Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Rheum-PACERDesign, Implementation, and Adoption of Innovative Visual Display Software.
Newman1, Eric D., Lerch2, Virginia, Jones2, J. B., Ayoub3, William T., Olenginski1, Thomas P., Harrington1, Thomas M., Bili1, Androniki
Electronic health records (EHRs) do not provide the information needed for optimal rheumatic disease care. Accordingly, we developed Rheum-PACER (Patient-Centric Electronic Redesign). PACER efficiently collects information from patients (touchscreen questionnaire) and effectively displays information from multiple sources (patient, nurse, physician, EHR) into a series of actionable views.
PACER is web-based but easily invoked using an EHR hyperlink. Functions include 1) demographics: diagnoses, treatments, social history, rheumatic tests; 2) outcomes: trends over time in simple measures (MDHAQ, pain, fatigue, stiffness, patient and physician global, joint countsFigure 1) and complex measures (DAS28, CDAI, GAS, RAPID3), in the context of treatment given and in real time; and 3) documentation: auto-generation of a clinic note and patient summary. Implementation involved ownership by key team members, training of staff, and aligning incentives. PDSA (Plan-Do-Study-Act) redesign methodology was used to integrate PACER into 2 Rheumatology Clinics (academic and multispecialty). A pre vs. post-PACER implementation analysis was done for efficiency (physician time for chart review and progress note completion, n=107) and productivity (physician work effort [RVUs], notes reviewed by a certified coder, n=100).
Over a 2 year period, 6,275 return patients completed 19,876 touchscreen questionnaires (TQs). 1,431 unique rheumatoid arthritis (RA) patients completed 6,781 TQs. For disease activity measures, 86% of RA patients had a completed RAPID3 (patient-derived composite measure) and 61% had a completed CDAI (patient and provider derived composite measure). PACER was well adopted by 12/14 physicians (Figure 2). Median chart review time fell from 5 to 4 minutes (p=0.39) and median progress note completion from 7 to 5.5 minutes (p=0.09). Productivity, as measured by RVUs per RA visit, increased (1.40 vs. 1.76, p=0.03) and net revenue per RA visit also increased ($74.10 vs. $93.33, p=0.03) from the pre- to the post-PACER implementation.
Rheum-PACER is innovative software that allows for the collection of objective information vital to optimal patient care delivery in real-time. Adoption of use was seen in 86% of physicians, and productivity improved significantly with no reduction in efficiency. Rheum-PACER has allowed the rapid development of a large objective rheumatic databasenext steps include development of quality and task management functions to improve population management of patients with rheumatic diseases.
To cite this abstract, please use the following information:
Newman, Eric D., Lerch, Virginia, Jones, J. B., Ayoub, William T., Olenginski, Thomas P., Harrington, Thomas M., et al; Rheum-PACERDesign, Implementation, and Adoption of Innovative Visual Display Software. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :753