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EHR Innovations for Improving Hypertension Challenge
ONC seeks to uncover the practices that have used clinical decision support to implement the most successful evidence-based blood pressure treatment protocols. ONC will then further reward organizations that can spread these tools for use by the most providers.
Department of Health and Human Services
Type of Challenge: Scientific
Partner Agencies | Non-federal: Million Hearts
Submission Start: 01/23/2015 12:00 AM ET
Submission End: 10/30/2015 11:59 PM ET
The goal of the EHR Innovations for Improving Hypertension Challenge is to gather specific descriptions of health IT tools and approaches used by individual practices to implement an evidence-based blood pressure (BP) treatment protocol that has led to improvement in practice-wide blood pressure control (Phase 1), and identify models for quickly and widely spreading these to other practices (Phase 2).
A comprehensive clinical decision support (CDS) approach supports these five protocol elements:
- 1. Blood pressure measurement/recording
- 2. Blood pressure follow-up
- 3. Initiation and titration of medications
- 4. Patient engagement
- 5. Workup/referral for poor control
In Phase 1 (three months), practices will document the electronic health record (EHR) tools they used to implement an evidence-based BP control protocol, as well as describe the details and results of the implementation. Practices must demonstrate high BP control levels and/or improvement to ensure that tools and strategies merit replication across practice settings.
In Phase 2 (nine months), practices and their partners will conduct, evaluate and document dissemination strategies for tools recognized in Phase 1, emphasizing widespread, effective use of these tools by other practices. Submitters must demonstrate successful use of these tools in at least two additional practices. Phase 1 will have up to four winners, each of whom will receive a $5,000 prize. Phase 2 will have a single winner of a $30,000 prize. Honorable Mention designations will be given for other Phase 1 submitters who provide CDS tools that reviewers select for Phase 2 dissemination efforts, and for other Phase 2 submitters with commendable CDS tool dissemination and implementation strategies. Both phases will recognize submitters in different categories such as practice type and size, based on the submissions received.
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Green Spring Internal Medicine
In an effort to apply for the Phase II award, we designed our own challenge titled “GreensSpringMed Hypertension Challenge” and invited practices in our PCMH pilot, practices who participate in our ACO, practices who are affiliated with the QIN-QIO in Maryland and Virginia, and those affiliated with the Department of Health and Hygiene in Maryland. We initiated the challenge in April 2015 (see attached flyer) and asked that each practice design and implement their own evidence-based hypertension control protocol. Thirteen practices expressed intent to participate in the challenge (listed in attachments). We held monthly webinars from April through October where we disseminated our strategy and tools (specifically CDS tools and registry use) and discussed various barriers and successes practices were experiencing in implementing these tools in their respective practices. During the challenge, a number of practices came up with their own CDS innovations. All of the webinars were recorded and resources were uploaded to an online shared workspace.
Mary Boles, Christopher Tashjian, Roseanne Matzek, Vibrant Health Family Clinics
Vibrant Health Family Clinics, previously River Falls, Ellsworth and Spring Valley Medical Clinics, has worked diligently over the past few years to improve the care we provide to patients with chronic disease. Our focus has been not only on patients exclusively with hypertension but those that have multiple co-morbidities, including Diabetes and Ischemic Vascular Disease. Saving the lives of our patients by helping them learn about healthy lifestyle changes, good nutrition, setting goals, caring about themselves and adjusting medications is something we take great pride in. We have been Million Hearts Champions twice over the past two years. We started our improvement work with one clinic site and moved our interventions into our other two clinic sites, maintaining excellent blood pressure control for all patients with hypertension at a rate of 76% based on NFQ 0018 report data from July 31, 2013-August 28, 2014. We have actively shared our work with other clinical sites, most recently a clinic from Chippewa Falls, WI which is located about 50 miles away. Our work has also allowed us to be in a national collaborative group, the LEAP learning community, with a focus on creating a toolkit for other clinics looking to improve patient care.
Holly Dahlman, Green Spring Internal Medicine, LLC
Our practice was nominated by the Maryland Department of Health and Mental Hygiene to submit this innovation which is based upon three interventions: registry use to identify high-risk patients, DASH diet recommendation, and patient self-monitoring protocols which are facilitated by automation within the EHR.
Cash Prize Amount: $30000
Phase 2 will have a single winner of a $30,000 prize. Honorable Mention designations will be given for other Phase 2 submitters with commendable CDS tool dissemination and implementation strategies.
