Overview:
Dr. Felix Carpio is a family practitioner who serves as Medical Director of Clinical Informatics at AltaMed Health Services, a federally qualified health center (FQHC) in Los Angeles, California tht includes twenty-six clinical locations that serve approximately 180,000 patients per year. AltaMed provides primary care services, including family practice, general medicine, OB/GYN, pediatrics, cardiology, urology, and orthopedics services, to a largely underserved patient population.
Dr. Carpio helped AltaMed optimize the health center’s electronic health record (EHR) system by establishing standardized workflow processes to eliminate gaps in health care and improve health care quality. AltaMed Health Services first adopted an EHR system in 2009. After an initial year focused on transitioning records and data entry, Dr. Carpio and his colleagues wanted to optimize the EHR system so that they could leverage Health IT to improve health care quality. “We determined that gaps in care were in part due to standard workflow protocols that were not working as needed in the EHR system,” Dr. Carpio says. To improve health care quality, the health system needed to redesign and standardize its workflow processes.
Outcome:
For AltaMed, the first step to redesigning workflows and leveraging Health IT for quality improvement was to establish a clinical informatics department and a quality department. These two new departments worked together to focus workflow redesign around fourteen Healthcare Effectiveness Data and Information Set (HEDIS) quality metrics. AltaMed next developed a system for using EHR data to monitor performance on those metrics.
When they found unsatisfactory progress in the EHR-generated data reports, Dr. Carpio and his colleagues began the effort to improve and update their clinical workflow processes. “AltaMed needed to modify its workflows” to move the needle on the fourteen quality metrics.
One way in which AltaMed adjusted its workflows was to revamp preventive screening protocols. In the new workflow, when a medical assistant receives a preventive screening alert, the assistant can initiate a lab order without obtaining authorization from the physician. This workflow redesign not only saves time, but also helps AltaMed ensure its patients get needed preventive screening and improves health care quality.
In the three years since it began optimizing its EHR system, AltaMed vastly improved its performance on all fourteen metrics. As examples, between 2011 and 2013, AltaMed increased:
- Breast cancer screening rate from 52% to 76%.
- Colorectal screening rate from 34% to 57%.
- Diabetic screening rate from 69% to 90%.
- Depression screening rate from 16% to 60%.
Lessons Learned:
Reflecting on this achievement, Dr. Carpio explained that meaningful use was an important facilitator of workflow redesign. “The EHR system provides access to data that was previously buried in paper charts. Meaningful use helped us redesign protocols to improve our health system’s workflows.”