1. 2014 EHR Certification
Meaningful Use 2014
Patient List
iCare (BQI) v2.3.3
Federal Leads:
Theresa Tsosie-Robledo
Kathy Ray, Clinical Lead, Navajo Area CAC
2. A Quick Look at the IHS
Provides a comprehensive health service delivery
system for approximately 1.9 million American Indians
and Alaska Natives.
Serves members of 562 federally recognized Tribes.
Indian Health Service staff consists of about 15,700
employees, which includes approximately 2,400
nurses, 800 physicians, 400 engineers, 500
pharmacists, 300 dentists, and 300 sanitarians.
3. Indian Health Service
Over 50% of programs are operated by tribes
through tribally run compacted or contracted
facilities
34 urban programs are contracted to provide
care to AI/AN populations in metropolitan
areas
Remaining care is provided through federally
operated ‘direct’ programs (majority of the user
population still receives care in direct
programs)
4. Indian Health Care System
Hospitals Health
Centers
Alaska Village
Clinics
Health
Stations
IHS 31 63 N/A 30
Tribal 14 240 166 102
The IHS also supports 34 Urban Clinics across the nation.
5. IHS Programs are Located in Remote Reservation
Areas and Urban Areas
7. Resource & Patient Management
System
IHS Health Information Solution since 1984
RPMS is an integrated Public Health information
system
• iCare – Named 2011 “Laureate” by The Computerworld
Honors Program
• EHR – Certified in April of 2011 for both inpatient and
outpatient
• Award Winning - Davies Award/ Best of Government IT award
• Composed of over 60 component applications
• Facilitates patient, provider, community and population health
perspectives
• Patient and Population based clinical applications
• Patient and Population based practice management
applications
• Financially-oriented administrative applications
8. Resource and Patient Management
System (RPMS)
Note: Not all packages are represented here.
14. iCare Population Management
Provides an intuitive, integrated view into diverse
patient data elements for populations as well as
individuals
Facilitates the proactive identification and
management of populations
Supports easy creation and customization of panels of
patients
Nationally deployed in May 2007
Iterative, phased development
Active workgroup, change control board and Subject
Matter Expert involvement
14
15. iCare – Background Processes
Performed routinely - nightly, weekly and monthly
Allows for quick panel creation and data display
Provides Clinical Decision Support
• Community Alerts
• Flags
• Reminders
• Performance Measures
• Best Practice Prompts
• Care Management Event Tracking
• Meaningful Use (Performance / Clinical Quality Measures)
• Improving Patient Care
16. iCare and PCMH 2011
PCMH 1: Enhance Access and Continuity
• Provides method to designate PCP
• Create care teams
• Monitor appointment wait times and office visit times
PCMH 2: Identify and Manage Patient
Populations
• Create defined panel lists
• Create and distribute reminders
• Use of disease/condition-specific registries
• Use of diagnostic tags
• Provides demographic information
• Facilitates Community Health Rep outreach
PCMH 4: Provide Self-Care Support and
Community Resources
• Provide summary care pages and reports
• Referral to IHS online resources
• Facilitates Community Health Rep outreach
PCMH 5: Track and Coordinate Care
• Create care teams
• Create defined panel lists
• Create and distribute reminders
• Monitor continuity of PCP and team care
PCMH 3: Plan and Manage Care
• Access to RPMS data from various system components
• Plan care through use of reminders
• Provides risk factor assessment
• Facilitation of care management
• Monitor continuity of PCP and team care
• Includes robust behavioral health care components
• Care plan functionality under development
PCMH 6: Measure and Improve Performance
• National Measures, GPRA, MU, IPC
• Provider/team//facility-level measurements
• Monitor ER and UC usage
• Monitor local patient satisfaction
17. PCMH 4: Provide Self-Care Support and
Community Resources
• Provide summary care pages and reports
• Referral to IHS online resources
PCMH 5: Track and Coordinate Care
• Create care teams and monitor coordination
• Create defined panel lists
• Create and distribute reminders
PCMH 6: Measure and Improve Performance
• National Measures, GPRA, MU, IPC
• Provider level and facility level measurements
18. iCare – Community Alerts
Splash Screen at first
login of the day
Anonymous
Related to Community
of Residence
Ready Access from
many views: Opening
View; Panel View;
Patient Record
User-defined display
19. 19
iCare – Opening View
Easy display of
user defined
patient panels.
Site level tabs
provide facility
level reporting.
