Agenda June 30, 20212Desired Outcome: CDS Design Team understands desired functionality, requirements, and challenges to building a CDS tool that can be integrated into EHR systems.
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Partner Talking PointsDesired Outcome: CDS Design Team understands desired functionality, requirements, and challenges to building a CDS tool that can be integrated into EHR systems.
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AllianceChicago Workflows
AllianceChicago CDS Worksheet
El Rio Health Clinical Workflow
Described are the opportunities to engage with a patient around the clinic encounter.
Pre-visit:
• Current State - Not applicable.
• Future State – Review care gaps – patients need HIV screening.
Check in:
• Current - Sexual Orientation/Gender Identity (SOGI) data is assessed via kiosks
• Future - Same
Rooming:
• Current - Care gap review is conducted by the Medical Assistant, and a standing order is in place for HIV
opt out testing for patients ages 16-21 years.
• Future - Care Gap review to be conducted by the Medical Assistant with a standing order for all patients
ages 16 +
MD/Clinician Extender visit:
• Current - Care Gap review; order HIV testing after discussion.
• Future:
o Discussion regarding sexual history and assess for STDs
o Consideration for Pre-exposure Prophylaxis (PrEP) if it fits the criteria
Post-visit with staff (in clinic):
• Current - Direct to the Laboratory if ordered.
• Future - Same, plus add note to the post-visit summary that HIV screening is recommended/due (when
applicable)
Pharmacist:
• Current – Not applicable. The Pharmacist is not involved in HIV opt-out testing.
• Future - nothing/not applicable
Post-visit/Care Coordination:
• Current – Coordinate via phone services
• Future –
o Referral for PrEP – if at risk and HIV negative, and need for further evaluation using the EMR
o Referral to Special Immunology Associates (SIA) HIV Clinic if the patient tests positive.
Proposed Intervention
We would like a streamlined approach to HIV counseling and testing – currently we are using the care guidelines
(alerts in the medical record system. Our referral process – for PrEP vs HIV positive results – includes using the
EMR (currently we use telephone and encrypted text services). We would like built-in order sets in the EMR – that
could help with STD evaluation/Sexual history / PrEP order sets etc.
1.Briefly describe the current approach to measuring and supporting the care team in HIV testing and follow up in your organization.
- Part of “care guidelines” a one-time check box for patients 18-65 years old – serves as a reminder for providers to perform HIV testing when they are seeing the patient
- Results are scored in a program – “Relevant” – where providers can see the percent of patients in their panel who have been tested, as well as the list of patients who have not been tested from their panel.
- Patients are assigned to a provider panel – based on who they have seen for the last three encounters.
2. Talk about the process you would have to engage in to design and get care team buy in for the design of content and interfaces to support HIV testing and follow up guidelines and workflow improvements.
- A Weitzman initiative was started four years ago – to make HIV testing mandatory at least 1 time for individuals 18-65 years old.
- Need for ongoing training with STI testing and management, considerations for PrEP
- Some of these trainings – occur during “Lunch and Learn” sessions and Operational Meetings
- As company is set to transition to EPIC – new workflows and teams are being created to set up new guidelines and templates
4. Discuss your technical path to implement new tools or significant improvements to your EHR/pop health tools to support HIV testing and follow up. Include approvals, costs, impacts, testing, vendor involvement if any. If there are unanswered questions you need to answer, OK to list here.
A. Do you have a portal where you can use FHIR applications inside your EHR?
- With our current Nextgen we do NOT have the FHIR technical capabilities to do this. We are working with EPIC on this as part of our Implementation workflow analysis.
B. Do you have a CDS engine to build content in your EHR?
- We are working with EPIC on this as part of our Implementation workflow analysis
Fenway Clinical and Data Workflows
Fenway CDS Worksheet
Montefiore Clinical Workflow
Montefiore Data Workflow
Montefiore CDS Worksheet
Ohio ACHC Clinical Workflow
Ohio ACHC Data Workflow
Ohio PCA CDS Worksheet
Project Teams
Roles are:
- Clinician SME advisor (clinical decision maker with training in HIV that also sees patients)
- Person familiar with the EHR and how to integrate new content into it (also hopefully knowledgeable about the lab system interface if it is separate from the EHR)
- Data analyst familiar with the HIV data
- HIV care coordinator to represent the care management component
- Other - Project Manager, IT Specialist, Admin, etc.
