Clinic Capacity to Track Health Status Data

Assessing the Capacity of Community Clinics to Track and Use Health Status Data

Prepared for the Tides Foundation and the Community Clinics Initiative Steering Committee

Prepared by Blueprint Research and Design 247 Fourth Street, Suite 105 Oakland, CA 94607 T: 510-893-9700 F: 510-893-9750 www.blueprintrd.com

February 2000 Key Findings

. Most clinics are tracking some health data elements and a significant number of clinics track a wide range of health data elements. However, the clinics’ ability to use this information for ongoing health management is limited because only about 30 percent of the health data elements are tracked in an automated fashion.

. Less than a third of the clinics use their practice management system to track basic patient health status such as acute and chronic diseases, immunizations and wellness reminders. However, one third of the clinics have practice management systems capable of tracking this information but have not implemented this functionality.

. Only 11 clinics report that they use their practice management system to present providers with a patient’s health status and history at the time of service.

. Clinics with a written IT strategic plan are much more likely to track health outcomes and have high levels of automation.

. There has been a significant increase in the proportion of clinics that report having a formal strategic information technology plan. Fifty four percent of the clinics applying for money in Dec 2000 reported having a strategic plan for their IT system. This represents a 23 percent increase from the last set of grantees.

. In the last six months, 17 percent of the grantees reported automating at least two additional clinic functions. Moreover, there has been a seven percent decrease in the number of clinics with low automation grades.

Methods This report serves as a follow-up to the initial analysis of the clinic information management assessment, presented to the Steering Committee in September 2000. At that meeting, the Steering Committee requested more information about the clinic community’s capacity to track and use health data elements for population health management. Measures to assess this information were incorporated into the online Letter of Intent (LOI), required of all applicants for the December 2000 round of Community Clinic Initiative grants. The LOI also included a repeat of measures of clinic automation to see if we could detect any increase in automation levels in the clinic population during the last six months. This analysis is based on the 132 clinic applicants that submitted their LOI on-line. Clinic Capacity to Track Health Status Data Page 3 of 8

I. Assessing Clinic Capacity to Track and Use Health Data Elements The survey asked clinics whether they tracked a sample of seven different health data elements. These elements were selected by the evaluation team to include commonly tracked health issues such as maternal and child health, as well as less commonly tracked diseases such as diabetes. The health data elements included:  Diabetics  Asthmatics  Immunizations  Hypertension  Abnormal Mammograms  Abnormal Pap Smears  Low Birth Weight

As illustrated in Figure One, at least 95 percent of the clinics reported tracking at least one of the health data elements listed in the survey. Forty-four percent tracked at least six of the seven possible elements). In general, the clinics collect data in the areas of maternal and child health (e.g., low and very low birth weight, childhood immunizations, abnormal mammograms) and chronic disease (e.g., diabetics, hypertension).

Figure 1.

Roughly half the clinics track a significant number of health data elements: Technical assistance should target those clinics that are tracking 3 health data elements or less

High (6 or more No tracking outcomes) 5% 44% Low (1-3 outcomes) 23%

Mid-level (4-5 outcomes) 28% Clinic Capacity to Track Health Status Data Page 4 of 8

However, as illustrated in Figure 2, most clinics are tracking this data manually. Tracking for childhood immunizations is most likely to be automated, because there is a state initiative with counties to automate immunizations and most of the software/PMS systems are set up to do this. Nearly a third of clinics have an automated system to track this indicator. In contract, only 10 percent of clinics have an automated system to track abnormal pap smears, even though nearly all clinics report that they track this element.

Figure 2.

Most community clinics are tracking a variety of health data elements; however, they need assistance in automating this task to utilize the data more effectively

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20 n 31 o i t r o p 10 16 o 13 12 r 10 P 7 5 0 Abnormal Pap Abnormal Childhood Diabetics Hypertensions Asthmatics Low and Ext. Low Smears Mammograms Immunizations Birth Weight Population Health Data Elements Tracked by Community Clinics

Automated tracking of health data elements is important in that it allows for quicker and more efficient integration of this data into the patient and population management systems of the clinics. For instance, with the availability of electronic immunization data, a clinic would be able to analyze the immunization rates by zip codes and determine where additional outreach may be needed.

A clinic’s health data element automation level is highly correlated with their general automation level. This suggests that a clinic must have a basic level of automation capability before they can be expected to automate effectively any health status indicators. It also suggests that clinics with this basic level of automation capability are more likely to automate their health outcome tracking.

Seven clinics reported having highly automated tracking systems. They report having automated systems to track at least five of the seven indicators. Given the California Endowment’s interest in the connection between the expanding of clinics’ information Clinic Capacity to Track Health Status Data Page 5 of 8 management capacity and the enhancement of clinics’ work in population health management, it may be useful to conduct brief telephone interviews with staff at these seven clinics to learn more about their health data tracking systems.