Share your
panels with
other users to
help manage
the workload.
20. 20
iCare – Panel Creation
Quickly define
the patients you
are interested in.
Numerous
options to filter
your search.
21. iCare – Diagnostic Tags
Currently 13 Diagnostic tags
available. Users are encouraged to
help define additional tags to be
implemented in future releases.
22. 22
iCare – Panel View/Patient List
Quick look at
your patients.
Customize
the view to
suit your
needs.
Share your
panels and
custom
layouts with
others.
24. Clinical Decision Support –
National Measure Views
24
Users select
Nat’l Measure
Display
Aggregate
View
25. iCare – Population to Individual
National GPRA
measures.
View patient’s
measures and
determine best
practices to
ensure health
and wellness.
26. iCare – Patient Record / National Measures
26
Through out
iCare’s grid
views you can
filter results.
Quickly focus in
on the data you
are looking for
using the drop
down filters.
27. iCare – Patient Record
27
The Snapshot
and Cover
Sheet provide
a wealth of
information.
Know more,
with less
effort.
Links to
detailed visit
details.
28. iCare v2.1 Introduced CMET
CMET = Care Management Event Tracking
Provides ability to track certain pre-defined events
• Breast
• Cervical
• Colon
• Skeletal health
Workflow includes four steps
• Event (a mammogram, for example)
• Findings (Bi-Rad 3)
• Recommendations for Follow-up (repeat mammogram in six
months)
• Patient Notification (documentation that the patient has been
informed of the Findings and Recommendations).
• CMET generates “ticklers” or reminders to ensure that the
next step is followed
• CMET work flow is available from all iCare views: Main View,
Panel View, and Patient View.
29. Main View CMET - Events
Filters allow
users to hone in
on specific
areas of
interest.
Events:
-Breast
-Cervical
-Skeletal
-Colon
30. Main View CMET: Tracked Events
Keep track of
patient status.
Organized work
flow using
“CMET
Worksheet”.
Feather
“Ticklers” let you
know when
something is
“Past Due”.
31. Main View CMET: Follow-up Events
Know who
needs a follow
visit and when it
is due.
Easy linking
back to the
preceding
event.
32. HIV Management System (HMS)–
Main View
HIV/AIDS
specific Care
Management
Windows are
designed for the
specific care of
HIV patients
33. HIV Management System –
Reminders View
HIV/AIDS specific
Reminders are
presented for
easy assessment
Patients can be
copied into
focused patient
panels for
specific
management
35. iCare v2.2 Introduced the Meaningful Use (MU) Tab
iCare v2.3 Improved the MU Tab!
Provides an easy display of MU measures
Supports Certification and MU
Broken down into 5 sub-tabs
• Provider Performance
• Hospital/CAHs Performance
• Provider Clinical Quality
• Provider Clinical Quality Reports
• Hospital Clinical Quality
Displays measures for up to 100 providers at a
time
36. Main View: Meaningful Use Tab
Provider Performance Measures
Weekly
background
jobs gather MU
Performance
data based on
the previous
year or 90 day
time frames.
Date presented
is by provider.
37. Main View: Meaningful Use Tab
Hospital/CAHs Performance
Performance data
is also presented
at the hospital
level
Hover help
through out iCare
ensures little effort
is needed to
determine what
the measure
definition is.
38. Main View: Meaningful Use Tab
Provider Clinical Quality
Display of
provider Clinical
Quality
Measures.
Filters can be
set to focus in
on specific
measures
39. Site Level National Measures
Get an easy
view of site
level National
Measures
40. iCare v2.3
Released April 2012
Introduction of Improving Patient Care
(IPC) view
Creation of teams/microsystems
Four IPC specific tabs available
• Patient Detail
• Provider Detail
• Provider Aggregated
• Facility Aggregated
41. IPC Goals
Optimization of IPC workflow
• Automation of data reporting
• Reduction in errors
Compatibility with IPC Data Portal
In line with GPRA reporting
• Supports National Goals
42. Additional Enhancements
Panel creation based on Labs
• Can also filter on what labs a patient does
not have
Panel creation based on Medications
43. IPC Site Parameters
Designation of IPC panels
IPC Site Parameters
• IPC Data Collection
• IPC data aggregation will be automatically performed
on the day of the month defined here during the iCare
nightly job. The default value is the 1st of the month.
Depending on the timeliness of data entry at your site,
this can be changed up to the 7th of the month.
