1. Update from The Pond Greg Belden, Senior Program Associate gbelden@leapfroggroup.org June 18, 2004 Founded By The Business Roundtable with Support From the Robert Wood Johnson Foundation

2. Populating the Pond Leapfrog represents.. More than 155 large health care purchasers More than 34 million Americans More than $62 billion in health care expenditures

3. Leapfrog Members to Date Ford Motor Company Gateway Purchasers for Health General Electric Company General Mills, Inc. General Motors Corporation Georgia Health Care Leadership Council Georgia-Pacific Corporation GlaxoSmithKline Greater Milwaukee Business Group on Health and the Health Care Network of Wisconsin Hampton Roads Health Coalition Hannaford Bros. Co. Healthcare21 Business Coalition HealthPartners HealthPlus of Michigan The Health Action Council of Northeast Ohio Health Alliance Plan (HAP) Health Care Payers Coalition of New Jersey Health Language Health Net Inc. Horizon Blue Cross Blue Shield of New Jersey Honeywell Inc. HCA - Hospital Corporation of America HIP Health Plan of New York Indiana Employers Quality Health Alliance International Association of Machinists and Aerospace Workers IBM IDX Systems Corporation International Paper Company JSA Healthcare Medical Group Johnson Controls, Inc. Johnson County Jostens Kellogg Company The KNW Group LG&E Energy Corporation LTV Steel Company Land O’ Lakes Lockheed Martin Corporation Lucent Technologies M-Care, Inc. MDanywhere Technologies Inc. MVP Health Care MaineHealth Maine Health Management Coalition Maine Municipal Employees Health Trust Maine State Employee Health Commission Marriott International, Inc. Massachusetts Healthcare Purchaser Group McKesson Corporation The Mead Corporation Merck & Co., Inc. Meridian Automotive Systems, Inc. Microsoft Corporation Midwest Business Group on Health Minnesota Life Minnesota Mining & Manufacturing Company (3M) Misys Hospital Systems Monsanto Company Motorola, Inc. National Education Association AT&T Aetna Inc. Allscripts Healthcare Solutions American Century Services Corporation American Federation of Teachers American Medical Systems American Re-Insurance Company AmerisourceBergen Corporation ArvinMeritor, Inc. AstraZeneca The Auto Club Group Aventis Pharmaceuticals Inc. Barry-Wehmiller Group, Inc. Bath Iron Works Corporation Becton, Dickinson and Company (BD) Bemis Company, Inc. Bethlehem Steel Corporation Board of Pensions of the Presbyterian Church (U.S.A.) The Boeing Company Brown Shoes Buyers Health Care Action Group Cargill, Inc. Carlson Companies Caterpillar Inc. Ceridian Corporation Cerner Corporation Charter Communications Chicago Business Group on Health CIGNA Corporation CITIGROUP INC. Cleveland State University Colorado Business Group on Health Comerica The Commonwealth of Massachusetts Group Insurance Commission Coors Brewing Company Cummins Inc. DaimlerChrysler Corporation Dallas-Fort Worth Business Group on Health Delta Airlines, Inc. The Department of Employee Trust Funds and State of Wisconsin Group Insurance Board The Doe Run Company The Dow Chemical Company Eastman Kodak Company Eclipsys Corporation Electronic Data Systems Eli Lilly and Company Empire Blue Cross and Blue Shield Employer Health Care Alliance Cooperative (The Alliance) Employers’ Health Coalition ESCO Technologies, Inc. Excellus Inc. Exxon Mobil Corporation FedEx Corporation Fidelity Investments Fisher Scientific International Flint Ink Fleet Boston Financial National Rural Electric Cooperative Association Nevada Health Care Coalition New Jersey State Health Benefits Program New York Business Group on Health North Carolina Business Group o Health, Inc. North Carolina Teachers’ and State Employees’ Comprehensive Major Medical Plan Northwest Airlines, Inc. Olin Corporation, Brass & Winchester Divisions Oxford Health Plans, Inc. Pacific Business Group on Health Pediatrix Medical Group Inc. PepsiCo Pillsbury Company Pitney Bowes Inc. The Procter & Gamble Company Promina Health System, Inc. Quality Systems Inc. Quest Diagnostics Qwest Communications International Inc. Ramsey County Reliant Energy, Incorporated Robert Wood Johnson University Hospital Robert Wood Johnson University Hospital at Hamilton Ryder System, Inc. Savannah Business Group Schering-Plough Corporation Siemens Corporation Solutia, Inc. South Central Michigan Health Alliance Southern California Schools Voluntary Employees Benefits Association Sprint Corporation State of Kansas Division of Personnel Services SUPERVALU INC. TCF Financial Corporation TI Automotive TRW Inc. Target Corporation Tennant Company Textron Inc. Trinity Health Plans Tri-State Business Group on Health Tufts Health Plan Union Pacific Railroad Union Pacific Railroad Employees Health Systems UnitedHealth Group United Parcel Service University of Maine System Verizon Communications WEA Trust Washington Mutual Bank Washington State Health Care Authority Wausau Benefits, Inc. Wells Fargo Wiseman and Associates Financial Services, LTD Xcel Energy Xerox Corporation The U.S. Office of Personnel Management (OPM); Centers for Medicare and Medicaid Services (CMS); the Department of Defense; and Minnesota Departments of Human Services and Employee Relations also participate as liaison members.