Previous analysis has suggested that community clinics’ practice management systems are highly underutilized. These systems are primarily used to support basic billing and scheduling needs. However, many practice management systems have the capability to track health data elements that could support better preventative care and population health management.

Clinics were asked if their practice management system could track three different health status indicators-- immunization, wellness reminders and acute/chronic disease – and if they used the functionality. Figure 3 shows that while about a third of the clinics use this functionality, another third have the capability but are not using it. The clinics that reported being capable of using their PMS to track these elements for individual patients but do not, generally cited one of two reasons for not doing so: 1) lack of the necessary module (often because the module is too expensive) and 2) lack of training. Therefore, some training and targeted software purchases could significantly expand a clinic’s capacity for automated health management.

Figure 3. Clinic practice management systems can support automated population health management: Many clinics need training and additional software modules to implement functionality

Functionality available but not implemented 70 Tracking capability currently used

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Tracking Capability of Community Clinics

Most clinics are not using these health status indicators to inform their providers on a regular basis about individual patients. Only 11 clinics use their practice management system to present providers with a patient’s health status and history at the time of service. Clinic Capacity to Track Health Status Data Page 6 of 8

II. Progress in Advancing the Field We also reviewed data from the LOI and compared it with the information management assessment survey from last summer to see if any growth in the field’s information management capacity could be measured.

First, there is a significant increase in the proportion of clinics that report having a formal strategic information technology plan. (See Figure 4) The Community Clinic Initiative’s message about the importance of a technology plan appears to have influenced both current and potential grantees. Moreover, 69 percent of clinics responding to the December 2000 RFP report that their clinic’s overall strategic plan includes a discussion of information management. It is important to encourage clinical development of written IT plans because the data suggests a strong correlation between IT plans and high levels of automation and health outcome tracking.

Figure 4.

The proportion of community clinics that report having a formal IT plan has increased significantly since the inception of CCI

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n 10 o i t r o 5 p o r P 0 CCI grantees, June 2000 CCI applicants, Dec 2000 Clinic Capacity to Track Health Status Data Page 7 of 8

Figure 5 shows the proportion of clinics in the December RFP applicant pool that have automated each of 14 basic administrative and clinical functions. The applicant pool from the December RFP showed the same general patterns for automation as reported by grantees last summer. Most clinics have automated basic billing and scheduling. Few have automated patient and case management. However, the proportion of really low- level clinics appears to be decreasing. When comparing the applicant pool for December RFP with the grantees as of last June, there has been a 7% decrease in the proportion of clinics with a low automation grade.

Figure 5. While many clinics are capable, few clinics have automated functions other than basic administrative services

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Clinic Functions

Over 70 percent of the clinics have automated their billing/claims and accounts receivable. More than half of the clinics reported that they had automated accounts payable, registration, appointments/scheduling, and payroll. A third of the clinics have automated patient tracking and recall; and, 25 percent have automated utilization review (as defined by the clinics). Nonetheless, almost a fifth of the clinics have not automated some of the most basic financial management functions. Clinic Capacity to Track Health Status Data Page 8 of 8

With regard to clinical management, many clinics reported that their software was capable of automating several clinical management functions but they were not currently using those features. About a quarter of the clinics reported that they were not using their software's capability to automate patient tracking/recall, case management, managed care features, and referrals. In summary, the data that would enable the clinic staff to provide more effective and efficient case management and population health analysis is not being automated.

Popularity of Practice Management Systems HealthPro is the most popular practice management system, used by 29 percent of clinics applying for grants. (See Figure 6) It is also noteworthy that 11 percent of clinics use no software and seven percent are using custom software.

Figure 6.

Current Practice Managment Software Brand

Custom No software 7% 11% Resources America 4% Other 21%

Health Pro Medical Manager 29% 7% Paradigm/CMMS 8% Megawest 13%

RECCOMENDATIONS . Target training and technical assistance for CCI grantees to promote the automation of health status data tracking systems and the effective use of this data to improve patient and population-level health services.

. Conduct follow up research on the seven clinics that report having highly automated health data element tracking systems to determine if there are lessons that could be shared with the field. Phone interviews may provide useful information on how their tracking systems work, how they use the generated information (i.e., for patient-level analysis or population-health analysis), and any plans for expansion. Samples of reports from these clinics should be requested.

. Provide outreach and training to those clinics that are tracking three or less health data elements.

. Continue to promote the importance of training and technical assistance to help the clinics maximize the information technology tools they already possess. Clinic practice management software continues to be underutilized.