8047 CMWF
FINAL (7.17.2008)
8047 Commonwealth Fund: IT and Care Coordination
FINAL Protocols (7.17.2008)
Contents
Thought Leader Interview Protocol
Introduction
Questions
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.IWrapup
Primary Care Practice Physician Interview Protocol
Introduction
Questions
Q.ITC.BConfirmation of Screening Information
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.DCare Within & Across Offices: Coordination of Care
Q.ITC.FEMR Capabilities
Q.ITC.E Interpersonal Communication
Q.ITC.HOther Types of IT
Q.ITC.IWrapup
Primary Care Practice Non-Physician Interview Protocol
Introduction
Questions
Q.ITC.BConfirmation of Screening Information
Q.ITC.CCare Within Your Office: Continuity of Care
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care.
Q.ITC.FEMR Capabilities
Q.ITC.ECare Within Your Office: Interpersonal Communication
Q.ITC.IWrapup
Specialist Practice Physician Interview Protocol
Introduction
Questions
Q.ITC.BConfirmation of Screening Information
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.DCare Within Your Office: Coordination of Care
Q.ITC.FEMR Capabilities
Q.ITC.ECare Within Your Office: Interpersonal Communication
Q.ITC.HOther Types of IT
Q.ITC.IWrapup
Specialist Practice Non-Physician Interview Protocol
Introduction
Questions
Q.ITC.BConfirmation of Screening Information
Q.ITC.DCare Within Your Office: Coordination of Care
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.FEMR Capabilities
Q.ITC.ECare Within Your Office: Interpersonal Communication
Q.ITC.IWrapup
EMR Vendor Interview Protocol
Introduction
Questions
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.CContinuity of Care
Q.ITC.FEMR Capabilities
Q.ITC.EInterpersonal Communication
Q.ITC.HOther Types of IT
Q.ITC.IWrapup
Thought Leader Interview Protocol
Introduction
Thank you for agreeing to speak with us today for our study on Electronic Medical Records and the coordination of care. We are from the Center for Studying Health System Change (HSC), an independent health policy research organization located in Washington DC. This study is funded by The Commonwealth Foundation.
The goal of our project is to learn about the extent to which physician’s practices employ their electronic medical record to coordinate care for their patients. By coordination of care, we mean the integration of care across a patient’s health care needs both within the practice, as well as between the patient’s regular physician and outside providers that patients may see, whether they are other physicians, hospitals, community services, or the patient’s family and caregivers.
Before we begin, I want to let you know that we are speaking with a number of people about these issues. We have a strict confidentiality policy. We do not share the names of our interview respondents or our notes with anyone outside of our research team. We do not attribute comments to specific individuals in our final reports. However, in some cases, we mention specific organizations by name in our reports when describing innovative practices, unless you indicate that you do not want us to do this.
We also have a system to mark specific comments as off-limits for public reports. If any of the information we cover today falls into that category, please let us know and we will mark it as confidential in our notes.
Also, if there are any questions that you feel you do not have the expertise to address, please do not hesitate to let us know and we can move on.
Do you have any questions before we begin?
Questions
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.A.01Thinking generally about EMRs, how, if at all, do they facilitate the coordination of care for patients across conditions and settings? Thinking more specifically about EMR functions, what are the key features of the EMR that are helpful in coordinating care for patients?
Q.ITC.A.02What are the things about the EMR that are difficult or a challenge for the coordination of care?
Q.ITC.E.01How, if at all, are EMRs, and other information technology, affecting the quality of interpersonal interactions between patients and health care providers?
Q.ITC.E.02How, if at all, are EMRs, and other information technology, affecting the quality of interpersonal interactions between different providers, for example between primary care physicians and other specialists?
Q.ITC.A.03How, in your opinion, can a balance be struck between the need for standardization across EMR users and settings, with the need for the EMR to be clinically relevant and adaptable to the physician-patient encounter?
