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.
4. 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
5. 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
6. 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
7. 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
21. 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
22. 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
23. 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
25. 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
26. 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
28. - -
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
30. Analytics via Innovative Pilots
• Natural Language Processing for intelligent
searching of free text
• QueryHealth
• PopHealth
31. Universal Availability of PHRs
• Tethered (Patientsite and eCW Patient
Portal)
• Non-Tethered (Healthvault and others)
• OpenNotes
32. 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
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….
