字幕表 動画を再生する 英語字幕をプリント Thank you for joining us for this webinar titled "Using Electronic Health Records to Support Diabetes Management and Type 2 Diabetes Prevention" Our presenter is Stephanie Rutledge who is a Health Scientist with the Centers for Disease Control and Prevention. I am Michelle Knight with ICF next and I will be your moderator today. The recording and transcript as well as the PowerPoint slide deck will be available on the CDC website later this year. For the next 60 minutes we will share information that will help you understand the importance of EHRs in supporting type 2 diabetes prevention and diabetes management. We will also discuss how state and local health departments can talk with healthcare providers about the benefits of using EHRs while being able to acknowledge the limitations of EHR. Then we will provide examples from the field to aid in learning and understanding. Finally we will wrap up by sharing additional resources. The companion guide for this webinar is titled "Using Electronic Health Records to Support Diabetes Management and Type 2 Diabetes Prevention" and will be available on the CDC website later this year. I will now turn the webinar over to Stephanie, Stephanie. Thank you Michelle. An EHR is a digital version of a patient's medical chart. A typical individual EHR may include a patient's medical history, diagnosis, treatment plans, pharmacy records, and laboratory and/or test results. EHRs are real-time records that make information available securely to authorized users ideally including users from multiple organizations. Electronic health record systems are in common use in both hospital systems and community-based health care provider offices. EHRs can help streamline communication among providers including community-based providers. EHRs automate and streamline provider workflows and allow providers access to evidence-based tools to help them make patient care decisions. Because of the cost of diabetes care improving the quality of diabetes management and type 2 diabetes prevention is an important priority. EHRs are one promising tool in these efforts and EHRs can help support efforts to increase awareness, referral, enrollment and retention in the National Diabetes Prevention Program also called the National DPP lifestyle change programs, LCPs, and in diabetes self-management education and support or DSMES programs for type 2 diabetes prevention and diabetes management. EHRs can help support the patient journey which we will further define later in the webinar. For example, EHRs can assist health care providers to educate patients about prediabetes and type 2 diabetes, screen or test for prediabetes and type 2 diabetes and refer patients to type 2 diabetes prevention or diabetes management programs. EHRs can also be used to send health care providers information about patient participation and progress in National DPP lifestyle change programs and diabetes self-management education and support programs. Health care providers are the primary users and owners of EHRs. Providers include large health systems and hospitals office based practices and pharmacies although almost all hospitals use EHRs not all providers use EHRs. These differences in EHR use can lead to challenges in interoperability or the secure exchange of information between authorized EHR users which can limit the flow of information between providers and other users. We will discuss interoperability in more detail later in the webinar. Individual patients are secondary users of EHRs. Patient access their health records that are stored in an EHR through a secure web site usually called a patient portal. Community or clinically based organizations may also be secondary users of EHRs. Use by these organizations can happen when they receive referrals to their type 2 diabetes prevention and diabetes management programs through an EHR in limited cases. Such organizations may also use EHRs to provide feedback on patient progress to the provider making referrals. Most EHRs are created by independent companies or EHR vendors. EHR vendors create a variety of EHR products and platforms with varying features and cost. On this slide are just a few of the common vendors used by hospitals and individual healthcare professionals. Health care providers have many options when choosing EHR vendors and products. The American Medical Association provides a detailed guide to selecting and purchasing EHRs. There are complete and modulate EHRs. One major distinction is a complete EHR is a complete package that has been certified as meeting all of the Federal government criteria for promoting interoperability or PI programs. A practice with a complete EHR has one vendor and one system to work with, which can make it easier to get support. A modular EHR combines multiple EHR modules that are individually certified for PI programs. A modular approach allows providers to use preferred applications, and it can be less expensive than buying a complete EHR. When complete EHRs or combinations of EHR modules meet federal government criteria for PI programs they are referred to as certified EHR technology. HIPAA privacy and security rules protect individually identifiable health information, sometimes referred to as protected health information or PHI. EHRs must comply with HIPAA regulations since they are electronic repositories of PHI. EHRs must be HIPAA compliant and providers are responsible for taking the steps needed to protect confidentiality, integrity, and the availability of electronic PHI. You can learn more in "The Guide to Privacy and Security of Health Information". The 2009 American Reinvestment Recovery Act included the HITECH Act