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Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
Karson approaching innovation with commercial ehrs
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Karson approaching innovation with commercial ehrs

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  • 1. Approaching Innovation with Commercial EHRs Andrew Karson MD MPH September 30, 2013
  • 2. Outline  Partners HealthCare  Partners eCare  Structure  Approach to Innovation  Advancing core work  Creating new and original solutions
  • 3. About Partners HealthCare  Integrated academic health care system founded by Massachusetts General Hospital and Brigham and Women’s Hospital in 1994  Largest private employer in Massachusetts  Over 60,000 employees 3 Patient Care • Among the sickest and most complex patients • Providing essential services • Caring for the most vulnerable Discovery • Over $1.4B in research funding • Discovering new treatments and cures • Testing new care delivery models Community • $205M in community benefits • 21 Community Health Centers • Over 100,000 Medicaid and uninsured patients annually. Teaching • 200+ accredited physician residency and fellowship programs • Harvard and Tufts Medical Students • Nursing and Health Professional programs
  • 4. Partners Tradition in IT Innovations  Long history of IT Innovations  BWH  Brigham Integrated Computing System (BICS)  MGH  Lab of Computer Science  Partners HealthCare  Longitudinal Medical Record (LMR)  MGH Order Entry  Chemotherapy Order Entry  EMAR  Enterprise Services  Many “best in class” systems
  • 5. Existing IT Environment  “A patchwork quilt”  Custom developed  Best-of-Breed  Supports niches of healthcare delivery  Can work against integration and coordination of care delivery  Expensive to maintain 5 2010 BWH MGH DFCI NWH FH NSMC Charter SRH SRC SRNS SCape PHC PCHI McLean NER/TBC Inp CPOE PHS PHS PHS Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A N/A Medtch C/S Inp MAR -nonbar N/A N/A N/A N/A N/A N/A Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A Medtch C/S Inp eMAR -bar code PHS PHS N/A Medtch Medtch Siemens Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A TBD Inp Nsg Assessment MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane Inp Nursing Notes MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane Flowsheets MVICU MVICU LMR TBD TBD TBD TBD N/A N/A LMR N/A N/A Consult (Inpt)Notes MVICU MVICU TBD TBD TBD TBD TBD TBD N/A N/A TBD Keane Inp Progress Notes MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD Keane Inp H&P MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD N/A Anesthesia Record MVOR MVOR N/A TBD TBD TBD TBD TBD N/A N/A N/A N/A Amb Chemo CPOE N/A PHS PHS TBD PHS PHS N/A N/A N/A N/A N/A N/A Amb CPOE - MEDs LMR LMR, OnCall LMR LMR, GE LMR, GE LMR TBD N/A LMR, GE TBD N/A Amb Nursing Notes LMR LMR, OnCall LMR LMR, GE LMR, GE LMR LMR Cerner LMR, GE TBD N/A Amb Visit Notes LMR LMR, OnCall LMR LMR, GE LMR, GE LMR LMR N/A LMR, GE TBD N/A OncAmb eMAR N/A PHS (pln) PHS (pln) TBD TBD TBD N/A N/A N/A N/A N/A N/A ED CPOE PHS PHS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A ED visit notes TBD EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A ED tracking BWH EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A ResultsViewing and Repository BICS, CDR/RV CDR/RV BICS, CDR/RV Medtch, CDR/RV Medtch, CDR/RV, BICS Siemens, CDR/RV Medtch, CDR/RV Siemens , CDR/RV Cerner CDR/RVMedtch C/S Keane Op Notes, D/C Sum BICS, CDR/RV CDR/RV N/A Medtch, CDR/RV Medtch, CDR/RV, BICS Siemens, CDR N/A N/A N/A N/A N/A N/A Pt Computing PG PG PG PG PG PG TBD TBD TBD PG TBD TBD LMR = Longitudinal Medical Record KEY: PG = Patient Gatew ay MV = MetaVision fromiMDsoft RV = Results View er Mdtch/CF - at SRH: Meditech and/or CareFusion for eMAR solution EDIS = (MGH) Emergency Dept Information System CDR = Clinical Data Repository
  • 6. Drivers of Change at Partners 6 Shift from volume to value-based care Risk sharing requiring tighter coordination and integration of care delivery Personalized medicine Heightened demands for healthcare reform from all sectors of the US economy
  • 7. Partners eCare Principles 7 One Patient, One Record, One Team, One Partners Statement
  • 8. Clinical Systems: Initial Implementation 8 Partners eCare (Epic) • Provider Order Entry • EMAR • Clinical Documentation • Ambulatory EMR • Radiant • Stork • Willow Inpatient • Kaleidoscope • MyChart • Phoenix Partners eCare (Epic add’l development) • Beacon • ASAP • OpTime/Anesthesia • Home Health • AMC Radiology Non-Epic (Partners eCare/ Other) • Ambulatory Pharmacy • Radiation Oncology • Gastroenterology •PACS (Image Archive and Communication) •Others Partners eCare Non- Epic Enterprise-wide • Blood Bank • Laboratory System
  • 9. Partners eCare Structure 9
  • 10. Partners eCare Structure 10
  • 11. PeC Clinician Team Sub-groups  Clinical Process Redesign  Clinical Content  Clinical Informatics  Clinical and Biomedical Devices  Clinical Deployment
  • 12. Clinical Process Redesign Project Prioritization Criteria  Alignment with Partners Strategy  Patient Safety  Quality of Care  Regulatory  Value/ROI  Usability  Standardization / Systemness  Facilitation of Epic build  Measurable (metrics/KPI)  Timed appropriately for PeC timelines 12
  • 13. Clinical Process Redesign Initial Process Redesign Areas Include: Admission Discharge Transitions in Care/Hand-offs Medication Reconciliation Peri-operative Services Plan of Care Preventive Care Patient Centered Medical Homes (10 Care) High Risk (iCMP) / High Cost Patients Patient Engagement/MyChart
  • 14. PeC Clinician Team Sub-groups  Clinical Process Redesign  Clinical Content  Clinical Informatics  Clinical and Biomedical Devices  Clinical Deployment
  • 15. Clinical Informatics  Clinical Decision Support (CDS)  Knowledge Management  Terminologies