4. Providers Not Seeing Case for Reengineering Insurers Not Letting Provider Value Show Through Purchasers Not Buying Right, Toxic Payment System Consumers Not In the Quality Game Why Isn’t Quality Better? Gridlock in the Health Care System: Everyone Responsible, No One Accountable New Thinking Needed to “Leapfrog” Gridlock

5. The Silent Calamity Needless mortality and morbidity 44,000-98,000 plus deaths each year from medical errors during hospitalizations (IOM, 1999) 7,000 deaths from medication errors alone $17-29 million in added costs Number of avoidable deaths in ambulatory care unknown

6. Preventable Deaths Personalized: The General Motors Example US Population: 250,000,000 Preventable deaths per year: 98,000 Preventable deaths per 100,000 Americans per year: 39 GM’s covered lives: 1,250,000 GM’s preventable deaths –Per year: 488! –Per day: 1.3!

7. The Costs of Poor Quality Care Patients, on average, receive recommended health care only 55 percent of the time (McGlynn et al. 2003) 30 percent of all direct health care outlays are the result of poor care (misuse, underuse, overuse, and waste) (Juran Institute/MBGH 2003) Employers Fund U. S. Health Care System – The Buck Starts Here Employers Fund U. S. Health Care System – The Buck Starts Here

8. How Are Employers Responding to Rising Costs? Source: Hewitt Associates, 2002 Kaiser/HRET Survey, 2003 Less than 15% of employers think these changes will be “very effective”.

9. The Leapfrog Group’s Mission Trigger giant leaps forward in the safety, quality and affordability of health care by: –Supporting informed health care decisions by those who use and pay for health care –Promoting high-value health care through incentives and rewards

10. Leapfrog’s Mission and Vision Aligned with IOM Pursuit of Comparative Excellence Measuring both hospital and physician performance across all 6 IOM Health Care Aims –Timeliness –Efficiency –Safety –Effectiveness –Equity –Patient-centeredness

11. Purchasing Principles Educate and inform enrollees Compare at the provider level Reward superior provider value –Patient volume (select/deselect/freeze, consumer incentives, consumer decision support) –Unit price (pay for performance) –Public recognition Highlight tangible, evidence-based quality and safety practices (‘Leaps’)

12. Criteria for Safety Leaps What’s the Difference? Leap will produce big improvement in safety Value Self-Evident: Leap can be appreciated by consumers Feasible Now: Implementation steps are doable Easily Ascertainable: Purchaser or health plan can see if Leap is in place Keep the List Short: Leaps can be remembered

