Resources for Improving Care Processes and Outcomes with CDS
In parallel with guiding and providing tools for Collaborative-related quality improvement projects, TMIT Consulting, LLC (TMIT) has worked with federal agencies and others to synthesize guidance for providers and their partners on improving care delivery and outcomes for high stakes targets. This guidance helps users apply the CMS-recommended CDS 5 Rights framework for ensuring that target-focused workflows and information flow support high quality decisions and actions by all those whose activities drive care results. The QI approach and tools guide users through addressing 'What are we doing today?' 'What should we be doing?' and 'How do we get there from here?' for these care processes. CDS/QI Worksheets and target-specific Change Packages (see below) are a centerpiece in addressing these fundamental questions.
Below is more information about and links to these federally-supported resources. Contact Jerry Osheroff for further information about them, or about enhanced versions of this material that TMIT uses in supporting target-focused QI efforts.
HRSA/BPHC Resources for Health IT-enabled Quality Improvement
In 2016, led development for HRSA of the Guide to Improving Care Processes and Outcomes, and developed/launched a training and technical assistance program to support application of this Guide in community health centers. This Guide builds on and improves the ONC eCQI Resources outlined below. Though health centers are mentioned specifically, the tools and strategies have been used successfully in various inpatient and outpatient settings. A webinar about the Guide and these approaches can be accessed here.
ONC eCQI Resources
In 2012 and 2013, TMIT led an ONC-supported Deloitte team in developing tools and resources for healthIT-enabled QI that were posted on healthit.gov. A description of that project and those deliverables is here. In 2015, TMIT worked with ONC to enhance that guidance and the resources by incorporating tools and learning generated by TMIT-supported QI projects. That updated material was folded into and replaced by the HRSA resource described above. (Note that the HRSA resource doesn't include the CDS/QI Worksheets for inpatient targets - if you're interested in those, contact Jerry Osheroff).
Target-focused Change Packages
As part of a CHCF-supported QI project on blood pressure control, TMIT began assembling and organizing tools that had been shown to help drive improved hypertension control. This work was amplified with CDC funding, and resulted in creation of the Million Hearts Hypertension Control Change Package (HCCP). This change package helps address 'What should we be doing?' regarding blood pressure control activities and tools in the same 3 categories for which the CDS/QI Worksheets help address 'What are we doing today' and 'How do we close gaps between the current and desired states?' These categories are Patient-specific Supports, Population Management, and Foundational Activities.
An EHR vendor has created a version of HCCP illustrating how its tools and capabilities can be applied to addressing the change concepts and change ideas in that generic tool. Email for more information about this vendor-specific hypertension control change package.
In another TMIT-supported QI project, a similar tool was created that provides change concepts and change ideas for diagnosing hypertension that is 'hiding in plain sight (HIPS)' in office practices. See here for the "HIPS" change package. Another project with HRSA produced a similarly-structured change package for colorectal cancer screening. Additional change packages for other improvement imperatives are planned.