Training providers: beyond the basics of electronic health records.

BACKGROUND: Training is a critical part of health information technology implementations, but little emphasis is placed on post-implementation training to support day-to-day activities. The goal of this study was to evaluate the impact of post-implementation training on key electronic health record activities. METHODS: Based on feedback from providers and requests for technical support, we developed two classes designed to improve providers' effectiveness with the electronic health record. Training took place at Kaiser Permanente, Mid-Atlantic States. The classes focused on managing patient-level information using problem lists and medication lists, as well as efficient documentation and chart review. Both classes used the blended learning method, integrating concrete scenarios, hands-on exercises and take-home materials to reinforce class concepts. To evaluate training effectiveness, we used a case-control study with a 1:4 match on pre-training performance. We measured the usage rate of two key electronic health record functions (problem list and medication list management) for six months before and after training. Change scores were compared using the Wilcoxon sign rank test. RESULTS: 36 participants and 144 non-participants were included in the training evaluation. Training participants were more likely to manage both medication lists and problem lists after training. Class material is now being incorporated into an enterprise-wide multi-modal training program available to all providers at Kaiser Permanente in the Mid-Atlantic States. CONCLUSIONS: Ongoing information technology training is well-received by healthcare providers, who expressed a clear preference for additional training. Training improved use of two important electronic health record features that are included as part of the Meaningful Use criteria.

Effects of between visit physician-patient communication on Diabetes Recognition Program scores.

OBJECTIVE: To determine whether physicians who interact with their patients between office visits using secure messaging and phone provide better care for patients with diabetes when controlling for physician, patient and care center characteristics. DESIGN: Retrospective study. SETTING: Kaiser Permanente Mid-Atlantic States. PARTICIPANTS: 174 Primary Care Physicians. INTERVENTION: We modeled the relationship between communication via secure messaging or phone communication and Diabetes Recognition Program (DRP) scores with a Generalized Estimating Equations model. Covariates included physician age and panel size, patient age, race, income and number of comorbidities, and the population density around the care center. MAIN OUTCOME MEASURE: DRP scores. RESULTS: Physicians whose patients were predominantly white or mixed race were more likely than other physicians to use secure messaging and phone with their patients between visits, but there was no significant association between such contacts and DRP scores (P> 0.1). In contrast, physicians with predominantly black or Hispanic patients had significantly higher DRP scores associated with the use of secure messaging (P< 0.01) and higher, though not statistically significant, DRP scores associated with the use of phone (P< 0.1). These associations were strongest for outcome measures such as HbA1c and lipid levels, and were weaker or nonexistent for process measures such as annual foot and eye exams. CONCLUSIONS: The use of secure messaging, and, to a lesser extent, phone, appears to be associated with higher quality diabetes care, particularly among at-risk populations.

Chlamydia screening in a Health Plan before and after a national performance measure introduction.

OBJECTIVE: To evaluate chlamydia-screening policies, testing practices, and the proportion testing positive in response to the new Health Plan Employer Data and Information Set (HEDIS) chlamydia-screening performance measure in a large commercial health plan. METHODS: We interviewed health plan specialty departmental chiefs to describe interventions used to increase chlamydia screening and examined electronic medical records of 15- to 26-year-old female patients--37,438 from 1998 to 1999 and 37,237 from 2000 to 2001--who were classified as sexually active by HEDIS specifications to estimate chlamydia testing and positive tests 2 years before and after the HEDIS measure introduction. RESULTS: In January 2000, the obstetrics and gynecology department instituted a policy to collect chlamydia tests at the time of routine Pap tests on all females 26 years old or younger by placing chlamydia swabs next to Pap test collection materials. Other primary care departments provided screening recommendations and provider training. During 1998-1999, 57% of eligible female patients seen by obstetrics and gynecology exclusively and 63% who were also seen by primary care were tested for chlamydia; in 2000-2001 the proportions tested increased to 81% (P < .001) and 84% (P < .001). Proportions tested by other primary care specialists did not increase substantially: 30% in 1998-1999 to 32% in 2000-2001. The proportion of females testing positive remained high after testing rates increased: 8% during 1998-1999 and 7% during 2000-2001, and the number of newly diagnosed females increased 10%. CONCLUSION: After the obstetrics and gynecology department introduced a simple systems-level change in response to the HEDIS measure, the proportion of females chlamydia-tested and number of newly diagnosed females increased.

Randomized trial of brief office-based interventions to reduce adolescent alcohol use.

OBJECTIVE: To determine whether office-based interventions change adolescents' alcohol beliefs and alcohol use. DESIGN: Randomized, controlled trial. SETTING: Five managed care group practices in Washington, DC. PARTICIPANTS: Consecutive 12- to 17-year-olds (N = 409) seeing primary care providers (N = 26) for general check-ups. Most of the adolescents (79%) were African American, 44% were male, and 16% currently drank. INTERVENTIONS: Usual care (Group I), adolescent priming with alcohol self-assessment just prior to check-up (Group II), adolescent priming and provider prompting with adolescent self-assessment and brochure (Group III). MAIN OUTCOME MEASURES: Adolescent alcohol beliefs at exit interview and self-reported behaviors at 6- and 12-month follow-up. RESULTS: At exit interview, Groups II and III reported that less alcohol was needed for impaired thinking and a greater intent to drink alcohol in the next 3 months than Group I. At 6 months, Group III reported more resistance to peer pressure to drink, and Groups II and III reported more bingeing than Group I. At 1-year follow-up, controlling for baseline levels, Groups II (odds ratio [OR], 3.44; 95% confidence interval [CI], 1.44-6.24) and III (OR, 2.86; CI, 1.13-7.26) reported more bingeing in the last 3 months than Group I. Group II reported more drinking in the last 30 days (OR, 2.31; CI, 1.31-4.07) and in the last 3 months (OR, 1.76; CI, 1.12-2.77) than Group I. CONCLUSION: Brief office-based interventions were ineffective in reducing adolescent alcohol use but may increase adolescent reporting of alcohol use.