Dr. Floyd Uses Health IT to Improve Fall Risk Screening for Elderly Patients
Dr. Frank Floyd is a practicing internal medicine physician and Associate Medical Director at United Health Services (UHS), a large medical group stretching across five counties in upstate New York. When the Centers for Disease Control and Prevention (CDC) selected UHS to pilot the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program, a national effort focused on fall risk screening and injury prevention, Dr. Floyd assumed leadership of the project. Through his work implementing a patient-centered medical home (PCMH) and other quality improvement programs at UHS, Dr. Floyd was familiar with using electronic health records (EHRs) and Health IT to improve health care quality. As a result, Dr. Floyd knew UHS’s EHR system would be critical in reducing fall risk among patients aged 65 and over.
Redesigned Workflows and EHR Optimization Capture Fall Risk
Dr. Floyd helped UHS incorporate several EHR workflow changes and optimize the EHR system to ensure fall risk screening became a standard component of every UHS office visit. For example, on the nurse intake template in the EHR, UHS added fall-risk screening questions, which nurses then integrated into their workflows. If a patient answers “yes” to any of the screening questions, a clinical decision support rule pops up and alerts the nurse to initiate a timed “up and go” walking test. If the patient fails the test or otherwise demonstrates an increased fall risk, the nurse records the information in the EHR system. Based on this information, the EHR system then generates a list of resources, educational materials, and possible treatments, such as balance programs and vitamin D supplements, which the nurse sends to the appropriate physician. “In the EHR system the nurse can track whether or not the patient enrolled in the right treatment programs and follow up if necessary,” Dr. Floyd explained.
In addition to helping UHS improve its fall risk screening processes, UHS’s EHR system allows UHS providers to track and monitor fall risk screening data. UHS incorporated a “date of last fall risk assessment” field into its nurse intake EHR template, enabling providers to identify patients that have not been screened in the past year. “We can look in the EHR system, by physician, to see how many patients had this problem and when they were last screened,” said Dr. Floyd, allowing providers to target their patient follow-up. “This quality improvement system is not something you could recreate in the paper world.”
Improved Health Care Quality
With EHRs, Dr. Floyd and UHS are improving health care quality. As a result of workflow redesign and EHR optimization, UHS is screening over 85% of its elderly patients for fall risk and bringing a 16th site into the STEADI program. “Our experiences show how you can leverage Health IT to develop successful screening programs,” Dr. Floyd said. As UHS continues to roll out the STEADI program to more sites, CDC will use UHS’s data and experience to guide program development and improve the program on a national level. UHS, in turn, is taking lessons learned from the STEADI program and applying them to other quality improvement programs. For instance, UHS recently developed a dashboard on its EHR system so that it can easily monitor performance on quality measures related to breast cancer screening, hypertension, and diabetes.