Versions Compared

Key

  • This line was added.
  • This line was removed.
  • Formatting was changed.

ACTS LHS Phase 1 Activity and Participant Overview

(Hyperlinks are to pages on ACTS LHS Concept Demo website)

UNVETTED DRAFT for Discussion and Stakeholder Outreach 

...

Provide Governance

Support Coordination / Synergy

Scaling Targets & Settings

...

...

  • Osheroff (overall coordination)
  • NCQA (facilitate creation of and support for Digital Quality Measurement WG - e.g., leveraging its current mechanisms)
  • Patient/Family/Caregiver advocates (e.g., from advocates who provided support letters; support as outlined here)

...

  • Care for targeted patients / populations as part of QI initiative
  • Adapt / integrate target-focused guidance into system and workflows (e.g., via CDS interventions and QI efforts)
  • Gather (using eCQMs) / analyze target-focused care process and outcome data - e.g., for regulatory reporting and local QI efforts; share data for public health, new evidence generation
  • Collaborate to leverage, enhance, and synthesize best QI practices in general and for the target (e.g., as outlined here)  

...

Targets being considered for clinical cross-fertilization include" pain/opioids, hypertension, preventive care (lung cancer screening), long COVID, sepsis

  •  CDOs
    • VA (potential targets = psychotherapy, long COVID, lung cancer screening)
    • NACHC (potential targets = hypertension/SMBP, long COVID, HIV prophylaxis, and women's health (post-partum care))
    • UMN (potential targets = COVID anticoagulation, sepsis, rib fracture, hypertension, diabetes 
  • Cross cutting support
    • Patient/Family/Caregiver Engagement and Support (e.g., from advocates who provided support letters; as outlined here)
    • ACCME (workforce development / engagement, continuous professional development integration with care/QI)

...

  • Collaborate to leverage, enhance, and synthesize best practices for creating living, computable evidence and guidance in general and for the targets

...

  • Sandy Lewis / EBQ Consulting (liaison to guideline developers)
  • C19 Digital Guideline WG (develop computable CPGs for some targets)
  • COKA, EBM on FHIR, Computable Publishing (support for standardized computable content development and aggregation)
  • Doctor Evidence (source for (computable?) evidence for targets)
  • Epistemonikos (source for (computable?) evidence for targets)
  • ECRI (ECRI Guideline Trust for guideline access for targets)
  • Cochrane CA / GRADE (support for identifying recommendations and updates)
  • [?CDC Opioid Initiative (source for computable guidance on pain/opioids)]

...

Tools related to the 'resource developer future vision' (leverage ACTS Standards & Infrastructure WG report)

...

...

  • Gather and harmonize care results data
  • Use data for public health improvement and cross-organizational QI efforts 

...

  • MedMorph initiative (support data harmonization)
  • NCQA (synergies with Digital Quality Measurement efforts)
  • [?NIH (research leveraging real world evidence)]
  • [?CDC (leverage data for public health)]
  • [?CMS (synergies with Digital Quality Measurement initiative)]

Discussion Notes about this Table (thanks Steve Singer!)

  • Do you agree with the your placement in the table? What would you change?
  • Is your placement appropriate to the value/services you think you can provide?
  • What do you see as problems/obstacles to addressing the role/function you've been matched to? From your own (singular) perspective? From the (collective) perspective of the task (ie, row of the table)?
  • Who is missing from the table? 

...

Organizations Working on Plan Execution and Coordinating Efforts

Names listed indicate willingness to participate / collaborate, and share information (as appropriate) for mutual benefit, but don't indicate any other specific commitment on behalf of any individual or organization.  Participation goals for public and private organizations include strengthen and amplify existing missions and activities (for federal agencies, to ensure that investments serve the greater good).

Care Delivery

  • VA: Ross Speir, Brenna Long, Ken Rubin, others
  • UMN: Chris Tignanelli, Mary Butler, others
  • NACHC: Raymonde Uy, Julia Skapik
  • Patient Advocates (via Janice Tufte)

Health IT

  • Epic: Dave Little, James Doyle
  • Computable Publishing: Brian Alper, Joanne Dehnbostel
  • Optum: Keith Toussaint
  • University of Michigan: Rachel Richesson

Quality

  • NCQA: Jim Foss, Brad Ryan, others
  • ACCME: Steve Singer

Evidence/Guidance

  • EBQ Consulting (Liaison to Guideline Developers): Sandy Lewis
  • Epistemonikos: Gabriel Rada, Camila Avila, others
  • Cochrane Canada/GRADE WG: Adrienne Stevens, Holger Schunemann
  • Doctor Evidence: Bob Battista, Arturo Devesa

Federal Agencies

  • CDC: Maria Michaels

Coordination Support Needs

  • Steering Committee (SC) to ensure overall effort meets individual & shared goals (logistics, agendas, notes, procedures, coordination among WGs, etc.)
  • Workgroups (WGs) to address specific Phase 1 project components, e.g.,
    • ‘Rules of engagement’: who can engage in Phase 1 efforts and how, managing regulatory, proprietary considerations, etc.
    • approaches for developing and maintaining living / evidence & guidance content
    • Computability / standards / infrastructure / tool development WG
    • QI / guidance implementation / change management / workforce development /Equity
    • measurement / reporting
    • one WG for each of the targeted conditions (see below), e.g., to pull together above issues around the targeted condition - e.g., prevention WG, pain/opioids WG, Hypertension etc.
  • Regular SC and WG working meetings– logistics, agendas, notes
  • Cross-project Convenings: e.g., annual/in person, quarterly virtual
  • Collaboration infrastructure (e.g., website/wiki, discussion forums)
  • Communications/publications/outreach
    • Provide transparency and actionable updates to continually amplify and expand synergies and drive scale / spread to additional targets and settings

Organizations to Explore Interest in Addressing  Coordination Support Needs  (different orgs provide different functions in a matrixed manner?)

