Society Perspective 07 SEPT 2018

EHR Landscape 1,100 commercially available EHR systems1 Member survey of ob-gyn EHR usage Email survey to members n=3198 Response rate = 16.7% 1. https://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Professionals.php

Unintended Consequences: Physician Burden Electronic health record use is contributing to physician burnout As much as 50% of a physicians’ time spent completing clinical documentation - “pajama time”1 Est. 64 minutes per day spent processing EHR alerts2 Documenting to fulfill billing requirements, not enhancing patient care3 1. Shanafelt, TD et al. Mayo Clinic Proceedings 91(7):836-848. 2. Murphy, DR et al. JAMA Internal Medicine 176(4):559-560. 3. Ommaya, AK, et al. National Library Of Medicine Discussion Paper.

ACOG Health IT Initiatives ACOG Prenatal Record ACOG Comprehensive Women’s Medical Record The Birth Registry Data Modeling Initiative (Revitalize 2.0) Patient Reported Outcomes OPA FPAR 2.0

Compare the two

ACOG Comprehensive Women’s Medical Record Abnormal Uterine Bleeding Menopause Gynecology Infertility Well-Woman/ Primary Care Breast Health Contraception Obesity Heart Health Family History Immunization Sexual Health Mental Health Pelvic Pain Genetics & Precision Medicine Urogynecology Prenatal Postpartum Prenatal Genetics ACOG Comprehensive Women’s Medical Record Obstetrics

Comprehensive Women’s Medical Record 2021 Timeline ACOG Comprehensive Women’s Medical Record APR: Continued marketing Comprehensive: Launch Genetics Module, Develop new modules 2020 APR: Market & Promotion Well Woman: Launch Well Woman and 2018 modules, Develop Genetics module 2019 APR: Additional EHR Platforms Well Woman: Develop Well Woman, Pelvic Pain, Abnormal Uterine Bleeding modules 2018 2017 APR: In Production

USPSTF Levels I: At least one properly designed RCT II-1: Well-designed controlled trials without randomization II-2: Well-designed cohort or case-control analytic studies, preferably from more than one center or research group II-3: Multiple time series with or without intervention. Dramatic results in uncontrolled experiments also could be regarded as this type of evidence III: Opinion of respected authorities, based on clinical experience, descriptive studies, etc

Recommendations A: Good and consistent scientific evidence B: Limited or inconsistent evidence C: Primarily on consensus and expert opinion

Overarching Issues Real World Evidence Federated Data Model vs. Harmonization Value Set Issues Missing data (coded, built, & used) Device-Centered vs. Patient-Centered Clinical workflow Data sharing/movement

Uterine Fibroids Predictive analytics for customized patient care: Shortest Symptom to Relief Time Best, Long-term Outcomes Least Invasive Managed Expectations/Counseling Cost-effective This slide is what ACOG wants out of the data

Sterilization and LARC Specific patient populations (eg, women with obesity, hypertension, etc) Physician technique (procedure and counseling) Physician practice patterns Adverse events (ectopic pregnancies, long term ovarian cancer risk, patient reported outcomes) Future procedures (hysterectomies) This slide is what ACOG wants out of the data.