Using a Health Information Exchange and Clinical Decision Support Tool to Improve Patient Care at Community Health Centers in Hawaii

BACKGROUND: Studies show that a Health Information Exchange improves patient care coordination and enhances communication between a provider and patient by making patient data available at the time of care. This project is a collaborative effort between the Association of Asian Pacific Community Health Organizations, three Community Health Centers (CHCs) in Hawaii, and AlohaCare Health Plan. OBJECTIVE: A decision support tool was implemented for clinical and support staff to monitor and follow-up diabetic patients with appropriate care. The decision support tool was developed and tested with pilot providers (N=6) at the CHCs. We hypothesize that the decision support tool will improve quality of care among diabetic patients and the entire clinical team's performance. METHODS: We conducted pre- and post- implementation surveys with CHC staff to evaluate the effectiveness of the decision tools. The pre-implementation surveys assessed potential barriers and feasibility of implementation. The post-implementation surveys assessed similar issues as well as implementation strengths and weaknesses and overall provider satisfaction. We conducted content and descriptive analysis on the survey items to provide summary statistics and determine differences between pre- and post-implementation. We also conducted 30-minute structured interviews with pilot providers that assessed knowledge of the tools, perceived usefulness, and feasibility of application in a clinical setting. We transcribed interviews and used Grounded Theory to code for common themes. RESULTS: All pilot providers agreed the decision support tool helps them to better track and monitor diabetic patients. Providers also enjoyed working as a team to focus their efforts on patient-centered care. DISCUSSION: This project supported the development of an integrated decision support tool that facilitated enabling processes and increased the efficiency in identifying and serving diabetic patients with gaps in care. This mechanism will enhance the care coordination process at CHC sites and support their efforts towards becoming Patient-Centered Health Care Homes.