North Carolina AHEC Program
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NC AHEC Program Top Rated Nationally in Primary Care Assistance
As part of an effort to modernize the nation’s health care system through health information technology, the NC Area Health Education Centers Program (NC AHEC) was recently recognized as one of the two top programs in the nation that help primary care providers use this technology to improve outcomes. NC AHEC is in the third year of a federal contract as a regional extension center (REC) for health information technology (HIT).
NC AHEC currently works with more than 1,100 primary care practices and over 3,900 providers across North Carolina, providing assistance in the selection, implementation and use of HIT.
A major goal of this effort is to improve health outcomes through the “meaningful use” of this technology through three stages. Stage 1 use focuses on functionalities that support the electronic capture of data and allowing patients to receive electronic copies of their own electronic health record (EHR). The Stage 2 (MU2) rules focus on increasing standards-based health information exchange between providers and with patients. Stage 3 documents improved outcomes.
“As a culmination to National Health IT Week (September 10-14, 2012) NC AHEC was named a winner of the MU2 challenge by the U.S. Office of the National Coordinator for HIT. Two of the 62 regional extension centers in the country were recognized for innovative programs that used Stage 1 meaningful use as a mechanism for practices to achieve excellent health outcomes for chronically ill patients. NC AHEC’s work in diabetes management was particularly noted,” said Samuel Cykert, MD, (photo right) associate director for medical education and clinical director of the NC AHEC REC.
“Many providers are already seeing how meaningful use of health IT like EHRs can help to improve outcomes and result in efficiencies, such as those who are working with NC AHEC,” said National Coordinator for Health Information Technology Farzad Mostashari, MD, ScM. “Through the use of EHRs and features like clinical decision support and point of care reminders, the positive impact on quality of care has been significant."
NC AHEC has incorporated quality improvement and medical home services into the culture of practice systems, which has provided additional benefits that translate into even larger improvements in preventive and chronic care while substantially lowering costs.
As an example, the Roanoke Chowan Community Health Center was able to decrease the number of patients with a hemoglobin A1c measurement greater than nine from 40% to less than 10% in their diabetic population. As measurement and templates in their system became consistent and point of care reminders were implemented A1cs less than seven have increased to 60% of the diabetic practice.
NC AHEC helped Ronald Caldwell, MD, of the Western North Carolina Hypertension Center conduct an analysis to determine what changes the practice could make to prepare for “meaningful use.” Through these efforts, the Center has achieved blood pressure of less than 140/90 in over 70% of their diabetic patients, established self-management goals through shared decision making in over 70% of diabetic patients, and performed smoking status inquiries in over 90%.
East Asheville Family Healthcare worked with NC AHEC to extract chronic illness quality measures from their EHR and translate them to a run chart. These run charts simply graphed the percentage of diabetic patients each month that met control parameters for the most clinically impactful care measures. As part of workflow redesign, nurses helped identify patients with elevated test levels or who were due for a diabetes follow up visit. Using population management principles, EHR data, evidenced-based guidelines in EHR templates, and a commitment to patient management, East Asheville Family Healthcare witnessed reductions of hemoglobin A1c > 9 rates to 5%, LDL cholesterol values of < 100 in 60% of their diabetic patients, A1cs < 7 in over 50%, and blood pressures < 140/90 in 70% of these folks – values that translate to remarkable long-term outcomes.
The NC AHEC Program Office is based in the UNC Chapel Hill School of Medicine and administers the REC through nine regional AHECs across North Carolina.