Use of electronic medical records on cancer screening rates: The proactive office encounter.

Abstract

289 Background: The Southern California Permanente Medical Group cares for a diverse population of 3.5 million members. An electronic medical record supports the care of patients at each outpatient and inpatient encounter. In the US, only about 55% of Americans receive recommended preventive care services. Methods: The Proactive Office Encounter (POE) was developed to proactively address care gaps in preventive or chronic care needs at the point of service with every visit to either primary or specialty care. Prior to a visit, the staff identify missing labs or screening procedures and provides the patient with pre-visit instructions. With a standardized workflow and checklist used during any office visit, care gaps are identified from decision support tools in the electronic record and office staff pend necessary orders to the physician. The room is prepared for any procedures necessary (Pap), iFOBT kits are made ready for use if indicated, and on exiting, the patient receives an after visit summary that includes any necessary follow up instructions. Successful Completion Opportunity Reports are produced for every department to measure the improvement of closing care gaps. A small financial incentive is applied for specialists for these successful comp-letions (P4P). Back office work flow reports measure the elements of POE at the individual staff level. Performance on screening rates is reported bimonthly for feedback. Results: Within two years of implementation, pre and post POE cancer screening rates increased from 85.6 to 88.7 (3.1%) for breast cancer; 82.0 to 86.6 (4.6%) for cervical cancer; and 52.5 to 69.7 (17.4%) for colorectal cancer. Rates for advising smokers to quit smoking increased from 53 to 68 (15%). Conclusions: Use of evidence-based logic integrated in an electronic medical record combined with standard work flows deployed in primary and specialty care reliably ensures that patients receive needed services at every visit. This contributed to sharp rises in preventive care quality measures. Care shifts from being reactive to team-based and proactive and is no longer dependent on a physician remembering all the needed elements of care.