Phase I Winner #1
Cash Prize Amount: $5000
Phase 1 will have up to 4 winners, each of whom will receive a $5,000 prize. Other Phase 1 submitters who provide CDS tools that reviewers select for dissemination efforts during Phase 2 will receive non-monetary recognition (e.g., Honorable Mention). Phase 1 practices may be recognized in different categories (e.g., practice type, size) based on the submissions received.
Phase I Winner #2
Cash Prize Amount: $5000
Phase 1: Submission period: July 7-October 6, 2014 Review period: October 7-October 21, 2014 Winners announcement: October 27, 2014
Phase II: Submission period: January 23-October 23, 2015 Review period: October 26-November 9, 2015 Winners announcement: November/December, 2015
A Practice is defined as the ambulatory care organization that has implemented the CDS-enabled hypertension protocol addressed in the submission. It can be a solo provider or much larger business entity, as long as the blood pressure management approach - and supportive CDS tools and their use - are uniform throughout.
1. Name/address of practice 2. Practice demographics:
- Type (e.g., private practice, health center, health system)
- Number and type of providers
- Setting (e.g., rural, urban)
- Size of practice’s patient population, including number of unique patients seen in the last year
- Hypertension prevalence in patient population
- Demographic data including: Race/ethnicity (African-American, Hispanic/Latino, Asian, American Indian/Alaska Native, Native Hawaiian / Other Pacific Islander); Gender; Age; Insurance status (Medicaid/CHIP, Medicare, self-pay/uninsured); LGBTI (optional)
SUBMISSION REQUIREMENTS In order for an entry to be eligible to win this Challenge, it must not use HHS’ or ONC’s logos or official seals in the Submission, and must not claim endorsement.
ELIGIBILITY RULES FOR PARTICIPATING IN THE COMPETITION To be eligible to win a prize under this challenge, an individual or entity—
(1) Shall have registered to participate in the competition under the rules promulgated by the Office of the National Coordinator for Health Information Technology.
(2) Shall have complied with all the requirements under this section.
(3) In the case of a private entity, shall be incorporated in and maintain a primary place of business in the United States, and in the case of an individual, whether participating singly or in a group, shall be a citizen or permanent resident of the United States.
(4) May not be a Federal entity or Federal employee acting within the scope of their employment.
(5) Shall not be an HHS employee working on their applications or submissions during assigned duty hours.
(6) Shall not be an employee of Office of the National Coordinator for Health IT.
(7) Federal grantees may not use Federal funds to develop COMPETES Act challenge applications unless consistent with the purpose of their grant award.
(8) Federal contractors may not use Federal funds from a contract to develop COMPETES Act challenge applications or to fund efforts in support of a COMPETES Act challenge submission.
An individual or entity shall not be deemed ineligible because the individual or entity used Federal facilities or consulted with Federal employees during a competition if the facilities and employees are made available to all individuals and entities participating in the competition on an equitable basis.
Entrants must agree to assume any and all risks and waive claims against the Federal Government and its related entities, except in the case of willful misconduct, for any injury, death, damage, or loss of property, revenue, or profits, whether direct, indirect, or consequential, arising from my participation in this prize contest, whether the injury, death, damage, or loss arises through negligence or otherwise.
Entrants must also agree to indemnify the Federal Government against third party claims for damages arising from or related to competition activities.
INTELLECTUAL PROPERTY Ownership of intellectual property is determined by the following:
Each entrant retains title and full ownership in and to their submission. Entrants expressly reserve all intellectual property rights not expressly granted under the challenge agreement.
By participating in the challenge, each entrant hereby irrevocably grants to Sponsor and Administrator a limited, non-exclusive, royalty-free, worldwide license and right to reproduce, publically perform, publically display, and use the Submission to the extent necessary to administer the challenge, and to publically perform and publically display the Submission, including, without limitation, for advertising and promotional purposes relating to the challenge.
ONC reserves the right to cancel, suspend, and/or modify the Contest, or any part of it, for any reason, at ONC's sole discretion.
ONC is administering this challenge under authority of the America COMPETES Reauthorization Act of 2010, Section 105 (15 U.S.C. 3719).
Phase 2: Number of practices in which the CDS interventions were implemented, or implementation is underway
Phase 2: Number of practices expressing interest in replicating the CDS implementation
Phase 2: Demonstrated blood pressure control improvements
Absent clear blood pressure control improvements, demonstration of compelling evidence that CDS tool implementation has made a positive impact on blood pressure care processes and/or that blood pressure control improvements are likely.
