Electronic Health Records Challenges and Innovations in 2015
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1 Electronic Health Records Challenges and Innovations in 2015 Bradley H Crotty MD MPH Clinical Liaison, Information Systems Director of Patient Portals, Division of Clinical Informatics Associate Director, Informatics Training, BIDMC Massachusetts Hospital Association June 2015
2 Disclosures Dr. Crotty reports no relevant conflicts of interest to disclose.
3 Learning Objectives Describe the journey of one of the last home-grown electronic health records in the country History and first principles Evolution of the BIDMC System Recent projects Data exchange Inpatient Medication Administration Outpatient Patient Engagement Share our perspective on path forward for sharing health data and interoperability Highlight novel patient-engagement projects
4 Evolution History of of Computing Clinical at Computing BIDMC Acid-Base Therapy Advisor Patient-Computer Dialogue CCC System (ADT, Labs, Rx, Lookup, Security) Hospital PaperChase Migration of CCC to BWH ClinQuery BeWell! Online Medical Record (OMR) OMR for HIV CareWeb Baby CareLink Cancer CareLink PatientSite POE WebOMR
5 BIDMC Clinical Systems BIDMC operates one of the last home-grown electronic health record systems. Ambulatory: Online Medical Record Inpatient: Inpatient Clinical Applications Provider Order Entry Perioperative Information Management System Portal: PatientSite Take a build vs. buy approach, and build where existing market products do not meet internal needs With network expansion, we place an increasing importance on exchange of data across electronic health records A quick tour
6 Record Tabs List and Task Management Demographics Magic Buttons Alerts & Reminders Care Coordination
7 Trigger GRACE Geriatrics Pathway DNR Status Quality Indicators Discharge Planning Inpatient Dashboard
8 Inpatient Provider Order Entry
9 Generate Admit Orders at time Of medication reconciliation
10 Priorities Reliability Security Regulatory Compliance Innovation Patient Safety Population Management Patient Engagement Quality Improvement Governance structures include clinicians, staff, programmers, leadership, and patients.
11 5 Innovations For Contemporary Needs System-Wide 1. Interoperability and sharing clinical data 2. Using EHR data to drive quality improvement 3. Care Coordination Outpatient 4. Condition-specific EHR views with SmartSheets 5. Engaging Patients Through Portals
12 Innovations SYSTEM
13 One ACO, Multiple Organizations, Multiple EHRs BIDCO BIDMC BIDHC Affiliated Physicians Affiliate Hospitals Partners Boston Campus & Physicians eclinicalworks athenahealth BID-Plymouth BID-Needham BID-Milton Atrius CHA webomr Meditech Meditech Medittch Epic Epic
14 One ACO, Multiple Organizations, Multiple EHRs BIDCO BIDMC BIDHC Affiliated Physicians Affiliate Hospitals Partners Boston Campus & Physicians eclinicalworks athenahealth BID-Plymouth BID-Needham BID-Milton Atrius CHA webomr Meditech Meditech Medittch Epic Epic
15 One ACO, Multiple Organizations, Multiple EHRs BIDCO BIDMC BIDHC Affiliated Physicians Affiliate Hospitals Partners Boston Campus & Physicians eclinicalworks athenahealth BID-Plymouth BID-Needham BID-Milton Atrius CHA webomr Meditech Meditech Medittch Epic Epic
16 One ACO, Multiple Organizations, Multiple EHRs BIDCO BIDMC BIDHC Affiliated Physicians Affiliate Hospitals Partners Boston Campus & Physicians eclinicalworks athenahealth BID-Plymouth BID-Needham BID-Milton Atrius CHA webomr Meditech Meditech Medittch Epic Epic
17 One ACO, Multiple Organizations, Multiple EHRs BIDCO BIDMC BIDHC Affiliated Physicians Affiliate Hospitals Partners Boston Campus & Physicians eclinicalworks athenahealth BID-Plymouth BID-Needham BID-Milton Atrius CHA webomr Meditech Meditech Medittch Epic Epic
18 Approach To Sharing Data Magic Button EPIC Mass HiWay Groundwork for exchanging data through modern web technologies
19 Data for Quality Improvement and Operational Support BIDMC uses metadata from the electronic health record to aid in quality improvement programs Nurse staffing ratios Process measures of quality Door to balloon time for STEMI through the ED A look at improving Door To Balloon Times
20 Example: Using Administrative Data for Quality Improvement Door to Balloon Time (2007) /15/ /14/ /07/ /06/07 09/02/07 08/18/07 08/14/07 08/10/ /09/07 07/06/07 07/02/07 06/29/07 06/17/07 05/15/07 03/29/07 03/29/07 03/28/07 03/12/07 02/14/07 01/22/07 01/08/07 12/27/06 12/16/06 11/28/06 10/12/06 09/22/ STEMI TIME SERIES FY07 Nurse Rm or Reg Time Arrival to ECG Cards Notified STEMI Pyxsis Meds Ready for Cath Lab Left ED Cath Lab Arrival Inflation Note: ED Arrival = 0 Exact Time of each segment noted at end of colored bar. Courtesy Ken Sands MD
21 Example: Using Administrative Data for Quality Improvement Door to Balloon Time (2009) /25/ /31/ /06/ /10/ /29/ /25/ /20/ /24/ /17/ /02/ /17/ /16/ /14/ /07/ /02/ /20/ /28/09 01/23/ /23/ /16/ /08/ /21/ /12/ /10/ /08/ /27/ /16/ /06/ /24/ Triage Time Arrival to ECG Cards Notified STEMI Pyxsis Meds Cath Lab Arrival Inflation Note: ED Arrival = 0 Exact Time of each segment noted in colored bar
22 Innovations AMBULATORY CARE
23 Smart Sheets EHRs contain many different data elements and narrative, but have difficulty focusing clinician attention on the right elements SmartSheets allow for condition-specific views care Diabetes Congestive Heart Failure Chronic Kidney Disease Anticoagulation Geriatrics
24 Smart Sheets
25 Engaging Patients The Patient is the least utilized resource in healthcare Warner V Slack MD PCMH Transformation Health Coaching Tools PatientSite OpenNotes HealthKit epro
26
27
28 OpenNotes Delbanco, T. et al., Annals of internal medicine, 157(7), pp P. 114 Primary Care Doctors and Their 20,000 Patients I. Patient Direct Access To Notes Through Web Portal 84% reported better understanding of their health and medical conditions C. No Access To Notes 73% felt better prepared for visits O. Survey Measures 84% reported remembering the plan for their care better 84% felt more in control of their care 70% reported taking better care of themselves (incl. med adherence)
29
30 BIDMC Process For Patient Feedback Patient reads note and is invited to give feedback in the reporting tool at the end of the note 35% 30% 30% 25% 22% Patient Relations reviews all responses Safety Concern? no Aggregate data on survey feedback is captured in database for study yes 22% Patient Relations reaches out to patient and/or clinician to discuss concern and then closes the loop with patient 20% 15% 10% 5% 0% Possible inaccuracies in 17% Report of symptoms Something important missing 13% Past medical history 10% Family history Physical Exam (including part of 9% Courtesy of Sigall Bell MD
31
32 Incorporating Patient Generated Data Using HealthKit
33 Contact Information Bradley H Crotty MD MPH Division of Clinical Informatics Beth Israel Deaconess Medical Center Bcrotty AT mail.harvard.edu Phone:
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