Family physician and HDC Board member, Dr. Angela Jennings, first remembers hearing about Quality Improvement projects (QI), also referred to as facilitation cycles, through a Family Physician Services Committee (FPSC) panel management project back in 2018. The project challenged physicians to look at their patient panel, assess the prevalence of chronic medical conditions and be more proactive in terms of chronic disease management. When Coppersmith Medical Clinic opened in 2020, Dr. Jennings and her colleague Dr. Christina Sun received extensive training on the Med Access EMR system. They realised the potential of the EMR to do more analysis resulting in QI projects that could not only improve patient care but also streamline clinic processes.

“We completed another panel management cycle after the transition over to the new EMR and new clinic. It was after that we were introduced to HDC. These two tools together triggered more ideas in terms of projects and QI cycles,” explains Dr. Jennings. “Having data available to us opened up opportunities to explore our panel and be proactive. That ability has really led to all the projects that we’ve done since and it’s certainly been beneficial for practice improvement overall.”

Many of the projects completed at the clinic have been preventative in scope, looking at vaccines and other proactive measures that may not always take priority during a clinic visit for an acute medical concern. Dr. Jennings and Dr. Sun both embraced the initial chart reviews that led to streamlining patient visits and panel management with the goal of improving patient care, particularly from a preventative medicine standpoint.  

“One of my early QI cycles that I initially started in 2021, after we transitioned to the new EMR system, was reviewing the pneumonia vaccine for patients aged 65 and up. I was going through patient files in a systematic manner, to review if everybody over 65 had either been offered or had received a pneumococcal vaccine,” continues Dr. Jennings. “During this process I identified that there were some gaps and I realised the power of the QI project. I thought, ‘if I put these reminders in next time I talk to this patient, it will take just 30 seconds to check if they’ve had this vaccine or if they are interested in receiving it.’ I quickly realised how helpful this would be for my practice to improve patients’ access to preventative care and my own overall delivery of care.”

Clinic staff members became involved in managing files and running cycles using the EMR. Immediately the team noticed how powerful and informative the data was to their practice and began looking at larger numbers of patients and bigger projects. Dr. Jennings and Dr. Sun were able to support one another, sharing ideas and projects. Together they saw the improvement to overall patient care and the effectiveness of the data was exemplified again. This quality improvement was something the whole team at the clinic and their support team was able to take part in.

“Kristine Dillague is our Doctors of BC Practice Support Program (PSP) Coach who keeps in contact with us several times a year to check where we’re at in terms of projects and new ideas,” explains Dr. Sun. “We also discuss and remind each other to keep up with QI projects on a regular basis. I try to do a project every three months. We also have our staff there to help out and to check in with us if they notice any possible deficiencies or anything out of date. We work together to keep one another on track.”

HDC supports the EMR data with its overview of clinical data in a digestible format. Physicians are able to look at measures for their patients, their practice and at the community level. The presentation of the data makes it easy to share, detect patterns and discuss with colleagues. HDC Discover also allows physicians to explore how they’re doing compared to others in their clinic, as Dr. Jennings and Dr. Sun do, to ensure they are sharing processes that improve the quality of care offered to their patients.

“One of the first projects I did with HDC Discover was related to screening for diabetes in patients age 40 and up. I looked at the measures and initially 88% of patients had a documented fasting glucose or hemoglobin A1c in the past three years” explains Dr. Jennings. “I asked myself what happened to the other percentage that hasn’t had a glucose level or hemoglobinA1c in the past three years? This realisation prompted me to dig into files and explore further to see what I could do to ensure patients remain up to date with their diabetes screening.  I was able to create follow up tasks and reminders to patients, and by reviewing these markers every few months, I was able to increase the percentage of patients screened to 94% and have been able to maintain this through a data review every few months.” 

In the course of seeing patients day to day you don’t necessarily get the bigger picture, but when you see the data at a clinic level through your patient population, you can see the improvements and changes in patient care through the data.

“The measures I can see on the HDC website really encourage and inspire projects within my own practice,” she continues. “Then the support through PSP really gives us the ability, resources and the funding to run these projects. They guide physicians in terms of ideas and identifying an area you want to work on or improve in terms of what metrics you can use and what data points will be  the most useful. Then with HDC Discover you can see those measures change with time.”

Initially these projects can feel overwhelming but once initial steps are taken and with the support of PSP, many streamlined processes and maintaining data input becomes habitual. Dillague explains, “HDC Discover is a useful and helpful tool that physicians can utilize when they are trying to come up with a Quality Improvement Project. As a PSP coach, my role is to help physicians identify gaps in care, test change ideas, implement and sustain improvements; all aimed at enhancing patient care.”

Quality Improvement happens when a patient can be supported in several areas during one visit due to accurate and up to date records. Physicians will know, without asking, which patients with high blood pressure or diabetes have been screened or have labs up to date, allowing physicians to offer gentle reminders or resources. Similarly, staff who may be involved in tasks, such as updating email and phone numbers, can also follow up with each patient, which can contribute to a consistent QI culture and enhance collaboration between team members.

“It’s just really been quite motivational. You can see the impact when you start contacting patients or directing your attention to areas that may be under-addressed,” shares Dr. Jennings. “In the course of seeing patients day to day you don’t necessarily get the bigger picture, but when you see the data at a clinic level through your patient population, you can see the improvements and changes in patient care through the data. It’s also nice to have more of a community feel when you have the PSP coaches, other practitioners and staff involved. Using data as a tool has made me feel more organised and more confident in my practice.”

“Once you’ve done a few projects and get a hang of the process, then each subsequent cycle becomes much easier,” adds Dr. Sun. “It’s not that time consuming and it’s very rewarding to know that you’re actively improving your practice. I encourage all physicians to consider incorporating practice data more regularly with HDC!”

Could your practice benefit from data informed quality improvement? Contact an HDC Clinical Services Manager at info@hdcbc.ca to get started. Interested in working with a coach? Connect with PSP at psp@doctersofbc.ca or submit a request.

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