  • NAM
  • NCQA
    • high degree of overlap between vision and objectives of ACTS and NCQA/DQM community (which grew out of NCQA Digital Quality Summit). Also overlap in tooling and infrastructure needs. They do a lot of work with health plans - interest in bringing them into the mix. Very interested in extending beyond measurement and integrating tightly with all the LHS other components. 
  • MCBK
  • ACCME
  • AHRQ
  • others?

Targets/Engaged Stakeholders/Initiatives

Overview: Targets And Potential Implementation Sites and Partners

...

Pain management/opioids - more details 

  • There’s major interest and activity around addressing the opioid crisis by many public and private stakeholders

►AHRQ

−Patient-centered CDS Learning Network’s Opioid Action Plan

Six Building Blocks: A Team-Based Approach to Improving Opioid Management in Primary Care Self-Service How-To Guide 

−Other AHRQ initiatives 

►Epic Opioid Management Workgroup

−Has produced valuable tools

►Care Delivery Organizations

−UMN, others?

AMA

CDC

Surgeon General

NAM

EHRA

ECRI/EHRA

Hypertension

Log COVID

Prevention (e.g., Lung Cancer Screening)

Others 

QI (Quality Improvement) SOP/Checklist – Early Draft for Discussion

[VA is developing this tool in collaboration with ACTS LHS Phase 1 Plan efforts, and exploring using it as a foundation for it's QI efforts.]

I. Sample Use case for this tool

QI team gets a call from care delivery organization (CDO) staff regarding their desire to improve patient care and outcomes related to a specific clinical target or outcome, e.g., long covid, lung cancer screening, psychotherapy, provider burden, optimal primary care workflows, etc.  To support these efforts, the QI Team will work through the steps below.

II. Relation between this tool and the Patient Journey/Service Blueprint Template

This Quality Improvement Checklist primarily aligns with backstage activities in the Service Blueprint template. Item 4ai corresponds to back backstage activities in the Service Blueprint. Front stage / care delivery activities are also addressed in care process reengineering planning and implementation addressed in parts of items 3 and 4.

III. This QI SOP / Checklist can support continuous Optimization of CDO QI Activities

QI Team engagements guided by the tool - and their outcomes - can be cross-fertilized and continually refined:

  • Mechanisms for cross fertilization across targets: weekly QI Team touch base
  • Collaboration infrastructure: tools being used for collaboration
  • Governance and Value delivery (QI Governance activities, such as VA IHP board)
    • E.g., through intake criteria/prioritization for QI Team engagements (see figure below)

IV. The QI SOP / QI Checklist

   1. Intake/Prioritization: Is this engagement appropriate for the QI program? If yes, then:

   2. Ensure shared understanding among QI Team of problem/issue scope

    1. Current state of issue (both inside and outside the CDO; see prioritization scheme from HIMSS guidebook [see slide below])
      1. Number of individuals affected
      2. How those individuals are affected
      3. Outcomes for affected individuals
      4. Implications for provider workflow and patient journey
    2. Current projects/programs/tools being used to address this (both inside and outside CDO)
    3. Known best practices and guidelines (both inside and outside the CDO)
    4. Current pilots/proofs of concept for targeted clinical outcome
    5. Synthesis of desired state for CDO
    6. Gaps between current state and best practices or ideal, desired state[1]

      3. Make a plan to close the gap1

    1. Are new workflows that are needed? (details)
    2. Do processes need to change? (details)
    3. If new workflows or processes are needed, are new tools needed to implement them? (details)
    4. Do these tools currently exist or do they need to be created? Can we get existing tools?
    5. Make implementation plans to help ensure that any changes to tools and workflows are successful in achieving desired outcomes (including/especially change management planning, leveraging user-centered design / human factors engineering)
      1. Ensure that plan includes gathering data to support monitoring use and impact of any new tools and workflows. What are data sources? How will this information be gathered and analyzed? Ensure that data gathering doesn’t exacerbate burden of front line and patients.

      4. Implement the plan

    1. Tool acquisition and development (as needed)
      1. Leverage Knowledge Ecosystem, e.g., for tool creation, underlying standards, development, and use, etc.
    2. Tool implementation and testing
    3. Training
    4. Change management
    5. Implement new care processes (leverage service blueprint)

     5. Evaluate implementation results (structure, process, and outcome)

    1. Who used what was implemented and how did they use it?
    2. How did the use of these tools alter care processes?
    3. How did the use impact the care gaps we were trying to close?

     6. If goal/gap closure was not achieved, restart the process (starting with understanding the current state of issue)

[1] see service blueprint template for desired activities and tools at each step the in patient journey

Image RemovedTo prepare for the next phase of LHS Plan execution, working files for next steps have been moved to a different collaboration tool. See this page for an overview.