Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology (New Mexico)

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Summary:

Hepatitis C virus (HCV) infection is a significant public health problem. The Centers for Disease Control and Prevention (CDC) estimates that 3.9 million people in the U.S. are infected with the disease and are at risk of developing liver cirrhosis and liver cancer. Treatment of HCV and eradication of the virus prevents future complications, but few patients outside the urban academic setting are able to receive adequate treatment. New Mexico-based Project ECHO – Extension for Community Healthcare Outcomes – partners with primary care clinicians throughout the State to safely and effectively treat HCV. ECHO trains and supports rural health care professionals so that rural patients receive the same level of care as patients at academic medical centers.

This project built on the work of Project ECHO: Extension for Community Healthcare Outcomes, previously funded by the Agency for Healthcare Research and Quality. This new project developed and deployed iHealth, an Internet-based disease management tool. iHealth collects data and generates reports to enhance management of HCV. The project focused on creating additional iHealth features and promoting its adoption.

The specific aims of this project were to:

  • Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. 
  • Develop a Web portal that creates a central identity for the HCV program and provides a single access point for its resources. 
  • Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. 
  • Develop a system that automatically uploads laboratory data from TriCore. 
  • Promote adoption of iHealth clinical management system. 

Focus groups with patients and clinicians were conducted throughout the project to elicit information about needs, desired tools and content, and the likelihood of iHealth and clinician and patient Web portals use. These sessions identified barriers to adopting the tool and provided feedback for the development of improved training tools. Pre- and post-tool implementation surveys were conducted. Prior to full release, iHealth was tested to get feedback on usability and acceptability.

The project team successfully designed and implemented the iHealth tool. The Web portal for clinicians was completed, and a prototype for a patient portal was developed. Adoption of the iHealth tool was promoted by identifying user needs, soliciting feedback, and providing enhanced training. Analytic data marts were created so that subsets of data could be extracted from the database to develop outcome studies. The project created the ability to automatically upload laboratory data into iHealth. At the end of the grant period, tools to support ad hoc reports, a data dictionary, and search tools to enhance iHealth were being developed.

Patient and clinician focus groups indicated that an HCV patient portal would be a valuable tool for patients to access disease information, treatment status, and to educate themselves and others about the disease. Clinicians supported the idea of a patient portal. The project team was able to demonstrate that iHealth is a useful tool in the treatment of HCV that participants were willing to use.

Project ECHO: Hepatitis C Ambulatory Care Quality Improvement in New Mexico Through Health Information Technology - 2012

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health Information Technology to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018171
  • Project Period: 
    July 2009 – July 2013
  • AHRQ Funding Amount: 
    $1,199,696
  • PDF Version: 
    (PDF, 316.12 KB)

Summary: This project builds on the work of Project ECHO: Extension for Community Healthcare Outcomes, which was previously funded by the Agency for Healthcare Research and Quality. Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO’s inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO’s rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers to site maintenance, VPN problems, and critical datafeed and reporting inadequacies.

To address these issues, Project ECHO will focus on the use of an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This system will improve quality of care and lead to greater knowledge sharing among health care providers for rural and underserved populations. Enhancements are being made to the electronic disease management tool iHealth. iHealth and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed via a Web portal, the central identity for the HCV program, providing a single-access point for iHealth resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data is being uploaded automatically into patients’ electronic health records.

The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. Web portals for patients are providing educational links and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can provide tools for HCV treatment and coordinate training activities. Patient needs were assessed and determined via patient focus groups.

Specific Aims:

  • Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. (Achieved)
  • Develop a Web portal that creates a central identity for the HCV program and provides a single-access point for its resources. (Ongoing)
  • Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. (Achieved)
  • Develop a system that automatically uploads laboratory data from TriCore. (Achieved)
  • Promote adoption of iHealth clinical management system. (Achieved)

2012 Activities: Patient focus groups were conducted and the patient portal prototype was developed. The team anticipated presenting the prototype before an HCV teleECHO clinic in spring 2013. Provider portal resources continued to be developed as informed by focus group findings. The treatment protocol was revised and made available with the summary report.