Q.ITC.D.02.aHow does use of the EMR affect the division of labor in a practice with respect to coordinating care?
Q.ITC.D.02.bAt what point, if any, does the EMR cease to be useful for coordination of care and do human processes need to take over? Can you give us some examples of these human processes required both at the larger level of thinking about coordination and then at the more minute level of care processes related to coordination activities?
Q.ITC.A.04Where providers are not using available EMR functions to improve coordination of care, what other contributing reasons are there? (Let them respond, but if they do not, then can use probes)
Q.ITC.A.04.aProbe: Technical limitations
Q.ITC.A.04.bProbe: Lack of awareness of specific EMR functions
Q.ITC.A.04.cProbe: Lack of leadership in organizations
Q.ITC.A.04.dProbe: Differences of opinion on how care should be coordinated
Q.ITC.A.05How might physicians and various members of the care team be coached to improve use of available coordination functions of EMRs?
Q.ITC.A.06How does utility of the EMR for care coordination vary for more vs. less complicated patients?
Q.ITC.A.06.aFor patients who see many different specialists?
Q.ITC.IWrapup
Q.ITC.I.01Can you suggest any small to medium single specialty practices with a commercial ambulatory care EMR that we should speak with for this study?
Q.ITC.I.02Is there anything else you think we should know to understand how EMRs are affecting care coordination?
Q.ITC.I.03Interviewer Summary
Primary Care Practice Physician Interview Protocol
Introduction
Thank you for agreeing to speak with us today for our study on Electronic Medical Records and the coordination of care. We are from the Center for Studying Health System Change (HSC), a non-partisan health policy research organization located in Washington DC. This study is funded by The Commonwealth Foundation.
The goal of our project is to learn whether and how physician practices employ their electronic medical record to coordinate care for their patients. We want to hear about your experiences with the EMR for coordination, including both its potential and how it might be improved.
By coordination of care, we mean the integration of care across a patient’s health care needs. This can include within your practice, as well as coordination of care between your practice and outside providers that your patients may see, whether they are other physicians, hospitals, community services, or the patient’s family.
Before we begin, I want to let you know that we are speaking with a number of people about these issues. We have a strict confidentiality policy. We do not share the names of our interview respondents or our notes with anyone outside of our research team. We do not attribute comments to specific individuals in our final reports. However, in some cases, we mention specific organizations by name in our reports when describing innovative practices, unless you indicate that you do not want us to do this.
We also have a system to mark specific comments as off-limits for public reports. If any of the information we cover today falls into that category, please let us know and we will mark it as confidential in our notes.
Also, if there are any questions that you feel you do not have the expertise to address, please do not hesitate to let us know and we can move on.
Do you have any questions before we begin?
Questions
Q.ITC.BConfirmation of Screening Information
Q.ITC.B.01Our understanding is that there are _____# physicians in your practice of the following specialty types: ______, ______, ______. Is this correct?
Q.ITC.B.01.aNumber of physicians in practice
Q.ITC.B.01.bSpecialty types of physicians
Q.ITC.B.02Our preliminary screening call with your practice indicated that you have had an EMR for ____years, and that it is ______(type). Is this correct?
Q.ITC.B.02.aNumber of years on EMR
Q.ITC.B.02.bType of EMR
Q.ITC.AOpportunities and Limitations of EMRs’ for Coordination of Care
Q.ITC.A.01What are the key features of your EMR that you find helpful in coordinating care?
Q.ITC.A.02What are the things about your EMR that you find to be difficult or challenging when trying to coordinate care for your patients?
Q.ITC.DCare Within Your Office: Coordination of Care with other specialists/providers
Q.ITC.D.01When referring to outside specialists, has the EMR affected your ability to convey a concise, pertinent patient history and reason for referral? [Probe, if necessary: Can the EMR help you to generate a concise patient summary rather than requiring you to cut and paste pages of text?]
Q.ITC.D.03How, if at all, does your practice use the EMR to keep track of referrals you make for your patients? Do you track referral completion as well via the EMR?
