Prevention/Care Management, 2011

integrated Physician Network

March 2011

The integrated Physician Network (iPN), a collaborative of more than 160 independent physicians in the North Denver/Boulder, Colorado area, participated in AHRQ's electronic Preventive Services Selector (ePSS) Knowledge Transfer project to promote population health. As part of this project, iPN integrated the U.S. Preventive Services Task Force (USPSTF) recommendations into its NextGen electronic health record (EHR) system.

The iPN—with 30 primary care and specialty practices and a federally qualified health clinic providing care—now has 2 years of patient data in its EHR system. Data analysis has led to significant improvements in outcomes and patient care.

Preventive services reminders such as smoking cessation, Pap tests, mammograms, and immunizations are now available to all iPN practice staff through the EHR system. According to David Ehrenberger, MD, Chief Medical Officer, "These ePSS reminders are now only one click away."

The ePSS is designed to provide real-time decision support for clinicians regarding appropriate screening, counseling, and preventive services for their patients. It is based on the recommendations of the USPSTF and can be searched by specific patient characteristics, such as age, sex, and selected behavioral risk factors.

Ehrenberger says, "Getting providers to use the [USPSTF] recommendations is highly correlated with how well the providers work as a team." The iPN identified the traditional structure of a primary care team as a barrier to providing the highest quality preventive care. Ehrenberger believes practices must move the responsibility for documenting preventive care from providers' hands and transfer it to team members, for example, to the medical assistant. According to Ehrenberger, "Change in responsibility can lead to better adoption."

To allow physicians to focus on patient care needs, iPN trained non-provider staff to update and order preventive services at the start of a patient visit. The iPN also modified its EHR system to include the USPSTF recommendations as preventive maintenance alerts in the clinical decision-support system. According to Carolyn Shepherd, MD, the network's Clinical Quality Improvement Committee Chair, "This modification has made the workflow seamless."

The iPN uses "a quality coach to get the practices in the habit of entering preventive services data in the EHR fields accurately," says Marjorie Martens, RN, MBA, CPHQ, iPN Quality Manager. Martens believes that it is "important that staff know the flow of the EHR and where the data should go" in order to get more accurate data for their population-based management and quality improvement initiatives.

The iPN has also been working with the Colorado Foundation for Medical Care, the Quality Improvement Organization for Colorado, on a project to improve quality. They have focused on USPSTF recommendations—including breast cancer screening and colorectal cancer screening—for Medicare patients.

AHRQ provided technical assistance to iPN to incorporate the ePSS tool into its NextGen EHR product. AHRQ has also worked with more than a dozen primary care provider groups across the United States in the following ways:

• Assisting providers in implementing the ePSS widget into their EHRs.
• Assisting providers in implementing ePSS recommendations into their EHRs' clinical decision-support systems.
• Working with EHR vendors to ensure appropriate support during the technical implementation process.
• Providing support in using the USPSTF recommendations.

The ePSS, which is updated as new recommendations are released, can be downloaded to a PDA, accessed on the Web, or installed on any Web site as a widget. More information on both the PDA and Web versions is available at http://epss.ahrq.gov/PDA/index.jsp.

Knowledge Transfer Case Study Identifier: KT-CP3-63
AHRQ Product: USPSTF, ePSS
Topic(s): Prevention, Health Information Technology
Scope: Colorado

U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, 2010-2011. Rockville, MD: Agency for Healthcare Research and Quality; September 2010. http://www.ahrq.gov/clinic/pocketgd.htm

Electronic Preventive Services Selector. Rockville, MD: Agency for Healthcare Research and Quality. http://epss.ahrq.gov/PDA/index.jsp

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