• Primary Care Clinics
• This is the list of primary care clinics that are used for
the Continuity of Care to a Provider measure. The
default list of clinics defined upon installation is:
GENERAL (01), FAMILY PRACTICE (28), INTERNAL
MEDICINE (13) and PEDIATRIC (20).
• Microsystem Providers
• This is the list of providers who are to be defined as
your site’s microsystem. Monthly data aggregation will
automatically be calculated for any provider who has
been designated as a Primary Care Provider and has
at least one patient assigned to them.
Site Managers: set
the day of the
month to run data
collection
44. IPC Tabs
Patient Detail
• For a panel designated as an IPC
panel, this displays all patients with
the values of their IPC measures.
The values are the values
calculated based on the last time
the iCare nightly job or weekly
National Measures job last
completed.
Panel Detail
• For a panel designated as an IPC
panel, this displays aggregated
data for all patients in the panel for
all IPC measures by provider. The
values are the values calculated
based on the last time the iCare
nightly job or weekly National
Measures job last completed.
45. IPC Tabs
Provider Aggregated
• As each month is processed, this
provides a view of all providers who are
Primary Care Providers for all IPC
measures. These values are not
refreshed once calculated. They are a
snapshot for the previous month
calculated the next month on the day
specified in the IPC site parameter for
data collection.
Facility Aggregated
• This provides a view on a month-by-month
basis for all IPC measures for all
providers who are Primary Care
Providers. These values are not
refreshed once calculated. They are a
snapshot for the previous month
calculated the next month on the day
specified in the IPC site parameter for
data collection.
Click “Export” to
populate your
provider templates
within a couple of
clicks!
46. Why the Focus on IPC?
Short Answer: They Asked for Help…
iCare is already proven it’s worth in RPMS data
collection. But there is still a lot more that can
be done to help sites.
The IPC program already had established
procedures to collect data and report out to a
central resource. This process proved to be
time consuming requiring a significant amount of
man hours to collect.
Through the realization that most of the data
already resided in RPMS, a solution was sought
out that would help automate this data
collection.
47. The IPC Workflow Before iCare
Areas in bold red text were automated.
Open iCare – set up panel for the
designated PCP in the microsystem. If
more than one DPCP in the micro-system,
create IPC team (micro-system)
that combines all the DPCP
panels into one IPC panel.
Open microsystem panel in iCare – open
National Measures Aggregate tab – find
Diabetes Comprehensive, Tobacco
Users, Tobacco Counseling numerator
and denominator .
Open the DPCP/microsystem panel – open
National Measures tab and modify panel to add
measures for the Health Risk Screening Bundle ,
Cancer Screening Bundle, and Outcome
Screening Bundle
* Most sites make three separate iCare panels –
one for each bundle measure
Enter data on to the Data Portal Template from
the:
1) iCare national measures tab (DM Comp,
Tobacco Use/Counseling)
2) Excel macro (bundle measures)
3) iCare panel (total # pts in panel) 4) Cycle
time worksheet
5) Staff satisfaction
6) Patient experience
7) Self-management support (RPMS)
8) Third next available (RPMS/PIMS)
9) % Empanelled/Continuity (RPMS)
Open Excel Macro – click on
green box – upload Excel
workbook for each bundle
measure (Health Risk
Screening, Cancer
Screening , Outcome
Screening) separately (3
Excel files) - macro will run
calculations and save in
Excel file
Log into Knowledge Portal
[www.improvingindianhealth. org] - IPC
– Team Resources – Resources –
Measurement and Reporting folder and
then to Data Reporting Tab
Download from Measurement and Reporting
folder in Knowledge Portal:
1) “2011 IPC Measures Manual” – review instructions
for all measures (Word doc)
2) 2011 Macro for Bundles (Excel sheet )
3) Cycle time workbook (Excel sheet)
4) Patient experience survey (Word doc)
5) Staff satisfaction survey (Word doc)
Download from Data Reporting tab:
1) Data Portal template for site/ provider
Open National Measures tab
for each bundle (health risk
screening, cancer and
outcome) – select “edit”
then “select all” (to select
all rows/patients for the
panel) – click on Excel icon
in iCare and save to an
Excel workbook on
desktop, or My
Documents/IPC folder, etc.