13. Initial Quality and Safety ‘Leap’ Summary An Rx for Rx –Computer Physician Order Entry (CPOE) –Up to 8 in 10 serious drug errors prevented Sick People Need Special Care –ICU Daytime Staffing with CCM Trained M.D. live or via tele- monitoring, or risk-adjusted outcomes comparison –29% mortality reduction (JAMA, 11/02) The Best of the Best –Evidence-based Hospital Referral (EHR) or risk-adjusted outcomes comparison –> 30% mortality reduction for 7 complex treatments New! Overall Safety (See Appendix) –Rolled-up score of the remaining 27 of the 30 NQF Safe Practices (CPOE, IPS and EHR are the other 3 of the 30 NQF Safe Practices)

14. Annual Gain Projected by Dartmouth: n  560,000-907,000 serious medication errors n  61,700 deaths n  61,700 X 5 disabilities n Potential savings $9.7 billion / year (if fully implemented in U.S. urban hospitals) What We Stand to Gain from Initial 3 Leaps Alone?

15. Leap Refinement – Creating More Sophisticated Measures CPOE: Online evaluation tool developed by First Consulting Group ICU Staffing: Joint project with JCAHO to develop risk-adjustment methodologies and reporting program; e-ICU (telemedicine) now applicable Evidence Based Hospital Referral: Seeking additional sources for outcomes reporting

16. Our Approach to Measure Development & Implementation Collaborate with measure developers –CMS, AHA, AHRQ, NCQA, JCAHO, others Seek consensus on breadth and content of measurement set Advance measures through NQF for consensus approval Develop rapid implementation strategy with key partners

17. Leapfrog Leaps, Today and Tomorrow Today: Hospitals CPOE, IPS, EHR, NQF Safe Practices Tomorrow: Hospitals and Physician Offices Physician Office Clinical Decision Support (See Appendix) –Initial development coordinated with HHS, awaiting outcome of HHS-led push toward nationwide EMR implementation –Minimum standards: E-prescribing, E-lab results management, and E-care reminders –Already in practice- CMS DOQ-IT, Bridges to Excellence Physician Office Link

18. Leapfrog’s Position on EMRs Leapfrog supports the promotion and use of electronic data to protect patient safety and quality and recommends that hospitals implement CPOE systems. An effective CPOE system rests on a broad array of patient information and an electronic medical record is one of the first steps to achieving this.

19. How Leapfrog Happens: Leaping in Unison Health Plans (MD Leadership & Governance) Purchasers Consumers Health Care Delivery System (hospitals, physicians, nurses pharmacy...)

20. Leapfrog’s Regional Roll-Outs Leapfrog is a national movement using targeted regions (Regional Roll-Outs) to develop best practices, creating early successes and learning from all stakeholders. *23 Regional Roll- Out areas reach 50% of Americans. Regions must have:  Effective leadership  Competitive health care market  High concentration of Leapfrog lives *LF Regions in Green w/ exception of NV and NC

21. First Wave:  California  Seattle/Everett/ Tacoma  St. Louis  Michigan  East Tennessee  Minnesota  Atlanta  Dallas/Fort Worth  Colorado  Kansas City  Wisconsin  Savannah  Metro NY & Western CT  Rochester NY  Massachusetts  New Jersey  Central Florida  Memphis  Wichita Second Wave:  Maine  Illinois  Hampton Roads, VA Third Wave: 23 Roll-Out Regions  Northern NV  *Raleigh/Durham/ Chapel Hill, NC Fourth Wave: *On Hold for 2004

22. Collecting Hospital Level Data Hospital survey available via The MEDSTAT Group n Ongoing voluntary Web survey n Outreach to hospitals in 23 Roll-Out areas to date, but nationally available n Survey captures hospitals on the path n Data publicly reported, format based on feedback from consumers and hospitals (survey and results: www.leapfroggroup.org www.leapfroggroup.org