that supported Electronic Health Records Meaningful Use, an effort led by CMS and the Office of the National Coordinator for Health IT ONC-HIT. Providers had to show meaningful use, in other words that their EHR was being used in a meaningful way specifically to improve quality, safety, efficiency, and reduce health disparities, engage patients and families in their health, improve care coordination, improved population and public health and, ensure adequate privacy and security protection for PHI. In 2018, CMS announced a new phase of the electronic health record incentive program with an increased focus on interoperability, including the exchange of data between health care providers and patient access to health data. CMS renamed the EHR Incentive program as the Promoting Interoperability PI 177 programs. In 2019, CMS introduced the Interoperability and Patient Access Proposed Rule to expand access to health information and improve the exchange of healthcare data. Starting in 2019, CMS and ONC require all eligible healthcare providers and hospitals to use the 2015 edition criteria for certified EHR technology to qualify for the PI Program. Health department play an essential role in partnering with health care providers to support EHR used to better manage and prevent type 2 diabetes in patients at high risk. In some cases, you will also need to partner with organizations offering type 2 diabetes prevention and diabetes management programs. EHR strategies can be used to increase patient awareness, identify risk, appropriately refer patients to evidence-based programs, and help support better diabetes management. When your healthcare provider partners implement specific EHR strategies you can provide support towards improved outcomes. Let's talk about how EHR interventions and partnerships with local health systems and health care providers can help you achieve your type 2 diabetes prevention and management objectives. To focus your efforts consider your overall objectives especially as they relate to the patient journey. Are you focused on improving patient awareness and education related to either prediabetes or type 2 diabetes? Increasing patient risk assessment to identify patients with prediabetes or undiagnosed diabetes? Increasing the rates of appropriate physician referral to type 2 diabetes prevention and diabetes management programs? Increasing enrollment in CDC recognized LDP's or DSME as programs? Or, improving diabetes management and clinical quality of care? Once you review your objectives and begin to identify where to focus your effort you will want to engage with potential health care provider partners to see what is feasible. You may want to engage with potential providers partners to understand what providers in your targeted area are already doing with EHRs and which EHR platforms are used. This slide and the next slide include several potential questions you could ask in interviews or surveys including: Do you use EHRs? What vendors and specific platforms? What subpopulations does your office or hospital serve? What special consideration should we be aware of? Can the EHR vendor accommodate EHR changes? Here on this slide are more questions you can ask in interviews or surveys. Would you be able to identify leadership or staff champions to support widespread adoption? What barriers or challenges to implementation do you anticipate? In summary use these and other questions to explore whether strategies you want to implement are feasible given cost, time, and other constraints. Let's explore how you can talk with healthcare providers about EHR use from the perspective of the patient journey. The concept of patient journey has developed as a way to describe how a patient with type 2 diabetes or prediabetes interfaces with the healthcare system. It is shown as a linear process in this webinar however an individual patient might experience the parts of the journey iteratively or in a different order. The patient journey includes these parts: awareness and education, when a patient learns about prediabetes or type 2 diabetes including risk and available programs; risk assessment and diagnosis, when a patient learns they have prediabetes or type 2 diabetes or learns about diabetes complications; referral, when a provider refers a patient to a type 2 diabetes prevention or diabetes self-management education and support program program; enrollment, when a patient enrolls in a type 2 diabetes prevention or diabetes self-management education and support program, and management, when a patient works with health care providers to manage their condition and prevent type 2 diabetes or diabetes complications. One part of the patient journey is patient awareness of and education about prediabetes or type 2 diabetes, including awareness of individual risk and programs to help prevent or manage these conditions. To improve patient awareness and education providers can strategically use patient portals which are secure website through which patients access health information stored in the EHR. Patient portals can increase access to health records by allowing patients to download, share and otherwise engage with their health data. A patient might collect data manually or with a tracking device and upload the information via the patient portal. Examples include blood sugar readings, medication taking, body weight and physical activity or nutrition logs. Providers review health data that have patient captures and records data in EHRs. Providers can then better understand their patients behaviors, habits and health risk. To educate patients providers can use patient portals to increase patient awareness of a disease and reduce