank you to partners and CDC, to Kathy and Ron for guidance

Create the 4-question Evaluation survey - (see NTTAP survey) Andrea will send out to participants. 

https://nachc.co1.qualtrics.com/surveys/SV_4N2OhyArfBownv8/edit