Connecting Patients, Providers, and Payers John D. Halamka MD
The US Healthcare IT Program Improving quality, safety, efficiency, and reducing health disparities Engaging patients and families in their health care Improving care coordination Improving population and public health Ensuring adequate privacy and security protections for personal health information
Physician Goals Core Objective Measure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. E-Rx E-Rx for more than 50% 3. Demographics Record demographics for more than 80% 4. Vital Signs Record vital signs for more than 80% 5. Smoking Status Record smoking status for more than 80% 6. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 7. Labs Incorporate lab results for more than 55% 8. Patient List Generate patient list by specific condition 9. Preventive Reminders Use EHR to identify and provide reminders for preventive/follow-up care for more than 10% of patients with two or more office visits in the last 2 years
Physician Goals Core Objective 10. Patient Access Measure Provide online access to health information for more than 50% with more than 5% actually accessing 11. Visit Summaries Provide office visit summaries for more than 50% of office visits 12. Education Resources Use EHR to identify and provide education resources more than 10% 13. Secure Messages More than 5% of patients send secure messages to their EP 14. Rx Reconciliation Medication reconciliation at more than 50% of transitions of care 15. Summary of Care Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 16. Immunizations Successful ongoing transmission of immunization data 17. Security Analysis Conduct or review security analysis and incorporate in risk management process
Hospital Goals Core Objective Measure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. Demographics Record demographics for more than 80% 3. Vital Signs Record vital signs for more than 80% 4. Smoking Status Record smoking status for more than 80% 5. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 6. Labs Incorporate lab results for more than 55% 7. Patient List Generate patient list by specific condition 8. emar emar is implemented and used for more than 10% of medication orders
Hospital Goals 9. Patient Access Core Objective Measure Provide online access to health information for more than 50% with more than 5% actually accessing 10. Education Resources Use EHR to identify and provide education resources more than 10% 11. Rx Reconciliation Medication reconciliation at more than 50% of transitions of care 12. Summary of Care Provide summary of care document for more than 50% of transitions of care and referrals with 10% sent electronically and at least one sent to a recipient with a different EHR vendor or successfully testing with CMS test EHR 13. Immunizations Successful ongoing transmission of immunization data 14. Labs Successful ongoing submission of reportable laboratory results 15. Syndromic Surveillance 16. Security Analysis Successful ongoing submission of electronic syndromic surveillance data Conduct or review security analysis and incorporate in risk management process
Patient Profile Screen
Patient Profile Screen, cont d
Problems
Medications
Medication History and Reconciliation
Reports
External Reports
Orders
Sheets
Care Plans
Health Information Exchange MassHealth Partners BIDMC DPH EOHHS NEHEN ecw EHX NwHIN Statewide HISP Direct gateway services PKI/certificate mgmt Web portal Provider/entity directory Audit log Atrius MD SafeHealth MD MD MD Fallon Clinic UMass Memorial MD MD MD MD MD MD
Updated plan Original high-level plan from 12/11/2011 Updated plan as of 10/23/2012 20
Multi-Stakeholder Governance Model HIT Council Chair: Secretary Judy Ann Bigby, MD HIE-HIT Advisory Committee Co-Chairs: -John Halamka -Manu Tandon Facilitator: -Micky Tripathi Business Analyst: -Mark Belanger Legal & Policy Workgroup Technology & implementation Workgroup Finance & sustainability Workgroup Consumer and public engagement workgroup Provider engagement & adoption workgroup Co-Chairs: -Wendy Mariner -Gillian Haney Co-Chairs: -John Halamka -Manu Tandon Co-Chairs: -Andrei Soran -Steve Fox Co-Chairs: -Jessica Costantino -Kathleen Donaher Co-Chairs: -Michael Lee, MD -Dirk Stanley, MD Facilitator: -Ray Campbell Facilitator: -David Delano Facilitator: -Micky Tripathi Facilitator: -Christina Moran Facilitator: -Mark Belanger Business Analyst: -Christina Moran Business Analyst: - Christina Moran
Analytics via Expert Query Hospital Analytics group Community Practice Analytics group Includes data cleansing, validity checking and creating repeatable queries Databases and data marts governed by a multistakeholder governance committee Primarily for Care Management, Government reporting, and Population Health
Analytics via Self Service Web-based graphical tool to query BIDMC s Clinical Data Repository Includes 2 million patients and 200 million facts (e.g., demographics, diagnoses, medications, lab tests, and procedures) from 1997 to the present Aggregate counts (e.g., preliminary data for grant proposals, population studies, etc.) do not require an IRB protocol With IRB approval, data sets can be obtained with help from the Decision Support team
Self Service Web Interface
Analytics via Repeatable Reports Parameter driven web-based reports in Performance Manager Acceleration of business intelligence capabilities with SQL Reporting and Analysis Services Dedicated expert consultant devoted to implementation Primarily for clinical and administrative operational support
Analytics via Outsourced Community Quality Repository and Claims Registry Combines BIDMC, HMFP, BIDPO, APG, API data into a single clinical care respository Used for all our Meaningful Use Measures, PQRS reporting, and AQC contract Also creates data marts of clinical data to support all payer claims data warehouse run by HDS Primarily for Pioneer ACO and Managed Care efforts
Patient-Level Information Assets BIDPO QDC - -
Provider Metrics and Measures Measure sets: 35 Contract Incentive Measures 44 NQF Meaningful Use Measures 24 PQRS Measures 31 Pioneer ACO Measures Qualified registry for the CMS 2010 PQRS program Certified as an ONC-ATCB (CCHIT) certified as a modular EHR for Eligible Providers for all 44 MU Stage 1 measures - -
Provider Measure Scorecard Slide title Massachusetts ehealth Collaborative MAeHC. All rights reserved. - -
Analytics via Innovative Pilots Natural Language Processing for intelligent searching of free text QueryHealth PopHealth
Universal Availability of PHRs Tethered (Patientsite and ecw Patient Portal) Non-Tethered (Healthvault and others) OpenNotes
Required PHR Functionality Secure Messaging with Provider Access to all records Convenience Transactions Request Appointments Medication Refills Referrals to Specialists Education Disease specific content Links to medication information Diagnostic test explanations
Decision Support Service Providers
Questions? 10 17