the risk of patients using unreliable information. They can also provide tailored information and educational resources to involve patients and share decision-making regarding treatment care plans or tests. Let's discuss an example from the field. The University of California Davis health system initiated a project to integrate patient generated data into EHRs. One part of the project focused on improving the health of patients with type 2 diabetes. UC Davis integrated fitness tracker data such as steps, activity, sleep, and caloric information from patients into their EHR. This application of patient generated data mad it easier for providers to compare the data to metrics like A1c and have conversations with patients about how behavior change impacts their disease management. How state health departments can facilitate awareness and education using EHRs. First you will need to determine the awareness and educational opportunities and limitations of the specific EHR system used by the healthcare provider partner. The following areas can be explored during your conversation. Find out whether your potential health care provider partner currently use or would promote the use of patient portals. More patients access their records when prompted by a provider. Identify the limitations of what kinds of data and information can be uploaded and integrated into the EHR. You can provide patient tailored educational resources that providers can share through a patient portal to promote awareness and education. Using another example from the field Epic Systems and the Mayo Clinic collaborated so that users of Epic Systems My Chart patient portal can access patient facing educational resources relevant to diabetes developed by the Mayo Clinic. The resources are available in English and Spanish. Mayo Clinic medical experts regularly review and update their resources and update the resources as needed. Another part of the patient journey is risk assessment and diagnosis when a patient learns that they have prediabetes or type 2 diabetes. The primary challenge for healthcare providers and health departments is to identify those patients with undiagnosed type 2 diabetes or diabetes complications. To address this challenge healthcare providers and health departments can use EHR data to apply risk scores to identify individuals with prediabetes or type 2 diabetes, such as the prediabetes patient risk assessment. Use EHR phenotyping, a practice of developing algorithms or formulas that use EHR data to identify population characteristics associated with prediabetes or type 2 diabetes. Embed or use computerized disease registry data, which is a list of patients with a certain disease or condition, within EHRs to aid with identification of patients with prediabetes or type 2 diabetes or risk for diabetes complications. Use clinical decision support systems, which combine clinical knowledge with person specific data, to help providers identify and treat high-risk patients for instance. EHR phenotyping can be used to screen for prediabetes or potentially undiagnosed type 2 diabetes. Phenotyping can also be used to identify non-traditional risk factors associated with type 2 diabetes development. Non-traditional risk factors may include diet, markers of chronic inflammation, metabolic abnormalities, genetic markers, or other factors. If you're implementing EHR phenotyping here are some possible considerations. As a state health department consider working with healthcare partners to identify an appropriate algorithm for data the provider has collected. You can also collaborate with your healthcare provider partner to add to algorithms and to provide appropriate training on the use of the algorithms. In another example from the field researchers at the University of California Los Angeles predicted patients type 2 diabetes risk by using an algorithm applied to information in de-identified electronic health records. They also identified previously unknown risk factors for type 2 diabetes. The researchers estimated that in the United States using EHR phenotype screening could identify an additional 400,000 people with active and untreated type 2 diabetes compared with conventional approaches. The purpose of Clinical Decision Support or CTS systems is to help providers get the right information at the right time reducing the likelihood of misdiagnosis or other errors. These systems help organized large volumes of EHR data. They combine specific, they combine scientific knowledge with person-specific data and can assist providers to identify high-risk patients, consider alternative diagnosis, order specific tests, and more. A CDS system integrated within an EHR can be used to identify patients at higher risk for developing type 2 diabetes or to help in the early detection of diabetes complications such as chronic kidney disease. Here are some considerations for implementation of clinical decision support systems. You can learn the specific challenges your healthcare provider partner faces in identifying patients with prediabetes or undiagnosed type 2 diabetes or in detecting diabetes complications and identify ways that a CDS system might be able to address these challenges. You can also determine how feasible it is to implement a CDS system within the EHR system. In the referral part of the patient journey EHR can be used to refer a patient to appropriate treatment. This can include referral to a type-2 diabetes prevention or diabetes management programs. The referral process can be streamlined by using EHRs or electronic referral using embedded referral forms. We will now turn our attention to the various ways that EHRs can be used in the patient