23. Leap Applicability to Urban/Rural Hospitals 2001-2003- Leaps Apply to Only Urban Hospitals Areas where consumers have a choice of hospitals Do not want to raise public expectation that rural hospitals should prioritize the leaps 2004 and Beyond- Leaps Apply to Urban and Rural 4 th Leap (NQF Safe Practices) applies to Rural Hospitals Rural task force working to apply initial 3 leaps to rural hospitals

24. Hospitals Are Reporting from All Over the Country No Participation Participation in Roll-Out Regions Participation in Non Roll-Out Regions NM WY SD VT RI MT

25. Progress 2nd Quarter 2004 (cont’d) Hospital Survey Results - Regions Final Results 1.0Final Results 2.0 810 hospitals nationwide responded to Leapfrog’s survey 558 of 949 targeted in Regional Roll-Out areas (58.7%) > 60% participation in 13 of 18 RROs 1,168 hospitals nationwide responded to Leapfrog’s survey 715 of 1,188 targeted in Regional Roll-Out areas (60.2%) > 60% participation in 17 of 22 RROs

26. Hospital Survey Results – Regions CPOE Final Version 2.0 –5% (34) of the responding hospitals have fully implemented CPOE - another 17% (118) will implement by 2005 Final Version 1.0 –5% of the responding hospitals had fully implemented CPOE - another 22% said would implement by 2005

27. Hospital Survey Results – Regions IPS Final Version 2.0 –24% of responding hospitals have fully implemented IPS Final Version 1.0 –21% of responding hospitals had fully implemented IPS - another 15% said would implement by 2004

28. Hospital Survey Results – Regions (cont.) EHR % of responding hospitals meeting Leapfrog’s standard Final Version 1.0 Final Version 2.0 CABG12%14% Coronary angioplasty/PCI 30%12% AAA21%16% PancreatectomyN/A15% Esophagectomy12%8% NICU23%39%

29. Consumers as Drivers “ Preventable mistakes” are frequent and serious Provider differences can be significant Enrollee Communications Toolkit by FACCT (NEW version available)

30. Engage Consumers Heart NEJM 12-12-2002 –Leapfrog toolkit –KFF survey results

31. Engage Consumers Heart –Leapfrog Toolkit –NEJM survey results Mind –Web Hits Subimo DQ SQC Health Grades

32. Engage Consumers Heart –FACCT Toolkit –NEJM survey results Mind –Web Hits Wallet –Co-pays, co-insurance DRAFT

33. The Leap Over the Gridlock Has Begun n Rapid growth in purchasers signing on to Leapfrog’s approach n Rapid growth in hospitals disclosing status to their communities n Active health plan support n 80% of Americans have access to information for at least one hospital in their community n Massive education of consumers through purchasers n Market reinforcement beginning through different channels

34. Inform & Educate Enrollees Compare Providers Rewarding & Creating Incentives for Quality & Efficiency Member Support & Activation Improved Value (Quality & Efficiency) Multipliers: Health Plan Products Federal & state purchasers Other distribution channels & partners Market Reinforcement: “The Multiplier Effect”

35. Where We are Beginning to Make Progress Transparency Movement towards standardization of measures –The National Quality Forum –Medicare Modernization Act 2003: IOM to “evaluate leading health care performance measures” Education Creation of consumer demand for good quality care –80% of Leapfrog members communicate to their employees about medical errors and 70% about Leapfrog

36. “Putting the Money Where Our Mouth Is- Working Markets Must Reward Quality” Current reimbursement system does little to encourage quality improvement –80% of Leapfrog members publicly recognize providers but only 30% are working to reward providers Optimal Incentive and Reward systems –Pay-for-Performance/Direct Financial Reward (DFR) models –Bonus payments/Financial awards –Volume/Market-share Shift/Direct-to-Consumer (DTC) models –Tiering, Payment differentials