Q.ITC.D.03.aHow does this tracking incorporate patient self-referrals to specialists?
Q.ITC.F.13How, if at all, does your practice use the EMR to make sure that a diagnostic test or service you or another provider wants to order for a patient wasn’t already performed? (That is to avoid duplication of services)
Q.ITC.D.06Does the EMR improve your ability to incorporate consultant reports from outside the practice?
Q.ITC.D.06.aHow, if at all, does the EMR affect your ability to reach consensus with other physicians for patients you comanage?
Q.ITC.D.07How, if at all, does your practice use the EMR to facilitate communication of specialists’ recommendations and results back to your patient?
Q.ITC.D.02What are the work-arounds you or your staff find yourselves using to compensate for areas where the EMR is not yet up to task in helping you to coordinate care? [Give respondent time to think about this, if they don’t answer, can use the Probe: what if you wanted to know which of your patients had not yet received a particular cancer screening test?]
Q.ITC.D.02.bAt what point, if any, does the EMR cease to be useful for coordination of care and do human processes need to take over? Can you give us some examples of these human processes required both at the larger level of thinking about coordination and then at the more minute level of care processes related to coordination activities?
Q.ITC.FEMR Capabilities
We’d like to hear how your practice uses particular EMR functions to accomplish coordination tasks. For some of the questions we will ask, your response may be that “we don’t use the EMR to do this.” When that is the case, please just say so, and if you could, indicate the reason you do not use the EMR for that function) NOTE TO INTERVIEWER: TRY TO FOCUS THE RESPONDENT ON HOW THEY USE THE FUNCTION FOR COORDINATION OF CARE. ONE OF OUR GOALS IS TO HEAR WHETHER AND HOW PRACTICES MIGHT BE USING THESE EMR FIELDS IN DIFFERENT WAYS AROUND COORDINATION
Q.ITC.F.01Problem list: Thinking about the patient’s problem list:
Q.ITC.F.01.aHow is the problem list function of the EMR used when you coordinate care for a patient across the patient’s visits and conditions? Can you search the entire EMR for all visit notes relevant to a particular diagnosis for an individual patient?
Q.ITC.F.01.bWhat could be improved about the EMR to better facilitate retrieving this information in a way that helps you/clinicians to coordinate care? (If the EMR is not used for this purpose please explain why that is)
Q.ITC.F.02Medications: Thinking about the patient’s medications:
Q.ITC.F.02.aHow are entries or updates in the patient’s medication list entered and viewed in the EMR in a way that affects how you coordinate care? How do you track and update prescriptions written outside the practice? [Probe: New medication and dose changes]
Q.ITC.F.02.bWhat could be improved about the EMR to better facilitate retrieving this information at the moment that you/a clinician needs it to coordinate care? (If the EMR is not used for this purpose please explain why that is)
Q.ITC.F.06Your prior decisions about management of the patient: Thinking about your prior decisions about management of the patient:
Q.ITC.F.06.aHow are entries or updates in your prior decisions about management of the patient entered and viewed in the EMR in a way that affects how you coordinate care? For example, if you have a hypertensive patient on whom you or other providers have tried particular medications which did not work, can this historical information be easily retrieved during a patient encounter or when you are on the phone with a patient?
Q.ITC.F.06.bWhat could be improved about the EMR to better facilitate retrieving this information at the moment that a clinician needs it to coordinate care? (If the EMR is not used for this purpose please explain why that is)
Q.ITC.F.10EMR Capabilities Table
Q.ITC.F.11Does your EMR have the capability of displaying on a single screen a summary of a patient’s problem list, medications, brief history, recent tests and referrals, and management plan?
Q.ITC.F.11.aWhat functions or capabilities are missing from the EMR summary screen that you think would be useful when you are coordinating your patient’s care?