referral process. EHRs can be designed to allow healthcare provider partners to electronically refer or refer patients to a community health program such as type 2 diabetes prevention or diabetes management program. Bi-directional e-referral occurs when a provider refers a patient to a type 2 diabetes prevention or diabetes management program through an EHR and the organization offering the program is able to provide feedback to providers through the EHR. This feedback means providers learn whether an enrolled patient participates and the details of their progress closing the information loop between the organization and the provider. Here are some considerations for implementation regarding eReferrals. For eReferral, you can work with a health care provider partner to understand why and how they refer patients to programs and how they access up-to-date information about available programs. Try to determine how electronic referrals can be part of the EHR and provide workflows. You can also learn how community or clinically based organizations will receive the eReferrals. For bi-directional referral recognize that access to EHRs is rare for community-based programs compared to clinic based and that workarounds to direct access to EHRs may be needed for community based programs to provide feedback. Consider working with partner organizations to understand existing referral practices and communication. In the Bronx New York Montefiore Health System partnered with the YMCA of Greater New York to deliver the YMCA's IVs prevention program, YDPP. They developed a referral system that was fully integrated with their EHR. At first the health system relied on paper referral but then shifted to electronic referrals integrated in the EHR. One of the first challenges encountered in this partnership was getting Montefiore providers to agree to the referral workflow which required obtaining written patient consent for referral to be sent to the YMCA. After program enrollment the final part of the patient journey is prediabetes or type 2 diabetes management in which the patient works with health care providers to manage diabetes and prevent complications. When providers, patients and program sites can share information readily and close feedback loops prediabetes or type 2 diabetes management can be a smoother process. Patient portal used for patient data and feedback and bi-directional eReferral and EHR Alerts can help stakeholders to learn when a patient enrolls, stay connected, and use available data for better management of prediabetes or type 2 diabetes. As we noted earlier in the presentation patient portals are secure websites that allow patients to access their health records from an EHR. Patients can use portals to download, share and otherwise engage with their health data. Patient portals can be used to support management of a patient's condition. Examples include integrating patient generated health data, or data that a patient captures and records in EHRs, such as blood sugar readings, body weight, or medication taking. Such data can be used to monitor patient progress during a treatment program. This can help providers create more tailored strategies for the management of chronic conditions. Another example is allowing patients to provide feedback via the patient portal during their type 2 diabetes treatment program. This can help patients feel a stronger sense of connection to their healthcare team. In addition providers can use feedback from patients to adjust care plans. As you're implementing patient portals here are some considerations as noted earlier. Find out whether your potential healthcare provider partners currently use, or would promote the use of patient portals. More patients access their records when prompted by a provider. Try to identify limitations for what kinds of data can be uploaded and integrated into the EHR. EHR alerts are reminders for providers that are integrated into the clinical workflow. Alerts can help with type 2 diabetes management and maintenance of treatment plans and ensure that critical points of patient care are not overlooked by patients or providers. As a part of bi-directional eReferral providers can receive alerts about a patient's progress in a community program. Alerts can help providers understand which tests are needed, problems that have been identified, and topics a patient needs more education on. Alerts and reminders may be part of a clinical decision support system within an EHR or they may be separate. Here are some considerations for implementation of EHR alerts. Learn how your health care provider partner already uses alerts to support type-2 diabetes management, if at all. You can determine whether providers would support the integration of alerts into the EHR system. You can also find out where alerts might offer the most benefit. Are there specific areas where the provider can better support type-2 diabetes management such as ordering appropriate tests, following up with patients who've missed tests or appointments or identifying patients with prediabetes or undiagnosed diabetes. In an example from the field Reliant Medical Group took advantage of EHR features to ensure a comprehensive approach to type-2 diabetes management. The EHR system includes alerts to inform diabetes education nurses about how a patient is doing in their type-2 diabetes self-management education and support program, alerts to remind providers to order needed tests, reminders to patients to have tests done including automated phone triggered calls triggered by the EHR, reminders to patients who miss appointments, and processes to follow up with patients who miss tests and appointments. EHRs have