269470 Utilization of an electronic health record (EHR) to manage chronic disease in vulnerable populations

Wednesday, October 31, 2012 : 10:30 AM - 10:45 AM

Esker-D Ligon, RN, MSN, ANP-BC , UCSF School of Nursing, Glide Health Services, San Francisco, CA
Christina Clark, RN, MSN, FNP-BC , UCSF School of Nursing, Glide Health Services, San Francisco, CA
Background: Glide Health Services (GHS) is a nurse managed health center with a designation as a Federally Qualified Health Center (FQHC). It is located in the Tenderloin area of San Francisco; residents experience a high rate of health disparities. The clinic provides integrated primary care, behavioral health and wellness services. An EHR was implemented in 2008 for use by all treatment modalities. Purpose: To provide an exemplar of ways that GHS has used their EHR to: manage chronic disease with an emphasis on patients with diabetes; screen clients for mental health and substance use disorders that could contribute to safety issues and treatment complications; and how the use of EHR medication applications address patient safety issues. Methods: Selected EHR functions: 1) Disease management protocols which prompt providers to perform diagnostics and screenings in compliance with established standards of care; 2) A combination PHQ-9 CAGE AID screening tool administered quarterly as a screening for depression, alcohol, tobacco, and other substances. PHQ-2 screening at every visit. Providers use the results to guide patient interaction, and make referrals for treatment; 3) A medications interactions checker which provides information about interactions between prescribed medications, foods, alcohol and other drugs, and allergies; 4) Electronic prescribing module with the capability to obtain a medication history report containing information about outside prescriptions Results: In 2010 the clinic served approximately 3500 clients for a total of 16,000 visits: 5% of clients have diabetes, and one third of all clients received behavioral health services. Dashboard reports revealed that approximately 70% of our diabetes cohort has good control of their disease. Discussion: EHRs can be a valuable tool for the management of chronic disease in vulnerable populations. They aid in addressing safety concerns and in accurately tracking data which measure the quality of services delivered.

Learning Areas:
Chronic disease management and prevention
Communication and informatics

Learning Objectives:
•Explain how screening tools in an EHR can aid in the identification of patient safety issues in vulnerable populations •Discuss how EHR medication applications aid in safe prescribing practices •Explain how use of an EHR can contribute to improved health outcomes

Keywords: Chronic Diseases, Nurse Managed Centers

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have functioned in the roles of both an adult primary care and mental health Nurse Practitioner in community health centers. My specific interests have been addressing the unique needs of multiply diagnosed patients in underserved populations. I am a member of my clinic's EHR implementation team, and have become skilled at developing content to aid my clinic in better addressing the unique needs of the patients that we serve.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.