Harnessing the Potential of EHR’s Clinical Decision Support and Portals to

Improve the Quality of Care

Virna Little, PsyD, LCSW-r, SAP

If You Do What You Have Always Done..

You are going to get what you always got….

Triple AIM

Triple AIM

• Improve Patient experience • Decrease Costs • Improve Quality

What is a Clinical Decision Support “Simply” Stated

• Individual patient prompt • Meet a quality measure • Real time prompt at point of care • Reminder for evidence based

practices/guidelines

Why Decision Supports ?

• Improve quality of care • Improve outcomes • Track compliance to quality guidelines • Identify providers who need support • Compliance

Tremendous Opportunities

• Comprehensive Management • Making decisions from real data • Population Management • Quality Care/ Outcomes • Patient Experiences

What are the benefits?

Communication Improved Care Compliance Savings

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Looking to the Future

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EMRs in the therapy session can be used to engage patients and review

decision supports together !

The New Manager…….

• How can we use the system to solve this problem ?

• What data do we need to help solve this problem ?

• Where in the system will we want this information ?

• What do you do differently ?

A Real Life Example..

• Addressing issue of suicide risk across system • Thinking of a “spectrum “and using the system

across the “spectrum” to address a problem

• Used consistently throughout health centers • Speak the same language • Attention to question 9

PHQ9 Tool

BPA for annual PHQ-2

Screening for Depression

PHQ-9 BPA

• Reminder to providers

• Allows quick access to needed tools or resources

• Can be “hard stop”

• Ability to report on providers who “ ignore” decision supports

Decision Support

Graphing Results

Monitoring Depression

• “Blows” into all encounters

• Readily seen by providers of all disciplines

• Able to be reported on ( number of patients)

Suicide on the Problem List

Problem List Documentation

Suicidal Ideation

“FYI” and “Flagging”

Suicidal Ideation- New Red Banner

• My Safety Plan document – Allows safety plan information to be available to all

providers during all visits for review and/or modification – Patients can access the document via patient portal for

reference – Community providers can see patients at risk through

physician portals – Provided in print to patients as part of after visit

summary – Signed by patient and provider

Safety Planning- An interdisciplinary collaborative effort using the electronic

record

Safety Planning

Safety Plan

Suicidal Ideation

Shared Care Plan

A patient portal is a healthcare related online application that allows patients to interact with their healthcare providers.

What is a Patient Portal?

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My Goals and Plans You have a diagnosis of DEPRESSION Here are your personal treatment goals: Call you friend Ana on Tuesday at 7pm

MyChart Questionnaires

Monitoring DePression with My Chart

Monitoring Depression

Suicide Risk Assessment

Suicidal Ideation

Operational Reporting Key Parameters

Population Management

PHQ-9 Reports

Monitoring Depression

Dashboard Components

Depression Registry

Registry and Analytic Reporting

• Physician portal as link to community • Almost 100 organizations and specialty providers on

“Institute Link” • Foster care, mental health residences, DD programs • Pharmacy providers • Seamless care system • By-pass admissions • Expedited services • Decreased admissions

It takes a Family……..

Overview of content in Medical Record

Chart Review

DIRECT SCHEDULING

• Review of all patients completed and attempts –analysis

• Hard stop decision supports for patients who are considered high risk

• Reports of patients who did not have safety plans reviewed

What Does The Future Hold ?

Compliance

• Use EMR for Compliance Program • Documentation Completion Decision Supports • Billing and Coding Reports • Treatment Plans -60, 85 and 91 days

Regulatory and Compliance

Ability to track and report on providers who “ignore” decision Supports

A Schedule Is Not Just a Schedule Anymore

• Clinical and Administrative Decision Supports • Patient Status • Incentives like “my chart” or other enrollment • Open Encounters • Hospital Discharges • Shadow Templates • “Hotspotting” • Open Slot Reports

On The Back End……

• Billing • Collections • Authorizations • Credentialing • Denials Decision Supports to Remind Providers to do OTR ….

Patient Care Oversight..

• Concurrent Documentation • Time Spent • Review Notes from “Afar” • Open Encounters

Clinical Decision Supports

• A tough balancing act • Support fatigue • Rotating Supports • Coordinating with current initiatives

Questions ??? VirnaLittle.com