CCBC CDS Learning Session

Introduction:

In October 2012, TMIT Consulting, LLC (TMIT) partnered with Primary Care Development Corporation (PCDC) to assist them in presenting a Learning Session on Clinical Decision Support (CDS) to 16 Crescent City Beacon Community Health Centers (HCs) in New Orleans. TMIT’s role was to co-present the CDS 5 Rights, and a worksheet based on this framework for successfully enhancing target-focused CDS strategies. (This worksheet was an earlier version of the latest CDS/QI Worksheets). A core focus of this support was to augment the planned PCDC training on implementing CDS with an exercise to introduce the HCs to an approach and structured tool for documenting and improving information flows tied to CCBC clinical measures that HCs prioritized to address with CDS. The HCs examined their current work flows and information flows pertinent to their top priority CCBC measures, and started brainstorming improvements. PCDC then launched an 8 week activity period where they helped the HCs put into practice the QI tools - especially the CDS 5 Rights framework and CDS/QI Worksheet - introduced during the CDS Learning Session.

Activities:

• To prepare for the CDS Learning Session – especially the target-focused CDS configuration Activity within the Learning Session – PCDC staff reviewed and adopted with minor changes a CDS/QI worksheet that had recently been developed by the CDS/PI Collaborative.
• The Phase 1 engagement also included TMIT leading a CDS/QI Knowledge Sharing session among PCDC, LPHI and TMIT staff.
• In the CCBC CDS Learning Sessions, HCs received a daylong, in-person, action-focused training program (based on the CDS guidebooks and worksheet, and related team expertise) in an outcome-oriented, CQI approach to leveraging CDS.
  • The HCs selected a specific, high-priority measure relevant to their patient population and the goals of the CCBC project that they wanted to target for improvement through an intensified CDS focus.
  • The centers then received step-by-step guidance (implemented during target-focused exercises and activities designed by PCDC staff and CDS subject matter experts) on key CDS implementation tasks (e.g., choosing clinical objectives, examining care flow related to meeting these objectives, training on rolling out CDS interventions, monitoring data related to these CDS interventions, etc.).
  • A centerpiece activity applied the CDS/QI worksheet to document the “who, what, when where, how” of current information flows in the HC related to the target (i.e., the current CDS configuration). The HCs then considered potential enhancements to this configuration that could accelerate their progress toward improvement goals. For example (and as called for in the Meaningful Use Stage 2 Final Rule), HCs considered the broad range of potential CDS interventions that could be used, and the many points in clinician and patient workflow where these interventions could be delivered.
• Flowing from this session were Planning Sessions with PCDC and LPHI to develop an Action Plan for PCDC/LPHI activities during the 8-week Action Period and beyond. The goal of the Action Period was for PCDC Coaches to help HCs build on the CDS/QI work during the Learning Session, and apply it to improving their targeted care processes and outcomes.
• Other TMIT support provided during the Phase 1 engagement included conducting an LPHI Clinical Seminar on CDS-enabled performance improvement, and attending an onsite PCDC coaching visit with a CCBC HC.

Results:

• All stakeholders indicated that TMIT’s participation in the Learning Session and related activities added significant value to CCBC efforts. For example, this value included providing a deeper understanding of the Meaningful Use context for CCBC’s CDS efforts, and empowering CCBC with useful new CDS/QI tools. More specifically:
  • LPHI achieved their objective of augmenting PCDC’s change management work with the structured, CDS 5 Rights-based tool to help improve information flow-enabled QI in CCBC HCs. The CDS/QI worksheet also provides LPHI with a richer framework for assessing process changes resulting from CCBC’s CDS/QI efforts.
  • PCDC likewise found that the collaboration enhanced the value of their CCBC CDS/QI training, including tying it tightly to other CCBC QI training modules and Stage 2 Meaningful Use requirements.
• All HCs that participated in the CDS Learning Session successfully completed the 20-minute exercise to consider and document current information flows and work flows – and potential enhancements - related to their high priority CCBC clinical measures. Each identified promising improvement opportunities, indicated the exercise was valuable, and they planned to continue building on this CDS/QI foundation.
• HCs indicated early in Dr. Osheroff's introduction to the CDS configuration worksheet that they considered “pop-up alerts” a core CDS intervention. Of great significance given the widely experienced problems associated with “pop-up alerts,” none of the HC report-outs of their potentially enhanced CDS configurations developed during the exercise included pop-up alerts as a central feature. Rather (as intended), the enhancements addressed more efficient and effective utilization of people, information delivery channels and formats, and workflow opportunities for CDS. That is, intervention configurations that better address the “CDS 5 Rights.”
• One HC Medical Director commented - after Dr. Osheroff reinforced during the coaching site visit that optimizing clinical information flow (e.g., via broad and robust approach to CDS) is very powerful QI tool - that this was a valuable, paradigm-altering revelation for her.
• Clinical Seminar Attendees generated rich discussion.