37. Lily Pads: Opportunities to Shape the Movement BOARD & MANAGEMENT COMMITTEE REGIONAL LEADERS ENROLLEE COMMUNICATIONS LEAPS & MEASURES BENEFITS CONSULTANTS INCENTIVES & REWARDSCLINICIAN HEALTH PLANS

38. Paying for Performance (DFR) Blue Cross Blue Shield of Michigan Blue Cross of California Bridges to Excellence Excellus Pay for Performance - Integrated Healthcare Association (IHA) Medi-Cal/Healthy Families - Integrated Healthcare Association (IHA) Massachusetts Health Quality Partners

39. Paying for Performance (DFR) Bridges to Excellence Physician Office Link –Physicians can earn up to $50 per sponsored patient –Must pass NCQA office practice performance assessment program http://www.ncqa.org/pol/ IHA Paying for Performance –Common measures –Clinical quality (40 percent) –Patient experience (40 percent) –Investment in information technology (20 percent) –Each plan comes up with own reward methodology

40. Paying for Performance (DFR) Other Initiatives Empire Blue Cross, IBM, PepsiCo, Verizon, and Xerox (NY) –Hospitals: 4% bonus if meet Leapfrog’s CPOE and ICU standards Group Insurance Commission (MA) –Health plans: $25-50K bonus if plans increase admissions to Leapfrog-compliant hospitals Anthem Blue Cross Blue Shield (NH) –Physicians: $20 per enrollee for group practices that finish in top quartile for quality scores

41. Market-share/Volume Shift (DTC) MinimumMaximum Closed Networks Provider Ratings Co-pay/ins differentials PBA fund Tiered Networks “COE”-type Benefits (travel, etc.) Provider Pressure Consumer Resistance Low High

42. Market-share/Volume Shift (DTC) Provider Tiering –Pacificare (CA), HealthNet (CA), Blue Shield (CA), Aetna (FL, TX, WA), Patient Choice Health Care (MN, CO, OR, MA) Co-pay, co-insurance, premium differentials –Hannaford Brothers –$250 co-pay difference for employee going to hospital meeting the volume criteria for 5 of LF’s high risk procedures –General Motors –Adjusts employee premium contribution based on plan’s cost and quality performance

43. Health Plans Using or Planning to Use Leapfrog Criteria in Incentive Programs Health PlanBrief Description of Program Anthem BCBS Midwest (KY, OH, IN)Agreement between Anthem and 38 hospitals (5 in KY and 33 in OH and IN) which links reimbursements to quality measurements (CPOE included). Anthem BCBS (VA)Awards for hospitals ICU staffing an d CPOE installation Harvard Pilgrim Health Care/ Partners (MA)Rate increases based on patient safety measures identified by The Leapfrog Group as well as other performance measures Empire BCBS (NY)Awards hospitals bonuses for meeting CPOE and IPS Leaps BCBS (IL)Helps hospitals pay for electronic intensive care units BCBS (MI)Rewards hospitals for including automated entry systems for prescriptions; BS (CA)Tiers hospitals on cost effectiveness and good quality scores (uses LF) HealthNet (CA)Incentive program modeled after Empire BCBS’s Independence BC (PA)Rewards hospitals that meet LF standards and JCAHO’s performance criteria Pacificare (CA)Tiers hospitals based on a number of variables including LF’s safety measures Tufts/ Partners (MA)Contract with Partners' hospitals to provide financial bonuses for implementing "electronic systems" that improves the safety and efficiency Tufts (MA)Tiers hospitals using quality and efficiency measures including CPOE and IPS Regence BCBS (WA)Has plans to incent hospitals if fully-compliant with LF Leaps

