STAGE 7 SPOTLIGHT Cook County Health and Hospitals System: Combating Clinical Depression

HIMSS Analytics

Meeting EMRAM Stage 7 requirements means that a healthcare organization has made a commitment to improving patient outcomes and organizational efficiency through the use of modern healthcare information technology. Time and time again, the EMRAM has proven to be an invaluable tool in prioritizing HIT investments and developing a strategy for successful implementation and adoption of these technologies.

It's no wonder that countless healthcare organizations have turned to the EMRAM for guidance as they look to optimize patient care. In this post, we'll dive into just one of the many examples of EMRAM stage 7 success: The Cook County Health & Hospitals System.

The Challenge

Located in the Chicagoland region, the Cook County Health and Hospitals System (CCHHS) is comprised of:

  • Two hospitals, John H. Stroger, Jr. Hospital and Provident Hospital.
  • More than a dozen community health centers, including the Ruth M. Rothstein CORE Center and the Community Triage Center.
  • Cermak Health Services, which provides healthcare to individuals at the Cook County Jail and the Juvenile Temporary Detention Center.
  • CountyCare, a Medicaid managed care health plan.

For more than 180 years, this system has provided care to more than 300,000 patients, including primary care for approximately 71,000 patients. CCHHS serves to innovate care provision in Cook County by promoting community-based primary and preventive care, building collaborative health plans and working to enhance the patient experience.

Committed to providing comprehensive, compassionate and cutting-edge care, CCHHS set out to identify patients at risk for depression and improve the follow-up and treatment process for this condition. It's well-known that ineffective treatment of depression increases healthcare utilization and impairs treatment compliance — and with a population more vulnerable to depression due to a variety of socio-economic factors, CCHHS knew they needed a better process for diagnosis and treatment.

The Implementation

CCHHS assembled a multi-disciplinary clinical team to design a comprehensive depression risk screening tool within the electronic medical record (EMR) system. Designed to include standardized validated instruments such as AUDIT-C, DAST-10 and PHQ-2/9, the tool contains questions to help identify risk factors for depression, including abuse, housing and food insecurity.

After implementation, the EMR tool was used by nursing staff to screen all adult patients during intake in the primary care setting. The survey was made available for updates at intervals of less than one year and was required every 365 days. Based on responses, the tool would automatically calculate a PHQ-2 score, which scores the likelihood of depression from 0-6. A score equal to or greater than 3 — indicating an increased risk for major depressive disorder — would then trigger a required PHQ-9 questionnaire, which charts the severity of symptoms and automatically adds up the PHQ-9 score for the nurse administering the screening.

Using this tool, clinicians were able to quickly and easily identify those with increased risk for depression, document those notified of a positive screening and automatically note the results of the screening tests for providers.

The Results

Over a two-year period after implementation of the depression screening tool, they found that nearly 8 percent of patients screened in the CCHHS system were depressed, 4 percent of which were found to be profoundly depressed. During this period, the number of antidepressant prescriptions significantly increased, indicating an improvement in the identification and treatment of depressed patients.

In addition to this uptick in the prescribing of antidepressants, there was a proportionate shift toward more potent antidepressant medications such as Mirtazapine being prescribed due to the discovery that 4 percent of the patients screened were profoundly depressed. Overall, the depression screening tool has helped providers in the CCHHS system identify and take advantage of opportunities for improved care of their patients with depression.

The Takeaway

When CCHHS and organizations like it meet EMRAM Stage 7 requirements, they gain more than a simple badge of honor. EMRAM validation provides real and actionable insight into where operational and clinical outcomes are falling short and outlines a clear roadmap for bringing those areas up to par.

In achieving Stage 7, CCHHS was able to treat an entire population of patients who otherwise may have gone undetected. In identifying and treating these patients more effectively, CCHHS was able to improve the health and satisfaction of their patients with depression, reduce the frequency of return visits and as a result, save time, money and effort to direct toward improving other areas of healthcare.

As CCHHS CEO Dr. Jay Shannon said, “case studies like this demonstrate the importance of leveraging electronic medical records to aggregate and act on data that can improve clinical outcomes for an individual patient and also the health of our community." Like CCHHS, healthcare organizations everywhere can use the EMRAM to transform the health, safety and satisfaction of their communities

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