Connecting Patients, Providers, and Payers John D. Halamka MD

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

Physician Goals Core ObjectiveMeasure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. E-RxE-Rx for more than 50% 3. DemographicsRecord demographics for more than 80% 4. Vital SignsRecord vital signs for more than 80% 5. Smoking StatusRecord smoking status for more than 80% 6. InterventionsImplement 5 clinical decision support interventions + drug/drug and drug/allergy 7. LabsIncorporate lab results for more than 55% 8. Patient ListGenerate 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

Physician Goals Core ObjectiveMeasure 10. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing 11. Visit SummariesProvide office visit summaries for more than 50% of office visits 12. Education ResourcesUse 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

Hospital Goals Core ObjectiveMeasure 1. CPOE Use CPOE for more than 60% of medication, 30% of laboratory, and 30% of radiology 2. DemographicsRecord demographics for more than 80% 3. Vital SignsRecord vital signs for more than 80% 4. Smoking StatusRecord smoking status for more than 80% 5. Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy 6. LabsIncorporate lab results for more than 55% 7. Patient ListGenerate patient list by specific condition 8. eMAReMAR is implemented and used for more than 10% of medication orders

Hospital Goals Core ObjectiveMeasure 9. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing 10. Education ResourcesUse EHR to identify and provide education resources more than 10% 11. Rx ReconciliationMedication 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. ImmunizationsSuccessful ongoing transmission of immunization data 14. LabsSuccessful 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

Patient Profile Screen

Patient Profile Screen, cont’d

Problems

Medications

Medication History and Reconciliation

Reports

External Reports

Orders

Sheets

Care Plans

Health Information Exchange eCW EHX NEHEN SafeHealth MD Fallon ClinicUMass Memorial Statewide HISP PKI/certificate mgmt Web portal Provider/entity directory Audit log MD BIDMC Partners Direct gateway services EOHHS NwHIN MassHealth DPH Atrius

20 Updated plan Original high-level plan from 12/11/2011 Updated plan as of 10/23/2012

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

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

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

Self Service Web Interface

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

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

- Patient-Level Information Assets BIDPO QDC

- 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

- Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. Provider Measure Scorecard

Analytics via Innovative Pilots Natural Language Processing for intelligent searching of free text QueryHealth PopHealth

Universal Availability of PHRs Tethered (Patientsite and eCW Patient Portal) Non-Tethered (Healthvault and others) OpenNotes

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

Decision Support Service Providers

10 17 Questions?