June 20, 2008 Alliance for Health Reform Janet Wright MD FACC IC 3 Program: Challenges, Lessons, and Hope

12% Epic 7% Logician (Centricity) 7% Next Gen 7% Powerchart (Cerner) 6% Hospital/Practice Own 5% GEMMS 4% Allscripts 3% Meditech 2% CIS 2% Misys 2% Primesuit 1% AHLTA 1% Carecast 41% Other Popular EMR/EHR Most cardiologists report using an EMR/EHR at their practice.

National CV Data Registry Guidelines Applied in Practice or GAP –Acute MI in Michigan: 1=> 5=> 33 hospitals –Heart Failure in Oregon –Stable Angina in Alabama –National Door to Balloon (D2B) Initiative –Highlight team-care, care coordination, data collection and utilization to improve outcomes

First NCDR ambulatory registry –Longitudinal data –Practice/physician level data –Assess physician adherence to ACC/AHA Performance Measures –Vehicle to transform performance measurement to quality improvement Improving Continuous Cardiac Care

Philosophy of the IC 3 Program Make it easier for busy clinicians to do the right thing for the right patient at the right time –Track key performance measures Internal QI and P4P practice level –Make care more efficient –Coordinate care

Program Conditions Coronary Artery Disease Heart Failure Hypertension Atrial Fibrillation Diabetes

Pitch to Practices Tools to improve care –Real-time reporting of office-based quality indicators Trusted mechanism for measuring performance –Support evolving CMS outpatient quality measures and regulatory reporting initiatives –Support Pay-for-Performance programs with payers

Sample QI Strategies Comparative Benchmark Reports Guideline adherence & decision support –Reminder Systems –Visit-based summaries of treatment plans

Sample QI Strategies Patient education resources Opportunity for personalized information: Ix Health management tools

Strategic Partnerships EMR Vendors Centra Healthcare System Payers Professional Societies Alliances: MedAxiom, Spirit of Women DocSITE: web-based data collection tool

Data Collection and Exchange Outpatient Visit ACC NCDR IC 3 Program ® Ongoing data submission to ACC Periodic data reports to practice Payers CMS/PQRIUnitedBC/BSOthers Annual reports to payers ACTION-GWTG Registry

Key Challenges IT infrastructure Program integration into clinical practice Quality improvement Alliances / Business case Incentives for participants

Data Collection Methodology EMR integration –GEMMS, NextGEN, GE, and ALLSCRIPTS interested in participating in pilot –Developing functional specs for all EMR vendors to become certified IC3 vendors Paper forms –Piloting in 2009

Challenges-IT Compared to hospital-based registries –No data collection form –No traditional data dictionary –No traditional DQR –No traditional on-site audit

Challenges-IT Vendors have software applications that… –Maintain patient demographics –Manage problems lists (any number of coding schemes) –Manage medication lists (any number of coding schemes) –Manage allergy and adverse reaction list –Document patient history –Record patient instructions –Create prescriptions –Order tests/manage test results –Manage patient advance directives –Support for standard care plans, guidelines, protocols

Challenges-Practice Integration Workflow redesign issues pervasive.. –Organizational culture –Provider preferences and behavior –Patient preferences and behavior –Change management theory (and practice!)

Lessons Learned-QI Platform needs to be flexible –Add new modules quickly to test new PMs –Facilitate testing appropriateness criteria –Support research network Quarterly reporting may not be best –Sub-optimal to improve physician adherence POC decision support tools critical to improve adherence to guidelines

Lessons Learned- Incentives Meet practices where they are Hassle reduction once program in place Enhanced patient and family satisfaction Health plan uptake PQRI ABIM-Maintenance of certification

Lessons Learned Establishing Ambulatory Registry is Transformational –Performance measurement –Health IT –Doctor/patient communication –Quality improvement Multi-pronged data collection approach is optimal… –Web-based data tool is not optional in world of advancing HIT –EMR strategies are not necessarily seamless –Cost issues associated with paper-based solutions

IC3 Program Enrolled Sites- May 30th 335 offices across the country… 41 states