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Improving Chronic Illness Care without an EHR

Identify an area of clinical care for improvement and a method/process to gather baseline data.  This may be through chart abstraction for care already provided in previous visits or possibly through a concurrent analysis as patients are seen in the practice over a specified period of time.  For example, you may want to identify how many patients have a weight (measured not stated) and a blood pressure recorded for each visit in one week.  If the number is not 100%, there is room for improvement in this aspect of clinical care.

Once the area for improvement has been identified and a baseline established, the steps to follow are the same as those for any improvement process.

Identify all possible barriers, bottlenecks, and breakdowns in providing the necessary care.
Consider possible changes that will make it easier to provide the identified care and reach your desired outcome.  Identify how your team will collect the data to know if the change is an improvement.

Conduct a small test of the change idea (i.e., with one patient, one provider) and decide if the change is better.  Remember that not all changes are an improvement and fixing one problem may unintentionally create several more problems.

Modify the change idea if necessary and retest on a small scale.  After refining the change idea, move forward with spreading the change within your practice to achieve optimal clinical care for all your patients.

A consideration for practices without an EHR is identification of patients who are in need of the targeted care but who have not been seen in the office recently.  Strategies must be considered related to reaching out to patients and engaging them in receiving important clinical care (i.e., colorectal cancer screening, mammogram, vaccination for influenza and pneumonia).

Continue to monitor available data to ensure implementation of the change becomes part of the clinical care within the practice.