1. Using HIT to (Help) Measure Quality James M. Walker, MD, FACP CMIO Geisinger Health System

2. Agenda Geisinger Overview Challenges Processes used to select metrics Lessons Learned

3. Geisinger Overview 40 counties (mostly poor, elderly, and under- served) 4 hospitals; 30,000 discharges 41 clinic sites, 1.5 M visits 2.4 million patients in EHR HMO

4. Clinical Information Systems Outpatient EHR – all docs, all activities Inpatient EHR – complete 2007 Patient EHR – 87,000 users Outreach EHR – 250,000 encounters/year RHIE – 4 M patients, record locator, results transmission Research – EHR benefits, information- optimized care processes

5. Challenges A welter of (evolving) requirements –Defining quality internally at least as much as externally –Achieving the minimum number of data elements (and definitions) required to manage quality internally and report to various recipients.

6. Challenges A welter of (evolving) requirements Un-organized recipients Lack of standards

7. Lack of Standards Lead time Topics Data elements (with definitions) Communications standards Operating systems and applications

8. Challenges A welter of (evolving) requirements Disorganized recipients Lack of standards Organizational silos Fragmented data repositories Data capture Clinician acceptance

9. Metric-Selection Processes Legacy metrics Clinical-process optimization

10. Clinical-Process Optimization Chronic and Acute Care –Create internal consensus on performance standards and metrics. –Re-design processes to capture structured data for metrics. –Create internal consensus on reports (internal and external).

11. Metric-Selection Processes Legacy metrics Clinical-process optimization Literature Review (inpatient) Data Standards and Applications Committee

12. Define unified reporting needs (internal and external). Commission necessary database (and data-warehouse) changes. Coordinate development of information-capture prompts and tools. Feed needs forward to policymakers.

13. Lessons Learned (internal) Prioritize internal and external needs. Focus organizational attention: –Multiple voices over time –The tipping point on the business case One organizational set of quality metrics Integrate the report, the databases, and the capture tools.

14. Lessons Learned (external) One national set of quality metrics One place to send the one data set EHRs designed to prompt for and report the right data

15. jmwalker@geisinger.edu