Dr. Carpio Optimizes EHR System to Eliminate Gaps in Care
Dr. Felix Carpio is a family practitioner and Medical Director of Clinical Informatics at AltaMed Health Services, a federally qualified health center (FQHC) in Los Angeles, California. The health center is comprised of 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, establishing standardized workflow processes to eliminate gaps in health care and improve health care quality.
EHR Optimization Necessary to Eliminate Health Care Gaps
AltaMed Health Services first adopted an EHR system in 2009. During the first year of EHR implementation, the health system focused on transitioning from paper and entering data into the system. In the second year, 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.
Workflow Redesign Fills in the Gaps
For AltaMed, the first step to redesigning workflows and leveraging Health IT for quality improvement was establishing a clinical informatics department and a quality department. Together, the two departments decided 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 the HEDIS quality metrics. Seeing 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 a preventive screening protocol. According to 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 preventive screening and improves health care quality.
Streamlined Protocols Lead to Measurable Difference in Healthcare Quality
In the three years since it began optimizing its EHR system, AltaMed vastly improved its performance on all fourteen quality metrics. Between 2011 and 2013, for example, AltaMed’s:
- Breast cancer screening rate increased from 52% to 76%.
- Colorectal screening rate increased from 34% to 57%.
- Diabetic screening rate increased from 69% to 90%.
- Depression screening rate increased from 16% to 60%.
Clinical workflow redesign helped optimize the use of AltaMed’s EHR system. By streamlining their health system’s workflows Dr. Carpio and his colleagues helped improve the health system’s screening rates and eliminated critical gaps in care.
The Important Role of Meaningful Use
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.”