44. Purchasers Using or Planning to Use Leapfrog Criteria in Incentive Programs PurchaserBrief Description of Program Pacific Business Group on Health (CA) Places 2% of health plans’ premiums at risk- must meet targets to obtain full amount, one target being support of LF implementation IBM, PepsiCo, Verizon, Xerox (NY) Cooperate and pools funds with Empire BCBS to reward hospitals that meet the CPOE and IPS standards Hannaford Brothers (ME)Applies an additional co-pay if an employee of theirs attends a hospital that does not meet the volume criteria for 5 out of the 7 LF high-risk procedures Wisconsin Employee Trust Funds (WI) Plans to evaluate health plans using HEDIS, The Leapfrog's recommended patient safety practices, and eventually the collecting and reporting of data around NQF's safe practices Group Insurance Commission (MA) The GIC has agreed to give their health plans financial bonuses if they meet standards for increasing admissions to Leapfrog-compliant hospitals

45. What’s in the Pipeline? PilotType of Incentive GE and Verizon; Albany, NYDFR and/or DTC Boeing; Seattle, WA DTC- Payment Differential Maine Health Management Coalition; Portland, ME TBD Healthcare 21; Eastern TNDTC- Tiering AHRQ Incentive and Reward Pilots

46. Market-share/Volume Shift (DTC) Creating Differential Hospital Insurance for Employees – The Boeing Company Part of collective bargaining agreement with two largest unions Effective July 1, 2004, union employees and early retirees will obtain 100% coverage after deductible for services provided by a Leapfrog-compliant hospital Hourly employees hospitalized in facilities that do not meet the Leapfrog safety practices will obtain 95% coverage after deductible This benefit design will remain in place until July 1, 2006 when a new collective bargaining agreement becomes effective

47. What’s in the Pipeline? Leapfrog’s E 2 (Effectiveness and Efficiency) Hospital Rewards Program- Piggy-backing on CMS-Premier “Pay-for-Performance” Demo –Actuarial analysis shows win for members –Data collection method already in place –No new measures –Plans can implement quickly for self-insured or fully-insured customers –Can implement nationally or at local level –Can expand to other GPOs/Hospital groups

48. Other Incentives and Rewards Initiatives/Leverage Points *I&R Toolkit *I&R Compendium Health Plan User Groups *Standard Health Plan Contract Language *eValue8 Common RFI *Update of Economic Implications of original three leaps Malpractice Study * Found on Leapfrog Web site: http://www.leapfroggroup.orghttp://www.leapfroggroup.org

49. Beginning to Leap Over Gridlock but Gaps Still Exist Transparent Market- nationally standardized measures of quality and efficiency Market Reinforcement- reward quality and efficiency and better demonstrate business case Engage Consumers- aware of variation, mechanisms for timely and effective delivery of information, financial incentives Engage Purchasers- including government- sufficient tools and critical mass New health plan products

50. APPENDIX

51. Appendix A: NQF Safe Practices 27 Safe Practices from the National Quality Forum Safe Practices Consensus Report (May 2003): The report is available at www.qualityforum.org www.qualityforum.org Applicable to urban and rural hospitals Rolled up measure of patient safety for release to public in August 2004

52. 27 Safe Practices 1. Create a healthcare culture of safety 2.Ensure an adequate level of nursing care 3.Pharmacists available for consultation with prescribers on medication ordering, interpretation, and overall medication use process 4.Read backs to the prescriber 5.Standardized abbreviations and dose designations 6.Patient care summaries or other similar records should not be prepared from memory 7.Care information, especially changes in orders and new diagnostic information, is transmitted in a timely and clearly understandable form 8.Patient or legal surrogate can recount informed consent discussion 9.Patient's preference for life- sustaining treatments prominently displayed in record 10.Standardized protocol used to prevent the mislabeling of radiographs 11. Standardized protocols used to prevent wrong-site or wrong patient procedures 12. Evaluate and provide prophylactic treatment for patients at high-risk of acute ischemic cardiac event during surgery