Phase 2: Comprehensiveness and innovation in supporting blood pressure protocol elements with CDS tools
Phase 2: Capacity for the CDS implementation-spreading strategy to be used outside the challenge
Phase 1: Blood pressure control (less than 140/90) among hypertension patients
This will be measured in blood pressure control rate (must be the same as that used for PQRS #236/NQF #0018) and/or blood pressure control rate improvement (percentage point increase in BP control rate over a specified time). Submissions will be evaluated based on the percent improvement, but no specific threshold must be demonstrated.
Phase 1: Comprehensiveness and innovation in addressing the protocol elements using EHRs or other health IT
Phase 1: Description of tool and its implementation detailed enough to be replicated
Phase 1: Ease with which others could implement the tool/approach
For example, a high degree of customization that makes it harder for others to replicate would result in a lower score.
How To Enter
Phase 2 submitters can include any organization or collaboration that is able to widely spread the successful use of the tools recognized in Phase 1, and need not have participated in Phase 1. Success will likely require partnership with organizations that have significant size and reach - such as specialty societies, quality organizations, Regional Extension Centers (RECs), health IT products or services vendors - to support the tool dissemination goals. Submitters must demonstrate successful use of these tools in at least 2 additional practices.
To participate in Phase 2, provide documentation describing the elements below. Narrative elements must be no longer than 5 pages, not including screenshots, artifacts, or worksheets.
a. CDS Tools Spread. Describe which tools from Phase 1 your team spread to other practices using the format of the Phase I CDS Intervention Details. Describe in detail any modifications that were made to the Phase 1 version of the tools.
b. Spread Results.
- Successful implementations: Describe the number and nature of practices to which the CDS interventions were spread. For each practice, provide details as described in Phase 1 Practice Information.
- Blood pressure control and process improvements: For each practice and in the aggregate, describe the blood pressure control improvements generated by the tools using the instructions in Phase 1 Blood Pressure Control Results. If BP control improvements have not yet been achieved, provide compelling evidence of significant value to the practice(s) and their hypertensive patients from the tool implementation.
- Additional commitments: Provide evidence about any additional sites that have committed to adopt the CDS tools you are spreading but have not yet reached implementation.
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A practice implementing the protocol must lead the submission. Practices are encouraged to form teams supporting their entry that include organizations such as a Regional Extension Center (REC), EHR developer, quality organization and/or professional society. Practices must demonstrate high blood pressure control levels and/or improvement to ensure that their tools and strategies merit replication across other practice settings.
To participate in Phase 1, provide documentation describing the elements below. Narrative elements must be no longer than 5 pages, not including screenshots, artifacts, or worksheets.
a. Blood Pressure Control Results. Challenge entry requires exemplary blood pressure control for hypertensive patients driven by EHR/CDS interventions – a practice-wide control rate of at least 70%, and/or a significantly improved level from before the enhanced CDS interventions described in the submission were deployed (no specific threshold must be met).
- Hypertension prevalence in practice: per cent of patients 18 or older whose diagnosis list includes hypertension.
- Per cent of patients with hypertension whose blood pressure is controlled (<140/90). The specifications used to determine this rate must be the same as that used for PQRS #236/NQF #0018 (see the US Health Information Knowledgebase). Significant improvement over time in BP control: Provide the percent of the patient population whose BP rate was improved over a specified period. Each submission will be evaluated based on the percent improvement and time period but no specific threshold for these must be met.
- Per cent of the patient population whose blood pressure rate was improved over a specified period, the per cent improvement, and the time period, using the specifications above for determining the rates.
- BP measurement/recording (e.g., use of documentation templates, highlighting abnormal BPs in EHR)
- BP follow-up and patient recall (e.g., use of registry reports)
- Medication selection and titration (e.g., use of order sets)
- Patient engagement (e.g., use of patient education and goal setting tools, templates for documenting and responding to home BP readings, patient reminders for medications/appointments)
- Workup/referral for poor control (e.g., reference information, hypertension-specific consult order forms)
d. Workflow Integration Details. Describe how you integrated into the practice and clinical workflow the interventions described in the previous section. Provide enough detail so that other practices wanting to use the same interventions you have used would experience similar success with them in controlling blood pressure. Use both a narrative description and the CDS/Quality Improvement worksheets for standard presentation/replication (e.g., similar to QI case example within the CDS/QI resources recently provided by ONC; see specifically II.A: CHC Inc. and Ellsworth QI Case Studies).
e. Practice Information. Provide information about the lead practice as detailed in the "Practice Information" section in Rules.