The team continued to train practices and promote the use of iHealth. Development of the Web portal was initiated. Dr. Arora is using 1-year a no-cost extension to develop additional portal resources and continue data collection. As last self-reported in the AHRQ Research Reporting System, project progress and activities are on track and budget spending is on target.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Adults, Chronic Care*, Hepatitis C

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*This target population is one of AHRQ’s priority populations.

Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology - 2011

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    RFA: HS07-007: PAR: HS08-270: Utilizing Health IT to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018171
  • Project Period: 
    July 2009 - June 2012
  • AHRQ Funding Amount: 
    $1,199,696
  • PDF Version: 
    (PDF, 194.16 KB)

Summary: This project builds on the work of Project ECHO: Extension for Community Healthcare Outcomes, which was previously funded by the Agency for Healthcare Research and Quality. Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO's inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO's rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers to site maintenance, VPN problems, and critical datafeed and reporting inadequacies.

To address these issues, Project ECHO will use an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This system will improve quality of care, and lead to greater knowledge sharing among health care providers for rural and underserved populations. The enhancements to the electronic disease management tool, iHealth, and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed as a Web portal, the central identity for the HCV program, providing a single-access point for its resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data from TriCore Reference Laboratories (TriCore) will be uploaded automatically into patients' electronic health records.

The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. Web portals for patients will provide educational links and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can provide tools for HCV treatment and coordinate training activities. Patient needs will be assessed and determined via patient focus groups.

Specific Aims:

  • Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. (Achieved)
  • Develop a Web portal that creates a central identity for the HCV program and provides a singleaccess point for its resources. (Ongoing)
  • Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. (Ongoing)
  • Develop a system that automatically uploads laboratory data from TriCore. (Achieved)
  • Promote adoption of iHealth clinical management system. (Ongoing)

2011 Activities: Disease management tools were developed during the year. There are two safety reports. One is automatically-generated based on audit parameters that are established clinical criteria; the other is a safety report that can be generated by anyone with appropriate authorizations to query certain clinical parameters. The final iteration of the HCV summary report is in the software that tracks clinical data over time during the patient's course of HCV treatment.

The following practice support tool has been developed: An internal calendar that identifies future dates for clinical encounters and labs that must be obtained for compliance with best-practices protocols. Adverse-event identification is accounted for in the safety report.

The provider portal was completed and includes links to provider educational resources including clinical protocols, National Institute on Alcohol Abuse and Alcoholism guides for alcohol interventions, and ongoing clinical trials. Functions to strengthen learning and enhance clinical decisionmaking, including non-identified patient-mirrored cases to enhance learning loops, have been developed. An interface with the iECHO partner relations management tool is being developed for didactics, continuing medical education, and other training functions.

It is now possible to obtain a subset of data from the database to develop outcome studies. Concerns regarding institutional review board and confidentiality have led the team to believe that this should not be a Web-based functionality at this time, and have opted for a human interface.

The first extracted data set was used for research and the results were published in June in the New England Journal of Medicine. This functionality can be provided to any researcher meeting authorization requirements. The roll-out of iHealth clinical management system was initiated.

As last self-reported in the AHRQ Research Reporting System, project progress and activities are mostly on track and project budget funds are somewhat underspent because of delays in staff hiring.

Preliminary Impact and Findings: The project has no findings to date.

Target Population: Adults, Chronic Care*, Hepatitis C

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use ofintegrated data and knowledge management.

Business Goal: Knowledge Creation

* This target population is one of AHRQ's priority populations.

Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology - 2010

Summary Highlights

  • Principal Investigator: 
  • Funding Mechanism: 
    PAR: HS08-270: Utilizing Health IT to Improve Health Care Quality Grant (R18)
  • Grant Number: 
    R18 HS 018171
  • Project Period: 
    July 2009 – June 2012
  • AHRQ Funding Amount: 
    $1,199,696
  • PDF Version: 
    (PDF, 384.38 KB)


Target Population: Adults, Chronic Care*, Hepatitis C

Summary: This project builds on the work of a previous Agency for Healthcare Research and Quality- funded project, Project ECHO: Extension for Community Healthcare Outcomes. Providers require access to patient-specific information to consult on cases, track patient progress, and evaluate clinical outcomes. At Project ECHO’s inception, community-based providers transmitted patient-specific information to specialists via a data management system. Data were entered and stored locally on a laptop, transmitted via a secure virtual private network (VPN), and maintained in a centralized Health Insurance Portability and Accountability Act-compliant structured query language database server to support both clinical and research activities. With Project ECHO’s rapid expansion, this type of data management proved inadequate because it presented numerous insurmountable barriers in site maintenance, VPN problems, and critical datafeed and reporting inadequacies.

