The problem we solve: In value-based healthcare, payers like CMS, state Medicaid, and private insurers, demand documentation of quality, sometimes with stiff penalties if benchmarks aren’t met. But just reporting of quality metrics has been estimated to cost $50,000 per physician per year (Health Affairs, 2016). Physicians are "drowning in a sea of advice," faced with literally thousands of clinical guidelines and recommendations that change constantly. As the guidelines change, so do the quality indicators. With each new quality indicator, healthcare systems struggle to capture, improve, and report them. They offer quality bonuses and salary withholds to incentivize providers to meet metrics, often undertaking a constant stream of expensive quality improvement efforts. The result is millions of dollars wasted and an epidemic of provider burnout. The decision support systems market is forecast to grow from $3.79 billion in 2018 to $6.4 billion in 2024, at a compound annual growth rate of 9.3%.
About our solution: CHICA automates quality reporting by providing highly efficient decision support. It assesses risk directly from patients and the EMR, sets a patient-tailored care agenda for the physician, allowing the physician to quickly document care provided, thus improving quality of care while producing quality reporting as a free side effect. When the patient arrives at the clinic, CHICA produces a health risk survey, tailored to the patient and based on data in the EMR. The patient completes the information on an electronic tablet in the waiting room. Based on the patient’s responses and data in the EMR, CHICA generates an agenda for the physician that appears in the EMR. The physician responds to the items in the agenda by clicking boxes that document care in the record and store data for future encounters and for quality reporting. Dozens of randomized controlled trials have shown that CHICA improves quality of care. Documenting quality measures is a happy side-effect of improving care.Progress to date:
CHICA went into production in 2004. In the succeeding 15 years, CHICA has served 64,000 patients and 40 physicians and nurse practitioners in 7 outpatient pediatric clinics. Over 50 publications demonstrate CHICA’s effectiveness. CHICA increased the rates of risk assessment for anemia by seven-fold and tuberculosis by more than double, maternal depression screening was almost universal. Attention deficit hyperactivity disorder (ADHD) diagnosis was 30% more likely to meet formal diagnostic criteria. Developmental screening rates tripled. Autism screening rates increased from 0 to 100%. CHICA increased diabetes screening rates four-fold, and HPV vaccination rates by 20%. CHICA also screens for social determinants of health, adolescent suicidality, and CHICA aids in parental smoking cessation counseling. CHICA produces a rich dataset of patient and physician reported data. DHS is entering into a $2M contract with the Child Neurology Foundation to build a child neurology version of CHICA.
Creator: Stephen Downs
Education: Indiana University, Regenstrief Institute, In
Bio: Stephen M Downs, MD, MS Dr. Downs, Jean and Jerry Bepko Professor of Pediatrics, is Vice Chair for General Pediatrics and Director of Children’s Health Services Research at Indiana University School of Medicine. He received his medical degree and master’s in medical informatics from Stanford University. He completed his residency in pediatrics and a Robert Wood Johnson Clinical Scholars fellowship at the University of North Carolina at Chapel Hill, where he served on the faculties of pediatrics, biomedical engineering and public health. Dr. Downs’s work is at the interface of decision sciences and medical informatics, and he has published well over a hundred articles in these fields. He is an elected fellow of the American College of Medical Informatics. He chairs the Partnership for Policy Implementation (PPI) and the Child Health Informatics Center Project Advisory Committee (CHIC PAC) for the AAP. He received the AAP Oberst award for significant contributions to the field of clinical information technology for children. He is the founding CEO of Digital Health Solutions, LLC and company created to distribute the proven software Dr. Downs’s team developed and researched over the last 15 years.
Hospital Affiliation: Indiana University Health, Eskenazi Health
Title: Jean and Jerry Bepko Professor of Pediatrics
Advanced Degree(s): MD, MS
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