Q.ITC.F.12Relative to paper charts, does your EMR have the capability of allowing you to enter a future care plan for the patient in a way that can be easily retrieved at future visits? (Probe: That is, in a way that would not require you to read through a series of old progress notes? Can you determine from your EMR whether a patient received follow-up care that they were supposed to get? PROBE: preventive care, ongoing chronic disease management, completion of diagnostic testing ordered.
Q.ITC.F.12.aIs this something that you’d find useful from a clinical management perspective?
Q.ITC.A.05How might physicians and various members of the care team be coached to improve use of available coordination functions of EMRs?
Q.ITC.ECare Within Your Office: Interpersonal Communication
Q.ITC.E.01How does the EMR affect the quality of communication and time you spend with a patient trying to coordinate care?
Q.ITC.E.03How does it affect the quality of communication with other physicians and staff within your practice in terms of coordinating care?
Q.ITC.E.04How does it affect the quality of communication with providers outside your office in terms of coordinating care?
Q.ITC.A.04Where providers are not using available EMR functions to improve coordination of care, what other contributing reasons are there? (Let them respond, but if they do not, then can use probes)
Q.ITC.A.04.aProbe: Technical limitations
Q.ITC.A.04.bProbe: Lack of awareness of specific EMR functions
Q.ITC.A.04.cProbe: Lack of leadership in organizations
Q.ITC.A.04.dProbe: Differences of opinion on how care should be coordinated
Q.ITC.A.03How, in your opinion, can a balance be struck between the need for standardization across EMR users and settings, with the need for the EMR to be clinically relevant and adaptable to the physician-patient encounter?
Q.ITC.HOther Types of IT
Very briefly, could you list for us whether your practice already has in place any other types of information technology that aid in the coordination of care, and whether they are part of or separate from your EMR?
Q.ITC.H.01Practice Management Software
Q.ITC.H.01.aDoes your office have practice management software for scheduling patient appointments?
Q.ITC.H.01.bCan information flow electronically between the appointment making software and the EMR?
Q.ITC.H.02E-prescribing software
Q.ITC.H.02.aDoes your practice already have e-prescribing software in place?
Q.ITC.H.02.bIs it part of the EMR or separate?
Q.ITC.H.03Secure e-mail software
Q.ITC.H.03.aDoes your practice already have secure e-mail software in place?
Q.ITC.H.03.bIs it part of the EMR or separate?
Q.ITC.H.04Patient registry software
Q.ITC.H.04.aDoes your practice already have patient registry software in place?
Q.ITC.H.04.bIs it part of the EMR or separate?
Q.ITC.H.08Instant messaging software
Q.ITC.H.08.aDoes your practice already have Instant messaging software in place?
Q.ITC.H.08.bIs it part of the EMR or separate?
Q.ITC.H.05Other practice software
Q.ITC.H.05.aDoes your practice already have other software in place?
Q.ITC.H.05.bIs it part of the EMR or separate?
Q.ITC.H.06Other Types of IT Table
Q.ITC.IWrapup
Q.ITC.I.01Can you suggest any small to medium single specialty practices with a commercial ambulatory care EMR that we should speak with for this study?
Q.ITC.I.02Is there anything else you think we should know to understand how EMRs are affecting care coordination?
Q.ITC.I.03Interviewer Summary
Primary Care Practice Non-Physician Interview Protocol
Introduction
Thank you for agreeing to speak with us today for our study on Electronic Medical Records and the coordination of care. We are from the Center for Studying Health System Change (HSC), a non-partisan health policy research organization located in Washington DC. This study is funded by The Commonwealth Foundation.
The goal of our project is to learn whether and how physician practices employ their electronic medical record to coordinate care for their patients. We want to hear about your experiences with the EMR for coordination, including both its potential and how it might be improved.
By coordination of care, we mean the integration of care across a patient’s health care needs. This can include within your practice, as well as coordination of care between your practice and outside providers that your patients may see, whether they are other physicians, hospitals, community services, or the patient’s family.