MEANINGFUL TECHNOLOGY TOOL-KIT TO

IMPROVING PATIENT HEALTH

Fall 2016

FEDERAL HEALTH INITIATIVE: MEANINGFUL USE

The Medicaid EHR Incentive Program provides incentive payments for eligible healthcare providers to adopt and use electronic health record (EHR) technology in ways that can positively affect patient care

Objectives are established by the Centers for Medicare and Medicaid Services (CMS) using a certified EHR; program is run by individual States

10 OBJECTIVES: MEDICAID AND MEDICARE STANDARDS

1 Protect Patient Health Information2 Clinical Decision Support (CDS)3 Computerized Provider Order Entry (CPOE)4 Electronic Prescribing (eRx)5 Health Information Exchange6 Patient Specific Education7 Medication Reconciliation8 Patient Electronic Access9 Secure Electronic Messaging10 Public Health Reporting

GOAL: USE EHR TO IMPROVE HEALTH

Improve quality, safety and reduce health disparities Achieve better clinical outcomes Engage and empower patients Improve care delivery, coordination and public health Build more robust research data on health systems

A VISION FOR UCSF

Adopt clinic workflow to align with federal (CMS) standards

Be at the forefront of the intersection of technology and human health

Prepare to become integrated with UCSF Health System

THE KEY TO OUR EXCELLENCE IS OUR….

Students Faculty Staff

Everyone has a role What is YOUR role?

FACULTY START CHECKS

Students are proxy providers Chart documentation is tracked by faculty and

by student No start check = no tracking for faculty, so

please obtain a start check at every session!!!

MEDICAL HISTORY

Update allergies Update problem list eRx query and manage Medications Hx Review meds in “medications” tab by clicking

“reviewed button”

VIDEO DEMO

1. Alerts/Allergies 2. Patient problem list 3. eRx managing medication history 4. Reviewing medications

MU TAB: THIS IS NEW!

@ every visit! Key to track continuous quality metrics related to

diabetes, hypertension, BMI, referral pattern, etc. In EHR, select “forms”, click Select “MU tab form” from pull down menu Fill out MU2 Measures Form THIS IS A KEY FORM FOR TRACKING VARIOUS

INTERVENTIONS!

VIDEO DEMO

5. How to fill out the MU form

NEED RX? – IT’S ALL IN ERX

Prescribe under faculty log-in in eRx Print and have faculty sign

If Schedule II drugs (ex: Vicodin, Norco, etc.), then ask faculty to take the printed eRx to the dispensary and request the secure Rx pad

UC PROTOCOL FOR DISPENSING MEDS Available medications:

Amoxicillin 500mg Clindamycin 150mg Acetaminophen 500mg and 325mg Ibuprofen 200mg

Enter code Q0203 in AxiUm as “complete” in the patient’s EHR Enter a progress note and indicate a). Medication name, b). Dose, c).

Primary reason for administration. The attending faculty must provide an electronic signature Enter the medication prescription into eRx, have the faculty sign it

electronically and print it At the dispensary window, provide the staff member with the patient’s

EHR number, printed eRx prescription, and ask a staff member for the requested medication

VIDEO DEMO

6. Prescribing medications in eRx

Remember: your faculty must have an eRxpassword!!!

See a Clinic Director if faculty doesn’t have one

CLINICAL DECISION SUPPORT (CDS)

5 programmed prompts Follow the prompts when they pop up

This is an exampleonly, not actual CDS

PATIENT EDUCATION

CAMBRA: In CRA click “yes, recommendations given” and print the correct info for patient

New: tobacco cessation New: BMI (letter for patients with BMI <17.8 or

>25) Go to “patient attachments” Click under “letters and general letters” Select from a list of letters relevant to your patient

VIDEO DEMO

7. Patient education letters Smoking cessationMetabolic health (obesity)

SOCIAL COGNITIVE THEORY

Reciprocal determinism: behavior is a result of and part of a continual interaction between individuals and their social and physical environment.

What role does UCSF School of Dentistry have in creating an influential environment for our patients?

SMOKING IS ONE OF THE LEADING CAUSES OF STATISTICS

From January- December 2015: We saw 10,700 patients in predoc 1,763 said “yes” to smoking 225 clinic instruction days 16.5% of our patients smoke 12% of people smoke in CA Opportunity: 7-8 patients/day

5 DETERMINANTS OF HEALTH

Medical Care – 10% Genetics – 20% Health behaviors – 40% Social circumstances – 20% Physical environment – 10%

70% of what influences health is rooted in broader social conditions that structure individual’s risk of being at risk – need social justice approaches

Remedial Approach

MESSAGING WITH PATIENTS: NEW

Send a “welcome message” All in axiUm email Green name color = patient Can also use Exan DoctorAccess to view these

emails remotely

PATIENT ONLINE ACCESS TO EHR

High level information Medication list Problem list Notes and details are not viewable to patients Patients go to: https://dentalhealth.ucsf.edu/ Patients log in with access code provided at the

front desk Please engage your patients in this process FA and ACC staff maybe of help to patients

VIDEO DEMO

8. Patient online access 9. Patient messaging

SO, WHAT DO I NEED TO DO STARTING OCTOBER 3RD?

At Every Visit: Get a start check from your faculty Ensure MU Tab form is filled out/updated Ensure Medications are “reviewed” and stamped with

”today’s” date In General, when appropriate:

Update allergy and problem list Use eRx for every prescription you write Provide relevant patient education materials

Engage your patients in online experience: Help patients log-in to their EHR online Send the patient a “welcome” email

THANK YOU!

Acknowledgements:Dr. Mark Kirkland and the Dean’s office Lenh Tsan – Project Manager Tom Ferris and NIS teamMaria GuerraDr. Sean MongDr. Nakahara and Dr. Singh