Log on to the Data Portal
(through the Knowledge Portal)
– and upload the completed
Data Portal template
Complete cycle time worksheet – add
data to cycle time worksheet to get total
minutes/visits
Complete staff satisfaction surveys and
total results
Patient experience survey – report
question #7
Run next third-available report, self
management report, % empanelled and
continuity to DPCP in RPMS
48. The IPC Workflow with iCare
Areas in bold red text were automated.
Open iCare – set up panel for the
designated PCP in the microsystem.
Enter data on to the Data Portal Template from
the:
4) Cycle time worksheet
5) Staff satisfaction
6) Patient experience
8) Third next available (RPMS/PIMS)
Log into Knowledge Portal
[www.improvingindianhealth. org] - IPC –
Team Resources – Resources –
Measurement and Reporting folder and
then to Data Reporting Tab
Download from Measurement and Reporting
folder in Knowledge Portal:
1) “2011 IPC Measures Manual” – review
instructions for all measures (Word doc)
3) Cycle time workbook (Excel sheet)
4) Patient experience survey (Word doc)
5) Staff satisfaction survey (Word doc)
Download from Data Reporting tab:
1) Data Portal template for site/ provider
Complete cycle time worksheet – add
data to cycle time worksheet to get total
minutes/visits
Complete staff satisfaction surveys and
total results
Patient experience survey – report
question #7
Run next third-available report.
Log on to the Data Portal
(through the Knowledge Portal) –
and upload the completed Data
Portal template
49. Provider Aggregated
IPC Template Population - Export
1. Select the IPC:
Provider Aggregated
tab
2. Download your
Provider Template,
click the IPC Data
Portal button (links to
portal site)
3. Click IPC Export
4. Select the Month
and Provider(s)
5. Select your
template
50. Employee Health Panel
Set the Employers Site Parameters
• This is the list of employers that
should be used for Employee
Health Care Management at your
site. This is a table of all employers
in your RPMS system which may
have many different spellings.
Create a panel based on Employer
• If you have been assigned the
proper security key, you will see this
selection in the Patient filters of the
Panel Definition. By checking
“Employer” (Filter Patients by
Employer), a panel can be created
or filtered by the list of Employers
defined in iCare Site Parameters.
Add the one or many
“employers” that
define your site.
Check this box to
create an
“employee” panel
51. Employee Health
Employee Health Care Mgmt Group
• Displays
• Flu
• Hep A
• Hep B
• PPD
• TDAP
• ILI
• MMR
52. Panel Definition Enhancements
Enhanced panel
management
through creation of
Categories and
color
Designate a panel
as an IPC panel
Check to
designate as
IPC Panel
Click to select
or create a
Category
53. Panel Definition Enhancements
Patients Assigned To
• Patients NOT Assigned to
a DPCP
• This is a tool to help identify
patients who have not yet
been assigned a Primary
Care Provider.
• **WARNING** - Creating a
panel based on this
selection could yield a large
number of patients. It will
include all patients unless
you apply additional filters
such as only ‘Living’
patients or a specific
community.
Identify patients
not assigned to
a DPCP
54. Panel Definition Enhancements
Multiple Providers
• The ability to pick multiple
providers has been added.
This is a feature to help in
creating panels where several
providers may share a group of
patients.
Teams
• You may also create teams of
providers and use that “team”
to create a panel of patients.
Only patients whose DPCP is a
team member will be added to
the panel.
• Teams can be created in the
Scheduling Menu => Primary
Care Provider Menu => Set
Up Primary Care Teams menu
in RPMS.
Create a panel
based one or
multiple providers
Define based
on Primary
Care Team
55. Panel Definition Enhancements
PCC
• Panels can now be created or
filtered by patients having a
selected lab or medication
during a timeframe or NOT
having a selected lab or
medication during a
timeframe.
• User can select a specific lab
test or medication or use an
existing taxonomy.
• An example of the use of
these new selections:
• Patients with an Asthma tag
who do not have a Controller
medication
• Patients with the new
Pregnancy tag who have not
had an HIV screening.
56. New Pregnancy Diagnostic Tag
Create a panel based on Pregnancy tag
• The definition has a choice of two methods of calculation. The
method can be modified from the iCare Site Parameters. The
default method upon installation of 2.3 is ILI Logic.
• ILI Logic
• Is based on the ILI Export Pregnant flag logic.
• iCare Logic
• Choice of 1 to 9 month time period
If Pregnancy Tag Status is ‘Pending’, changing the Site
Parameter value may change the tag to ‘NLV’ (No Longer
Valid).
