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

Partner Report Out - Alliance Chicago 

Roxane Padilla

Dr. Lisa Masinter

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.

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

• The BPA has already been voted on for the GDM - if they had a result,  (??) this will move into production in July or August (12:38pm)
• For the Express Lane, in September, will assess how it is used currently and see how it is being used and see if other service areas want to use it.  If so, they can put in a ticket and it can be spread to other centers.
• Training materials - yes, there is training documentation for how to use it.   There are some who have used Express Lanes or Smart Sets before, others have not, so there may be two different trainings.
• consistent documentation of episodes, consistent documentation of outcomes.  pretty much consistency and interoperability
• AllianceChicago will be scaling and spreading this, starting with the pilot sites, and planning for this to go live in EHR in those sites over the next month, and get initial feasibility data then will go network-wide so all health centers caring for pregnant patients will be better able to do better case management on the front end and data extraction, data management on the back-end. Additionally, will have technological ability soon to create registries.
• from Julia Skapik (privately):    12:45 PM
  Tableau dashboards--> health catalyst, registry approach
• Ability to track (12:45pm) even if the person is not our patient?? 
• 12:48 - lost this... see transcript
• Kim Cardoso What can be taken out of the payor? Payor provides registries...  patient should be at the center, not tied to the payor or health center or county

• Pending CDC funding, Learning Community for Obstetrics Informatics - how to deploy pregnancy registry, Express Lane.
• Continuous care support - when we find out someone is pregnant, have a 12:52 transcript - have an ideal algorithm, and compare patient's trajectory - is the information being exchanged from hospital to clinic?
• Lisa Romero:  measure and then determine the right metric to promote at a policy level 
• LM: Look at the right outcomes to measure (maternal mortality is thankfully rare) how to link data sets to look at more vital statistics data - 12:55pm better metrics for utilization and encounters.  
• MW: If what we believe will make a difference is more coordinated care, involve patients - motivate them to get care perhaps coordinated care would help, create a pregnancy registry for the community, in a city for example, like an HIE.  For those less likely to be motivated to get care, these interventions may not actually measure needs because those women do not participate 12:58pm.  

• see Mentimeter - Edit that last one to "involve the patient directly!"

ACOG Dorsata - reduced NICU days for the baby

ACOG Annual Meeting 2022

Women's Health Paper