53. 27 Safe Practices, con’t 13. Evaluate each patient upon admission, and regularly thereafter, for the risk of developing pressure ulcers 14.Evaluate at admission (and treat), and regularly thereafter, for risk of deep vein thrombosis (DVT)/venous thromboembolism(VTE) 15.Utilize dedicated anti-thrombotic (anti-coagulation) services 16. Assess at admission, and regularly thereafter, patients for risk of aspiration. 17. Use effective methods of preventing central venous catheter-associated blood stream infections 18. Assess risk of surgical site infection; implement antibiotic prophylaxis and other measures 19. Reduce risk of renal injury based on the patient’s kidney function evaluation using standardized protocols 20. Evaluate risk of malnutrition, at admission and thereafter; employ clinically appropriate strategies to prevent malnutrition 21. When utilizing pneumatic tourniquet evaluate patient risk for an ischemic and/or thrombotic complication, and utilize appropriate prophylactic measures 22. Decontaminate hands with either a hygienic hand rub or by washing with a disinfectant soap after contact with patient or patient objects 23. Vaccinate healthcare workers against influenza

54. 27 Safe Practices, con’t 24. Keep workspaces where medications are prepared clean, orderly, well lit 25.Standardize the methods for labeling, packaging, and storing medications 26.Identify all "high alert" drugs (e.g., intravenous adrenergic agonists and antagonists, chemotherapy agents, anticoagulants and anti-thrombotics, concentrated parenteral electrolytes, general anesthetics, neuromuscular blockers, insulin and oral hypoglycemics, narcotics and opiates) 27.Dispense medications in unit- dose or, when appropriate, unit-of-use form, whenever possible

55. Appendix B: Physician Office Clinical Decision Support Rationale: E-Prescribing Medication errors affecting as many as 9% of prescriptions. E-prescribing systems have the potential to improve quality and safety by: –Eliminating legibility problems –Reducing the occurrence of drug interactions, dosage errors, and other adverse effects by guiding prescribing based on computerized assessment of patient and medication information

56. Specifications: E-Prescribing Physician office adopts and uses an electronic system which includes all of the following:  Decision support based on drug reference information  Patient-specific decision support database which includes age, weight, medications prescribed by that office, diagnoses, allergies, specified lab results, and electronically- available formulary information; inclusion of medications prescribed by other physicians is encouraged, but optional  Printing of a paper prescription or its NCPDP- compliant electronic transmission to the pharmacy

57. Rationale: E-Lab Results Management Errors in managing lab results are common. E-lab results management systems have the potential to improve quality and safety by:  Making a practitioner aware if lab test results which have been received have not been reviewed and/or shared with the patient  Reducing unnecessary test ordering by giving a practitioner easier access to previous lab test results

58. Specifications: E-Lab Results Management Physician office adopts and uses an electronic system which includes all of the following:  Tracking whether results have been reviewed by the practice  Tracking whether results have been communicated to the patient, either electronically or via telephone or regular mail  Storage and retrieval of LOINC-compliant lab results reports (excepting microbiology) in database-structured format

59. Rationale: E-Care Reminders Preventive services, or services recommended for chronic conditions, are underutilized. E-care reminder systems have the potential to improve quality and safety. Examples include:  Increase vaccination rates  Improved screening for breast cancer, colorectal cancer, cervical cancer, and other diseases  Improved cardiovascular risk factor reduction  Smoking assessment and counseling

60. E-Care Reminders, con’t.  Dietary assessment and counseling  Improved management of hypertension  Improved management of diabetes  Increased detection of medication errors and adverse drug events

61. Specifications: E-Care Reminders Physician office adopts and uses an electronic system which includes all of the following:  Patient-specific database which includes age, gender, diagnoses, treatment codes, lab test results, and medications documented by a clinician, AND  Specified reminders for clinicians drawn from current US Preventive Services Task Force and other nationally recognized care guidelines (Appendix B)

62. Specifications: E-Care Reminders (2) The electronic system enables all of the following clinician reminders:  Patients needing guidelines-based services at the time of patient contact  Patient lists for outreach communications to patients who require scheduling for guideline-based services  Generation of periodic reports of guideline-adherence rates for the physician office’s patient population as a whole