CMS Physician Quality Reporting J. Marc Overhage, MD, PhD Director of Medical Informatics, Regenstrief Institute Regenstrief Professor of Medical Informatics, Indiana University School of Medicine President and CEO, Indiana Health Information Exchange Regenstrief Institute, Inc. A Healthcare Laboratory and a Community of Scholars

Electronic Medical Records (EMRs)  The PERFECT solution – when we get there!  Deployment will take many years  There are a lot of them and it will cost a lot  Much of the data comes from outside the practice – though important data such as vital signs comes from inside the practice  Providers often do not enter or capture data in a structured fashion even when using an EMR  Any one provider’s EMR contains a subset of the patient’s data

EMRs Are Very Costly $190 Billion or 70% of the estimated cost of a Nationwide Health Information Network over 10 years $190 Billion or 70% of the estimated cost of a Nationwide Health Information Network over 10 years CITL HIEI estimates

Electronic Health Record Adoption is Behind the Curve Ford et al JAMIA 2006 Optimistic Average Conservative Already off the curve?

Indianapolis MSA Data Landscape

Additional Clinical Data Needed for Quality Reporting  Claims alone are not enough  Revenue codes  Laboratory results  Limited diagnoses  Not longitudinal (requirement for continuous enrollment)  Uninsured/underinsured  Long delays © 2006 Regenstrief Institute, Inc.

Most Data Needed for Quality Reporting is Electronic  Much, but not all, of the data needed for quality reporting is already electronic  Important exceptions  Vital signs  Family history  Behaviors (e.g. smoking)  Aggregating requires a trusted third party © 2006 Regenstrief Institute, Inc.

Are we making use of the available electronic data?  Case in point: Wellpoint receives data from national labs under contract – How many of the cholesterol results for their patients come from their contract national laboratories? © 2006 Regenstrief Institute, Inc.

2006 © Indiana Health Informaiton Exchange 9

Cohort CARE Query CARE Query DA Quality DB Quality DB Global Patient Index

11 Example On-line Report

12 Q Children with Pharyngitis Q You are here!