Using data to close care gaps in Miami-Dade County
“The data we were collecting was not complete, " says Diego I. Shmuels, M.D., chief quality officer for Borinquen. “And if the data requested [by a provider] was not proper, that meant we were paying for something that isn't worth it. That's why we're learning to utilize data in a different way."
What does that mean exactly? Consider this: Borinquen Health Center is a federally qualified health center with 11 locations that serve 47,000 people in the Miami-Dade County area. The center offers primary care services and social and education services, including dental and behavioral health. As a community health center, it does not have an inpatient setting, but does collaborate with hospitals under referrals. That's a lot of information coming from a lot of places; with so many facilities and types of care, the need for providers to have access to thorough healthcare records is crucial for the best patient outcomes.
In 2018, Borinquen did a significant self-examination and restructuring of the healthcare data system it launched four years prior. The subsequent restructuring serves as an educational tale for other healthcare systems, and also shows the need for constant oversight — and the agility and willingness to examine and improve existing systems when needed. Let's take a look.
In 2014, when Borinquen first established its new data collection system and integrated it with their athenahealth EHR, they saw immediate improvements. For example, documentation time was reduced by 40 minutes per day, per provider, and it became easier for medical assistants and nurses to review appointments and prescription orders.
Borinquen also benefited from their digital records during the 2015 Zika outbreak. Officials at the health center integrated Zika guidelines from the Centers for Disease Control into their EHR database to identify high-risk patients and encouraged them to come in for a screening.
Gaps in care
But as time went on, issues with the record keeping became apparent. For one thing, it was complicated to retrieve records from partner hospitals and other facilities. And even when they were available, the records were often incomplete, lacking proper medical histories related to specific conditions. For example, there were instances in which patients were hospitalized for myocardial infarctions or heart attacks, but the details of their hospitalization weren't always shared with primary care providers at Borinquen.
Shmuels says expanding and regulating the patient database through a network of both hospitals and primary care providers is a crucial step to improving patient outcomes. The process of collecting data is not only important for day-to-day operations, but is also helpful in other situations. Consider an unexpected catastrophe or natural disaster, like a hurricane (not unrealistic for Miami), or the aforementioned Zika outbreak; having a thorough and accessible collection of patient records and their needs would prove advantageous.
Being proactive with high-risk patients
Another issue Borinquen wanted to address? Making sure patients are seeking care at the right frequency. To address this challenge, Borinquen healthcare providers can now generate reports based on diagnosis, zip codes, providers, medications, and appointment dates to target those with lapses in care, particularly individuals designated “high-risk patients," or those whose illnesses have not been controlled. To identify a patient as high-risk, healthcare workers evaluate 19 markers of chronic disease management, such as hypertension, cervical cancer screening, immunizations, colorectal cancer screening, and glycosylated hemoglobin. Registries of patients are created through the EHR and “we track them and call them back for care," Shmuels says.
Managing for patients misreporting their medical histories
Knowing what medications a patient is taking is crucial to providing proper care; patients themselves often lack an understanding of their prescriptions and are often unsure or incorrect about a drug's name, dosage, and frequency. Borinquen, like many other health centers in the same situation, has found this particularly challenging while caring for low-health literacy populations, primarily low-income, Spanish-speaking populations.
Often, when asked about their medical history, patients “disclose the information they think is proper and correct, but it isn't," says Shmuels. "Helping and educating patients is a must to close gaps of care."
To combat this issue, Borinquen has developed a two-pronged, data-informed approach: “Patients listed in the registry are called back for appointments, and we also implement shared medical education visits, where a team of providers and a group of patients attend an educational session," explains Shmuels.
Data + People = Results
Shmuels talks about the continual effort to close gaps of care, and through the power of data to inform patient care decisions and patient education needs, Borinquen is working to do just that for Miami-Dade County.
Joe Cantlupe is a frequent contributor to athenaInsight.