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Utilization of Electronic Medical Records In Working towards Achieving the ‘Gold Standard' In Chronic

Sunday, October 21, 2012
Room 270 (Morial Convention Center)
Ayesha Mirza, Melissa Scites, S. Z. H. Bukhari and Mobeen H. Rathore, Pediatrics, University of Florida, Jacksonville, FL


Purpose: The National Committee for Quality Assurance (NCQA) developed the patient centered medical home model for improving standards in primary care. Objectives of NCQA's vision for a medical home are: physician centered, comprehensive, coordinated system of care with quality, safety and enhanced access. NCQA emphasizes importance of Electronic Medical Records (EMR) to achieve these standards. This is particularly important when providing care for individuals with a chronic illness eg. human immunodeficiency virus (HIV). We report our recent experience in applying for NCQA recognition and the vital role electronic medical records (EMR) played in this endeavor.

Methods: NCQA medical home criteria comprise 9 standards, with total 30 specific elements, 5-10 are must pass. Following steps were taken: a) exhaustive evaluation of current processes using NCQA survey tool (below), b) development of new procedures/processes facilitated by recent conversion to EMR and took 11 months.


Action (** must pass elements)

Access and Communication

Access & communication processes** and results**

Patient Tracking and Registry Functions

EMR for managing patient data, Organizing clinical data ** Use of system for population management

Care Management

Guidelines for important conditions** Preventive service clinician reminders, Practice organization, Care management for important conditions

Patient Self-Management Support

Documenting communication needs, Self management support**

Electronic Prescribing

Electronic prescription writing, safety, efficiency

Test Tracking

Test tracking and follow-up** EMR for managing tests

Referral Tracking

Referral tracking**

Performance Reporting and Improvement

Measures of performance** Reporting to physicians** Setting goals/ taking action, Reporting standardized measures,  reporting to external entities

Advanced Electronic Communication

Availability of interactive website, Electronic patient management and care support

[NCQA Medical Home Criteria **must pass ]

Results: The following procedures were then developed:1) processes to support patient access/communication. 2) systematically manage patient information with unique patient registries. 3) organize/document clinical information and identify at least 3 most frequently seen diagnoses for practice: HIV infection, hyperlipidemia, depression. 4) conduct activities to support patient/family self-management. 5) improve HIV quality care (HIVQC) by using timely information on all test/results/consultations. EMR was integral throughout this process.

Conclusions: Preparation for NCQA recognition required taking a hard look at existing practice policies/procedures. The corner stones of a robust medical home are care plan development/patient coordination, evidence based care management, and patient data management/tracking. Our center had the capability to perform all these functions but required concerted effort and pooling all resources to put into practice as well as extensive utilization of EMR to develop patient registries which would allow future  tracking of different health outcomes. This process will result in a) emphasis on improving HIVQC/improved health outcomes, b) potential greater reimbursements/cost savings by health plans, c) practices should consider utilizing this model to further enhance chronic disease care.