the potential to change provider workflows and improve patient care including for type 2 diabetes prevention and diabetes management, however there are limitations in how EHRs are used and perceived by providers, patients and others. We'll take a few moments now to provide an overview of these limitations. Technological limitations for EHRs include: interoperability. EHR systems work in different ways. These differences can limit the ability to exchange information between EHR systems. Standardization, EHR data are recorded, stored and exchanged in different ways. This lack of standardization can interfere with communication between EHRs. And adaptability, EHR vendors often do not provide customized products. Providers may be left with EHRs that don't work as well as expected. Legal limitations of EHRs include HIPAA. The Health Insurance Portability and Accountability Act law presents real and sometimes perceived limits to sharing patient data to improve patient care. Another limitation is state regulations. Because states have different patient privacy and health data exchange laws health care provider partners may be confused by various state level requirements and meaningful use policies. Previous policies provided limited incentives to ensure collaborative healthcare as we discussed earlier. New proposals aim to expand incentives for collaboration and promoting interoperability. Clinical workflow limitations for EHRs include interference with patient engagement. Use of EHRs can decrease provider engagement with patients and reduce the amount of time they spend with patients. And information overload and lack of readily available information is another clinical workflow limitation. EHRs can be an administrative burden for providers with too many alerts, decreased quality of care and job satisfaction and missing test results. Providers also may not enter information into the EHR or they may enter incorrect information. There are also access limitations associated with EHR. For instance not all patients have access to providers who use EHRs. Some patients don't have access to portals and even patients willing to access portals may not want to provide other personal data. In addition some patient populations prefer traditional communication methods. In many rural areas EHR technology has been adopted more slowly. There are more infrastructure barriers, less electronic sharing of data and less overall preventive care. Less buy-in, access and exposure to new charts occur in some urban areas as well. Collaboration limitations for EHRs include the standardization. Proprietary EHR platforms, antiquated systems and lack of standard referral processes and reporting standards make it hard for providers and community partners to use EHR platforms as bi-directional referral systems. Another collaboration limitation is health care provider partner buy-in. A lack of buy-in and product champions leads to lags in referrals to community programs. Resistance to change on the part of health care provider partners can also be a factor. If health care provider organizations and community organizations do not have a shared vision and mission for how they will work together to use EHRs success is more challenging. One of the challenges in working with EHRs is changing policy and technology landscape. Government policies and private sector technologies specifically address existing challenges and limitations of EHR. CMS's focus on interoperability and the emergence of third-party apps are two areas that are rapidly changing. Keeping current with these changes will help you to keep your proposed interventions relevant and effective. As we mentioned earlier CMS announced new proposed rules in 2018 and 2019 with an increased focus on promoting interoperability. Additional announcements and policy changes related to CMS's focus on interoperability are emerging and expected. These changes should help overcome some of the current EHR interoperability challenges allowing for better exchange of information between healthcare providers, patients and potentially community organizations. You can stay current with updates by visiting the CMS website and the Office of the National Coordinator for Health Information Technology ONC website. As use of EHRs become increasingly common the need for solutions to common EHR challenges is being recognized. Third parties are developing applications or apps to help healthcare provider partners to address specific EHR challenges. One app platform is Smart Health IT which is run by the not-for-profit institution Boston Children's Hospital Computational Health Informatics Program and a Harvard Medical School Department for Biomedical Informatics. The platform was initially funded by the US government to develop standards, open source technology, and a community of app developers. Smart Health IT are publicly accessible. You should now be able to define EHRs, describe the importance of the EHRs, discuss EHR capabilities with health systems and healthcare providers, identify EHR strategies to support type 2 diabetes prevention and diabetes management objective and describe the limitations of EHRs including the changing landscape of EHR policy and technology. Here are some links to resources that you might find useful. Additional resources are available at www.cms.gov and www.cdc.gov. On behalf of CDC I want to thank you for participating in the "Using Electronic Health Records to Support Diabetes Management and Type 2 Diabetes Prevention" webinar.
B1 中級 電子カルテを活用した糖尿病管理と2型糖尿病予防の支援 (Using Electronic Health Records to Support Diabetes Management and Type 2 Diabetes Prevention) 2 0 林宜悉 に公開 2021 年 01 月 14 日 シェア シェア 保存 報告 動画の中の単語