If Pregnancy Tag Status is ‘Accepted’, the tag will stay around
until the patient has a birth or other pregnancy ending visit then
the tag status will automatically become ‘No Longer Valid’.
Changes in the Site Parameters will not change any ‘Accepted’
Pregnancy tags.
57. Templates
New functionality has been
added so that a user can
define multiple template
layouts. Templates can also
be created and added so that
anyone can download and use
the templates.
Tools=>Manage Templates
• “Your Templates”
• List of all a specific user’s
defined templates and what
layout is contained in that
template.
• “Public Templates”
• List of all templates at the site
available to be downloaded to
the list of “Your Templates”.
58. Additional Site Parameters
Inactivity Timeout
• iCare has
implemented
inactivity timeout
functionality. This
site parameter
determines how long
before the application
will timeout and
shutdown due to user
inactivity.
59. iCare Functionality
iCare is a reporting and case management
tool for clinical decision support
Panel definitions allow users to create custom
patient lists based on users needs
Definitions are applied to all patients in RPMS
Lists are utilized to:
• Manage care for groups of patients
• Report on site measures
• Report on provider measures
61. iCare’s Role in MU2014
Patient List
MU Objective
Generate lists of patients by specific conditions to
use for quality improvement, reduction of
disparities, research, or outreach.
2014 Edition EHR Certification Criteria
§ 170.314(a)(14) (Patient list creation)
62. Core Measures
Objective: Generate lists
of patients by specific
conditions to use for
quality improvement,
reduction of disparities,
research, or outreach.
Measure: Generate at
least one report listing
patients of the EH or
CAH with a specific
condition.
No exclusion.
Eligible
Hospital (EH)
and Critical
Access
Hospital
(CAH)
Objective: Generate lists
of patients by specific
conditions to use for
quality improvement,
reduction of disparities,
research, or outreach.
Measure: Generate at
least one report listing
patients of the EP with a
specific condition.
No exclusion.
Eligible
Professional
(EP)
Patient List
63. Core Measures (Continued)
Objective: Use clinically relevant
information to identify patients who
should receive reminders for
preventive/follow-up care and send
these patients the reminders, per
patient preference.
Measure: More than 10 percent of all
unique patients who have had 2 or
more office visits with the EP within
the 24 months before the beginning of
the EHR reporting period were sent a
reminder, per patient preference when
available.
Exclusion: Any EP who has had no
office visits in the 24 months before
the EHR reporting period.
Preventive Care
Eligible
Professional
(EP)
64. Certification Criteria
§ 170.314(a)(14) Enables a user to electronically
and dynamically select, sort, access, and create
patient lists by date and time based on each one
and at least one combination of the following data:
i. Problems
ii. Medications
iii. Medication allergies
iv. Demographics
v. Laboratory tests and values/results
vi. Ambulatory setting only - patient
communication preferences
65. Subject Matter Experts Engaged
Kathy Ray
(Navajo
Area CAC)
Catherine
Moore -
Lab
(Fed Lead)
Clinical End
Users
Care/Case
Managers
67. General Statement About
Defining Panels
When defining panels you are effectively
narrowing down the list of patients you will
be presented with
Each additional filter applied to your
definition will further narrow your results
reducing the number of patients in the list
1 Filter
Patient
Patient
Patient
2 Filters
Patient
Patient
3 Filters
Patient
68. Screen Mockups
i. Problems
ii. Medications
iii. Medication allergies
iv. Demographics
v. Laboratory tests and values/results
vi. Ambulatory setting only – patient
communication preferences
Patient Notification Reminders
79. Definition Details Tab
iCare uses an addition tab/view to display
more complex patient data conceived due
to the potential large amount of data that
may be presented to a user based on how
a pane is defined
• Labs
• Medications
• Problems
80. Certification Tester’s First
Unanticipated Question
Tester wanted to be presented with a list
which displayed all data elements
simultaneously.
• IHS provided an accepted rebuttal based on
test documentation referring to a
“combination of 2 or more data elements”
• iCare is able to display lists containing
multiple data elements than can be sorted
by clicking on the column headers
82. Certification Tester’s Second
Unanticipated Question
Tester wanted to be able to export
patient list
• iCare is able to export patient lists and data
elements as present on screen out to Excel
85. Thank you
for your interest in iCare
For more information, please visit our web site. Training
classes are conducted regularly as well as posted recordings
of classes and demonstrations.
http://www.ihs.gov/icare/
Site Management Providers Nurses Administrative Get Started with iCare