To address these issues, Project ECHO will use an Internet-based clinical management system for patients undergoing treatment for hepatitis C virus (HCV). This will improve quality of care, and lead to greater knowledge sharing among health care providers for rural and underserved populations. The enhancements to the electronic disease management tool, iHealth, and the clinical management system will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. The iHealth tool will be accessed as a Web portal, the central identity for the HCV program, providing a single-access point for its resources. The portal includes search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. Laboratory data from TriCore Reference Laboratories (TriCore) will be uploaded automatically into patients’ electronic health records.

The underlying iHealth architecture supports effective management of patient data across multiple provider organizations. The Web portals for patients will provide educational links, and allow patients to see their summary reports, facilitating better communication with their providers. The provider portal can be used to coordinate training activities and provide the tools for HCV treatment. These patient needs will be assessed and determined via patient focus groups.

Specific Aims:
  • Develop a disease management tool that will standardize data collection, provide practice support, create a central data repository, and allow authorized personnel to view individual patient records. (Ongoing)
  • Develop a Web portal that creates a central identity for the HCV program and provides a single-access point for its resources. Create search tools that program personnel can use to extract data for monitoring data quality, profiling, quality improvement, and research. (Ongoing)
  • Develop a system that automatically uploads laboratory data from TriCore. (Ongoing)
  • Promote adoption of iHealth clinical management system. (Ongoing)

2010 Activities: Many programming enhancements were completed including: improved screen flow with less mouse-clicking to access data; a home page dashboard to review and access common activities quickly; messaging system for e-mail, phone, and walk-ins; communication directly entered into chart and/or archived; improved readability of protocol summary and lab flow sheets; better entry of medication information with type-ahead lookup and single-click entry of information; a case presentation system to generate information for clinics easily; electronic documentation of recommendations are accessible via the patient’s flow sheet; HCV summary reports to follow treatment over time; calculation of visit schedule; display of priority medications in all the hepatitis C tabs; display of previous presentations done for the patient; ability to add or remove patients to or from a presentation; ability to freeze or unfreeze clinics; and the ability to print patient HCV reports.

Beta testing of iHealth was conducted with nine ECHO HCV community participants, representing four ECHO partner health organizations and eight clinic locations. The pilot test was followed by a focus group to capture participants’ comments on the iHealth disease management tool.

The team developed an electronic survey to query current participants of Project ECHO’s HCV Telehealth Clinic. This survey asks ECHO clinicians and their teams about their thoughts on electronic medical records, disease management tools, and access to a Web-based portal for HCV patient information. Fifty-five surveys were sent out and 40, or 72.7 percent, were completed and returned to Project ECHO.

Project ECHO's database interface linking iHealth patients with TriCore’s master patient index has been established. Effectiveness is being evaluated on the test server.

Grantee's Most Recent Self-Reported Quarterly Status (as of December 2010): The project is mostly on track and is meeting its aims on time, but funds are somewhat under-spent. This is a result of delays in fully staffing the project as well as conservation of funds in anticipation of a no-cost extension.

Preliminary Impact and Findings: The project does not have any findings to date.

Strategic Goal: Develop and disseminate health IT evidence and evidence-based tools to improve health care decisionmaking through the use of integrated data and knowledge management.

Business Goal: Knowledge Creation

*AHRQ Priority Population.

Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology - Final Report

Citation:
Arora S. Project ECHO Hepatitis C Ambulatory Care Quality Improvement in New Mexico through Health Information Technology - Final Report. (Prepared by the University of New Mexico under Grant No. R18 HS018171). Rockville, MD: Agency for Healthcare Research and Quality, 2013. (PDF, 116.01 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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