  • 16. Partners Enterprise: Multiple Types of CDS  Drug-Drug Interactions  Drug-Pregnancy  Drug-Laboratory  Drug-Disease  Drug-Utilization  Duplicate Therapy  Food-Drug Interactions  Nephros (Renal Dosing)  Gerios (Geriatric Dosing)  Insulin Ordering  Chemotherapy (includes oral and investigational)  Order sets  Clinical Reminders  Health Monitoring  Critical Lab Results  Relevant Lab Results  Immunization Schedules  Family History  Problem list refinement 16
  • 17. Planned approach to CDS  Define CDS priorities based on Partners programs and initiatives: governance  E.g., MU, Safety, Quality, Care Redesign, ACOs, etc.  Understand features and content available in Epic: learning  Compare with features and content available at Partners: recommendations  Define implementation strategies: gradual deployment with long-term maintainability 17
  • 18. PeC Clinician Team Sub-groups  Clinical Process Redesign  Clinical Content  Clinical Informatics  Clinical and Biomedical Devices  Clinical Deployment
  • 19. Partners eCare Leadership Team 19
  • 20. Innovation Council Guiding Principles Definition • Innovation is the application of new solutions that meet new requirements, inarticulate needs, or existing market needs. The term innovation can be defined as something original and new that "breaks in to" the market or into society. Innovation differs from improvement in that innovation refers to the notion of doing something different rather than doing the same thing better. Where Innovation Will Occur • Sites vs. at Partners centrally Types of Innovation • External (including publication, patents and potential commercialization) • Internal (for use at PHS exclusively) Endpoints/Goals of Innovation • Where do the innovative ideas take PHS as an organization as related to the Health IT and EMR desired future state? Dimensions to Address Regarding Innovation Prioritization • Managing competition between innovators Other Process Issues to Address • How to address conflicts of interest? • How to support initiatives? • How will the “bake-off” rules work? Funding • Internal • Entity, PHS • External • Government, foundations, industry Dissemination of Innovation • How to communicate and foster an environment to promote innovation? • Support of cross-collaboration between institutions w/in PHS and external to PHS 20
  • 21. Guiding Principles to Foster Innovation Subgroup 21
  • 22. Fostering Innovation Guiding Principles Draft Overview Objective  Create guiding principles that would inform how to facilitate innovation across the Partners organization and promote an innovative environment. These principles go beyond the Partners eCare project and will influence health IT as a whole. Innovators  Innovators need access to others with different skill sets, and to resources that will enable them to refine their ideas. Prioritization of Partners Support for Innovation  Innovations will have higher priority if they are aligned with Partners strategic initiatives, and there will be an explicit set of criteria for prioritization. Whether Innovation Should Be Done In or Outside Epic  Applications should leverage Epic functionality when available and can be built inside Epic but can also be built outside of Epic when such functionality is inadequate or unavailable  If something is built inside Epic, then there are intellectual property considerations. 22
  • 23. Fostering Innovation Guiding Principles Draft Overview (cont’d) How Partners Should Support Innovation  Leverage existing site support for innovation  If commercialization potential to engage Research, Venture, and Licensing group.  To enable investigators, ideas and concepts will require “sandbox” environments to develop and test approaches.  Funding to support innovation: institutions, private donors, government, internal Partners, others. Dissemination of Innovations within Partners  Innovations that improve care in some important way should get support for spread across Partners. 23
  • 24. Prioritization Framework Subgroup 24
  • 25. Prioritization Framework Draft Overview Objective  Create a framework that will allow for the Innovation Council to evaluate innovative projects with a standard set of criteria and build/prioritize a portfolio of innovations. Development Approach  Using the “PIRC” model as a starting point, group tailored a number of focus areas and questions within each category to determine how closely an innovation would align to the framework criteria.  Once the focus areas were defined, group will develop a process utilizing a scoring system to prioritize innovative ideas for the Innovation Council to review and approve projects. 25
  • 26. Sample: “PIRC” Prioritization Framework Priority ReadinessImpact 1. Value Creation (Evidence Based, Scalable) 2. Generalizable 3. Measurable impact on quality, access, and revenue 4. Volume 1. Business Model/Value 2. Clinical Champion with Engaged Team 3. Project Manager and Technology Lead 4. Potential Clients Complexity 1. Data Transfer Needs 2. Workflow impact (videoconferencing, etc..) 3. Documentation 4. Credentialing and/or Licensing 1. Supports Mission 2. Supports Strategic Initiatives 3. Site Sponsorship and Resources 4. Innovation A selected group of Steering Committee members and subject matter experts will evaluate and approve future pilot programs. 26
  • 27. Conclusion  Partners is in the early stages of our engagement with a commercial EHR  We are attempting to innovate in multiple dimensions:  Advancing core work  Clinical Process Redesign  Clinical Informatics  Creating new and original solutions  Currently developing frameworks  Foster Innovation  Prioritize Innovative ideas
  • 28. Thank you Andrew Karson MD MPH akarson@partners.org 617-724-8262

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