Connecting Patients, Providers and Payers John Halamka Keynote

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Connecting Michigan for Health 2013 http://mihin.org/

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  • High level real-time view of info from registration, scheduling and clinical systems. Demographics, providers, proxy, pharmacy for eRX Allergies, medications, problem list, recent results, recent encounters Alerts for patients who are admitted, anti-coagulated, diabetic, prenatal or have abx resistance (MRSA, VRE, etc)
  • Service specific problem lists. Add , edit, inactivate, delete, combine. Add comments. Associate notes to problem(s) in a patient’s list. This allows clinicians to easily view notes related to a specific problem or problems Restrict and un-restrict the display of a problem
  • View active and inactive medications Interaction/Allergy alerts Add, modify, renew, inactivate, hold medications Document that the medication list was reviewed with the patient Reconcile inpatient meds after discharge Add medications as “Recording Only” (prescribed by another provider) E-prescribe to retail and mail order Identify formulary medications based on the patients insurance
  • Reports = narrative results View and print clinical reports. Select time frame, sort by report type, ordering provider, status. View PACS Radiology Images via Centricity Web Viewer View Endoscopy Reports and Images stored in 3 rd party system View reports from other Caregroup hospitals Provides integrated view of results from within and outside the HIS
  • View active/inactive orders Support staff can enter orders, but ordering provider must sign.
  • Track clinical data over time. Standard and user defined sheets. Results from BIDMC’s Clinical Systems automatically displayed. Other results can be entered manually. Standard sheets included: Periodic screening, Vital Signs, Immunizations, Health Education, Diabetes Screening & labs, HIV Monitoring, Lipids, Anticoagulation, Prenatal, Asthma, Gerontology
  • Some sheets have additional disease management and alerting features, e.g., diabetes, anticoag, narcotics
  • Tasks allow providers to efficiently manage their queue of signed notes, discharge summaries and orders to be signed, review messages sent by other webOMR users and manage their patient related “to do” list. This is also the option used to access the Test Results Tracking System which electronically routes Radiology, Cardiology, Cytology and Pathology results to the ordering and responsible providers for their review and action.
  • Vocab deferred Clinical data repository – deferred Claims relay – part of HIX MDPHnet – Graphic Last year phase 2/3 New phase 2 MPI consent is now part of Phase II
  • The registry is a longitudinal asset that is built at the patient level. As new data is available and integrated, the patient is the key unit of analysis and storage. That data can then be analyzed and aggregated to describe care at a doctor level, or a disease population level, or a plan level. Inside that registry is data in blocks that will look very much like medical record. Vitals, labs, diagnoses, procedures. But it will also include data from the admin side– costs, eligabilty, and other demographics. The layer in red are the new data elements that we create and capture as part of the loading process. These are the True and False answers, new combinations of elements, counts of activity, or the lack thereof (sometimes it’s more important to see what’s not happening). It’s also additional analyses like risk scoring of patients. These are stored alongside the basic care and cost data as a rich set of analytic variables that support a range of uses for management and providers. (transition) This data is made available through a scorecard structure….
  • Connecting Patients, Providers and Payers John Halamka Keynote

    1. 1. Connecting Patients, Providers, and Payers John D. Halamka MD
    2. 2. 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
    3. 3. 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
    4. 4. Physician Goals Core Objective Measure 10. Patient Access 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
    5. 5. 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
    6. 6. Hospital Goals Core Objective Measure 9. Patient Access 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 Successful ongoing submission of electronic syndromic surveillance data 16. Security Analysis Conduct or review security analysis and incorporate in risk management process
    7. 7. Patient Profile Screen
    8. 8. Patient Profile Screen, cont’d
    9. 9. Problems
    10. 10. Medications
    11. 11. Medication History and Reconciliation
    12. 12. Reports
    13. 13. External Reports
    14. 14. Orders
    15. 15. Sheets
    16. 16. Care Plans
    17. 17. Health Information Exchange eCW EHXNEHEN SafeHealth MD MD MD MD Fallon Clinic UMass Memorial Statewide HISP PKI/certificate mgmt Web portal Provider/entity directory Audit log MD MD MD MD MD MD BIDMCPartners Direct gateway services EOHHS NwHIN MassHealth DPH Atrius
    18. 18. 20 Updated plan Original high-level plan from 12/11/2011 Updated plan as of 10/23/2012    
    19. 19. Multi-Stakeholder Governance Model Legal & Policy Workgroup Technology & implementation Workgroup Finance & sustainability Workgroup Consumer and public engagement workgroup Provider engagement & adoption workgroup Co-Chairs: -Wendy Mariner -Gillian Haney Facilitator: -Ray Campbell Business Analyst: -Christina Moran Co-Chairs: -John Halamka -Manu Tandon Facilitator: -David Delano Co-Chairs: -Andrei Soran -Steve Fox Facilitator: -Micky Tripathi Business Analyst: - Christina Moran Co-Chairs: -John Halamka -Manu Tandon Facilitator: -Micky Tripathi Business Analyst: -Mark Belanger Co-Chairs: -Jessica Costantino -Kathleen Donaher Facilitator: -Christina Moran Co-Chairs: -Michael Lee, MD -Dirk Stanley, MD Facilitator: -Mark Belanger HIT Council HIE-HIT Advisory Committee Chair: Secretary Judy Ann Bigby, MD
    20. 20. 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 multi- stakeholder governance committee • Primarily for Care Management, Government reporting, and Population Health
    21. 21. 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
    22. 22. Self Service Web Interface
    23. 23. 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
    24. 24. 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
    25. 25. - - Patient-Level Information Assets BIDPO QDC
    26. 26. - - 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
    27. 27. - -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved. Provider Measure Scorecard
    28. 28. Analytics via Innovative Pilots • Natural Language Processing for intelligent searching of free text • QueryHealth • PopHealth
    29. 29. Universal Availability of PHRs • Tethered (Patientsite and eCW Patient Portal) • Non-Tethered (Healthvault and others) • OpenNotes
    30. 30. 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
    31. 31. Decision Support Service Providers
    32. 32. 10 17 Questions?

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