| NACHC Informatics Team | Alphora | AllianceChicago | El Rio | Fenway | Montefiore | Ohio ACHC |
|---|---|---|---|---|---|---|
Julia Skapik (Deactivated)Clinician SME, familiar with EHR Pedro B Carneiro (Deactivated) Data Scientist familiar with EHR, HIV Data Raymonde Uy (Unlicensed) Physician SME on Informatics John GreshData Management Andrea Price Old Account (Deactivated)Project Manager | Bryn Rhodes | You can copy from Item #3 on the CDS Worksheet /wiki/spaces/HP/pages/1253581296 | Sudha Nagalingam, MD- Clinician SME, Familiar with EHR Greg Raglow, MD- Physician SME Informatics Dustin Holloway, MPH- Data Management/Analytcis Erin Dougherty, MPH- Grants Management Erika Solis- HIV Care Coordinator | You can copy from Item #3 on the CDS Worksheet /wiki/spaces/HP/pages/1253581296 | Lower Lights CHC Dr. Lynnette Palmer, Quality Director, familiar with EHR Richard Harris, Data Analyst, familiar with EHR Southeast CHC Nick Nelson, MPH, NP-C SME advisor, familiar with the EHR |
Discussion Questions
| Q | Item | Notes | Action Items |
|---|---|---|---|
| 1. | What would you like a Clinical Decision Support routine to do? | ||
| 2. | Discussion with the technical ppl on what their protocols are for integrating the CDS into their system
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| 3. | Data form and manner including whether you capture:
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Partner Profiles in Brief - (These are estimates and do not need to match the data pulls. The timeframe is any time frame that is convenient for you)
| HIV Prevalence/New Infections per year/percent of pop that lives with HIV | Demographics (however you define them - your categories) | Substance Abuse Profile/Rate | |||||
|---|---|---|---|---|---|---|---|
| Race | Ethnicity | Gender Identity | Sex Assigned at Birth | Sexual Orientation | |||
| AllianceChicago | |||||||
| El Rio | Percent of Health Center Population Living with HIV/AIDS: 1.5% (2019) New HIV Diagnoses in 2019: 62 (this number includes new infections diagnosed within the organization and outside referrals to El Rio SIA upon a positive HIV diagnosis outside of our El Rio system) | 2% - Asian 0.08% - Native Hawaiian 0.16% - Other PI 4.45% - African American 7.26% - American Indian 80.87% - White 0.99% - More than one Race 4.38% - Unreported/Refused All Race Data: UDS, 2019 | 57% Hispanic/Latinx (UDS, 2019) 42% Non-Hispanic (UDS, 2019) 1% Refused (UDS, 2019) | 0.55% - Transgender (UDS, 2019) | 41%- Male (UDS, 2019) 59%- Female (UDS,2019) | 3.1%- Lesbian, Gay, Bisexual (UDS, 2019) 1.7% -Other/Something Else (UDS, 2019) | 3.95% Other Substance-related Disorders (excluding tobacco) and Alcohol-related Disorders (UDS, 2019) |
| Fenway | |||||||
| Montefiore | |||||||
| Ohio | Lower Lights CHC Health Center Patients living with HIV - 0.19% (21 pts) New HIV Dx: UDS 2020 Southeast CHC Health Center Patients living with HIV - 0.46% (37 pts) New HIV Dx: 10 (HIV Linkage to Care measure) 2020 UDS Data | Lower Lights CHC 2% Asian 1% Other PI 22% Black/AA 49% White 14% more than one race 12% Unreported/Refused 2020 UDS Data Southeast CHC 0.8% Asian 0.05% Native Hawaiian 0.05% Other PI 30.8% Black/AA 0.4% AI/AN 62.2% White 3.1% More than one race 2.6% Unreported/Refused 2020 UDS Data | Lower Lights CHC 15% Hispanic/Latino 77% Non Hispanic Latino 8% Unreported/Refused 2020 UDS Data Southeast CHC 2.2% Hispanic/Latino 97.5% Non Hispanic Latino 0.3% Unreported/Refused 2020 UDS Data | Lower Lights CHC 0.18% Transgender 2020 UDS Data Southeast CHC 0.73% Transgender 2020 UDS Data | Lower Lights CHC 3894 (36%) Male, 5664 (53%) Female 2020 UDS Data Southeast CHC 3977 (50.2%) assigned male 3737 (49.7%) assigned female 2020 UDS Data | Lower Lights CHC Lesbian/gay (1%) Bisexual (0.8%) Something else /don’t know (15%) 2020 UDS Data Southeast CHC 3.1% Lesbian/gay 4.6% Bisexual 1.1% Something else/don't know 2020 UDS Data | Lower Lights CHC 6.0% Other Substance-related disorders (excluding tobacco use and alcohol-related disorders) Southeast CHC 26.2% Other Substance-related disorders (excluding tobacco use and alcohol-related disorders) 2020 UDS Data |
Links to Workflows and CDS Planning Worksheets
| Clinical & Data Workflows | CDS Worksheet | |
|---|---|---|
| AllianceChicago | Workflows | Template |
| El Rio | Workflows | Completed Worksheet |
| Fenway | Placeholder | Template |
| Montefiore | Workflows | Template |
| Ohio | Workflows | Completed Worksheet |