Rajeev Chaudhry MBBS MPH
Consultant Primary Care Internal Medicine
Leader, Health Information Management Systems
Leader, Mayo Clinic Connection Platform, Center for Innovation

Employee and Community Health
( Mayo Clinic’s Primary Care )
• 105 Physicians
• 154 Nurses ( 12 new case managers)
• 182 Allied Health employees
• 6 Practice locations
• 2 Divisions, 1 Department
( Internal Medicine, Family
Medicine and Pediatrics)

Mayo’s Primary care’s Connected
Care needs
•
Systems must be designed to enable longitudinal care compared to “usual” episodic care :
•
Know who our patients are
•
Know what our patients need in a proactive manner
• Alert patients and provide them “coordinated” access
• We must “care for” the patient at all times, not just when they request our care for a symptom related illness
•
When we see them we need to provide all the care they need

Who we need to provide
“connected” care for…
•
All preventive services for 140,000 patients ( cancer screenings, immunizations, metabolic screenings and wellness counseling)
•
Chronic disease management
•
20,000 Hypertension patients
•
•
10,000 Depression patients
8,000 Diabetes patients
•
•
•
•
7,000 Asthma patients
7,000 Coronary Artery Disease patients
3,000 Congestive Heart Failure patients
And many other chronic conditions
•
Acute Illness management for all 140,000 patients

So what we needed…
•
Information systems to know needs of all of our patients needs for care
•
Utilizing our allied health staff to offload responsibilities from MD’s both at population level and for patients being physically seen (
GDMS-Vitalhealth Software) for preventive care and care for chronic conditions so that our MD’s can spend their valuable time caring for patients and not spending their time searching for the information

Health Information Management
Systems at Mayo
•
Point of care –Generic Disease
Management System ( GDMS, 2007)
•
Population Management and Quality
Reporting (Microsoft Amalga, 2009)
•
Cost and utilization Reporting
( Currently physician portal)

GDMS Application Structure
Mayo Clinic
EMR Data
MICS
Cl. Notes
Web
Services
Labs, Vitals
Preventive services
Problem list
Immunizations
Allergies
Vital Health
GDMS
Web interface
CRD Demographics
GDMS application
Colonoscopy
Flex Sig
GI
Tobacco use
GDMS database
PPI
CP1309217-13

GDMS ECH User Satisfaction Survey
April 2008, All staff n=122
Time saved per patient for preventive services, diabetes and CAD care
•
3.9 minutes per patient for MD's
•
2.7 minutes per patient for LPN's
•
2.17 minutes per patient for CA's/ appointment coordinators
CP1309217-8

GDMS
ECH Zoster Vaccine Volumes
600
ECH
500
400
376% increase
300
200
PCIM
FM
100
0
Ja n
Fe b
Ma r
A pr
Ma y
Ju n
2007
Ju l
A ug
Se pt Oc t
N ov De c
Ja n
Fe b
2008
CP1309217-4

Percent of People that Received AAA Screening after their Appointment and had not
Received the Screening in the past 5 years in 2007and 2008
30.00%
25.00%
25.29%
21.84%
20.00%
20.00%
18.24%
15.75%
15.00%
10.00%
3.80% 4.05%
5.00%
0.00%
0.00%
Mayo Family Clinic
Northwest
0.00%
Mayo Family Clinic
Northeast
Family Medicine-
Baldwin
Mayo Locations
Primary Care Internal
Medicine
3.22%
Total
2007
2008

ECH Satisfaction Survey for GDMS – April 2008
Physicians n=38
4.
The GDMS recommended action for patient age and sex-specific average risk preventive services help me with identifying the services that need to be scheduled
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
26
11
0
0
0
%
70.3
29.7
0.0
0.0
0.0
0 20 40 60 80 100
5.
The GDMS recommended action for patient tests needed for diabetes mellitus
(DM) help me with identifying the tests that need to be scheduled
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
24
12
2
0
0
%
62.3
31.6
5.3
0.0
0.0
0 20 40 60 80 100
6.
GDMS supports my work flow and improves efficiency in providing average risk preventive services and testing for diabetes patients
Response
Strongly agree
Somewhat agree
Neither agree nor disagree
Somewhat disagree
Strongly disagree
Frequency
24
11
2
0
0
%
64.9
29.7
5.4
0.0
0.0
0 20 40 60 80 100
CP1309895-1

EMR Interfaces Overview for HIMS at Mayo
MICS
Lastword
Clinical
Notes Labs
Reg
Vitals
Immunizations
Allergies
Problem List
Views/Queries/
Reports
MSS/GPAS Patient Appointments
Provider Panels
PPI
Tobacco Use
External Services
Preventive Services
Data Base
Medications
Patient Visits
Cost
Mastectomy
Hysterectomy
Rules/
Applications
DSS
Dept.
Systems EOP
SIRS

Amalga UIS Applications at Mayo
Data from Clinical Systems
Parsing of data for application
Systems for end users
Systems are designed to lead to Standardized care

Registry view to get “real time” information of all the Diabetic patients

List of all the Diabetic patients to be contacted in “next 30 days” with “real time” data

List of all the patients that “care manager” needs to contact in next 7 days for “optimal care”

Patient “detail view” enabling navigating from all the patients to one patient in “real time”

“Plan of care” module to record patient’s preferences and “goal setting”

Past processes of care r
Consume
Preventive Services
Report received
Clinic
Call MD Office for Mammogram
Call patient
MD to RN
Appointment Office takes message
Mammogram done
Message to
RN
MD reviews message
OK to
RN
Mammogram ordered
Call back appt. office
Retrieve
Message
RN to Appt.
Office
Call
Patient
Not Home

r
Population Management (Prevention and Diseases) New Process
Consume
Mayo
Population
Management
Clinic
Pull data of all 140,000 patients
Identify who is due
(Evidence based)
ECH
130,000 patients Services performed
Schedule services due
( visit or non visit based)
Communication to patients
Call PAC

•
Population-based systems to improved breast cancer screening by 33% in a randomized controlled trial for 12,000 patients.
•
Only 0.5 FTE appointment secretary needed to manage the needs of all patients
Chaudhry R, Scheitel S, McMurtry E, et al. Web-Based Proactive System to Improve
Breast Cancer Screening: A Randomized Controlled Trial. Arch Intern Med 2007; 167:606-
611.

Will population management help
Primary Care-Contd.
•
Diabetic patients managed with a single contact based on information systems had significant improvement in low-density lipoprotein control
(35.4% vs 13.3%; P=.004). The intervention group also had a greater percentage of patients who also showed better control of hemoglobin
A1c
•
Chaudhry R , Tulledge-Scheitel SM , Thomas MR , Hunt VL , Liesinger JT , Rahman AS ,
Naessens JM , Davis LA , Stroebel RJ , Clinical Informatics to Improve Quality of Care: A
Population-Based System for Patients With Diabetes Mellitus, Primary Care
Informatics, 2009 ; 17: 95-102
33

Population informatics-based system to improve osteoporosis screening in women in a primary care practice.
•
25% of the 689 patients responded to the letter and completed osteoporosis screening. Patients who had osteoporosis screening received appropriate treatment.
J Am Med Inform Assoc. 2010 Mar-Apr;17(2):212-6.
Kesman RL , Rahman AS , Lin EY , Barnitt EA , Chaudhry R .

Thanks !
Needs of Patients Come First
— Dr. Mayo