regional collaboratives september 14, 2009. - 1 - massachusetts ehealth collaborative slide title ©...
TRANSCRIPT
REGIONAL COLLABORATIVES
September 14, 2009
- 2 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE
• Company launched September 2004
– Non-profit registered in the State of Massachusetts
• CEO on board January 2005
• Backed by broad array of 34 MA health care stakeholders
- 3 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC ARCHITECTURE AND DATA FLOWS
Brockton Newburyport North Adams
Community-level:HIE
Outcomes analysis
BenchmarkingMAeHC-level:Analysis Negotiated reporting
to plans• P4P
• Chart review
MAeHC-level:QDC
Provider-level: EHR
- 4 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
QUALITY MEASURES DON’T HAPPEN, THEY GET DONE
Overall project management
Readiness assessment &
planning
Practice transformation
& workflow planning
System deployment & Implementation
Post- implementation
support
Reporting, decision support, and performance measurement
Inter-operating with internal
and external systems
Illustrative EHR Implementation Value Chain
Vendor contracting
and management
• Gaps at any point along the way will undermine adoption
- 5 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
WHY DO SO MANY PHYSICIANS OFFICES LOOK LIKE THIS?
Courier just dropped off moreenvelopes
Courier just dropped off moreenvelopes
Prescription refill request on fax machine (Rightbehind the joke of the day)
Prescription refill request on fax machine (Rightbehind the joke of the day)
Unopened mail
Unopened mail
Printer with results from one lab
Printer with results from one lab
“Hey Sally! Where is Mrs. Jones x-ray?”
“Hey Sally! Where is Mrs. Jones x-ray?”
Unsorted results
Unsorted results
About to ring with stat results
About to ring with stat results
Web portal (from one hospital)
Web portal (from one hospital)
- 6 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008)
Community 1 Community 2 Community 3
%
- 7 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
BREAKOUT OF CLINICAL USE MEASUREMENT
Community BrocktonPracticeName (All)Quarter (Multiple Items)
Specialty GroupsData Primary Care Specialty CareClinical Enc 90.7% 82.6%Follow-up 82.8% 76.2%HPI 68.5% 41.1%Allergies 34.4% 23.3%Vitals 65.0% 22.5%Current Meds 42.3% 50.2%Medical Hx 45.9% 33.1%Social Hx 23.3% 21.7%Family Hx 19.5% 11.7%Surgical Hx 14.2% 16.3%ROS 22.7% 17.6%Rx 41.6% 15.2%Phys Exam 11.8% 14.4%Exam 68.0% 32.7%Total Office Encounters 204,079 213,134
Legend:1 - Includes all Caritas site including central support2 - Quarters = Q3 2006 thru Q1 2008 (last data feed)3 - Includes Brockton data only4 - Clinical enc = an encounter that had any clinical documentation
- 8 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
NORTH ADAMS HIE SCREEN SHOT
- 9 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC ARCHITECTURE AND DATA FLOWS
Outcomes analysis
Benchmarking Other reporting• P4P• Chart review
Brockton Newburyport North Adams
How to handle consent policy for unanticipated expansion of use, even if it’s legally allowed?
Is 5-10% opt-out acceptable for public health and population health?
How to handle physician desire for routine re-identification?
Are physicians enthusiastically pursuing consent? How to deal with “non-believers” and free-riders?
Entity-by-entity opt-in consent
(North Adams exception)
Encrypted identifiers
Re-identifiable
- 10 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
DATA BEING SENT TO THE MAEHC QDC TODAY
• Problems
• Procedures
• Allergies
• Medication
• Demographics[de-identified]
• Social/Family hx if it can be sent in discrete data
• Smoking status- if it can be sent over in discrete data
• Visits
• Diagnosis
• Lab results
• Rad results
• Future[ inpatient data to include surgical history]
- 11 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
Records Received By MAeHC QDCThrough May 2009
North Adams
Newburyport
Brockton
000
• 437,000 total records since Jul 2008• 57,000 records received in May 2009
- 12 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAEHC QDC DATA COUNTS (I)
Patients Patient visits
Diagnoses Procedures
North Adams
Newburyport
Brockton
- 13 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
Problems Lab results
Medications Vaccinations
MAEHC QDC DATA COUNTS (II)
North Adams
Newburyport
Brockton
- 14 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAEHC QDC LOG-IN SCREENSHOTS
- 15 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAEHC QDC REPORT SCREENSHOTS
Peer comparison report (1)
Drill-down reportBenchmark summary report
Peer comparison report (2)
- 16 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
QUALITY DATA CENTER IS BECOMING A “PUBLIC UTILITY” AS WELL AS A COMMERCIAL PLATFORM
MEANINGFUL USE INTEROPERABILITY REQUIREMENTS COULD PUSH THE ENTIRE INDUSTRY TOWARD HIE
• Lab results delivery
• Prescribing
• Claims and eligibility checking
• Quality & immunization reporting, if available
2011
Increases volume of transactions that are most commonly happening today
– Lab to provider
– Provider to pharmacy
• Registry reporting and reporting to public health
• Electronic ordering
• Health summaries for continuity of care
• Receive public health alerts
• Home monitoring
• Populate PHRs
2013
Substantially steps up exchange
– Provider to lab
– Pharmacy to provider
– Office to hospital & vice versa
– Office to office
– Hospital/office to public health & vice versa
– Hospital to patient
– Office to patient & vice versa
– Hospital/office to reporting entities• Access comprehensive data from all
available sources
• Experience of care reporting
• Medical device interoperability
2015Starts to envision routine availability of relatively rich exchange transactions
– “Anyone to anyone”
– Patient to reporting entities
Meaningful Use objectives requiring health exchange
- 18 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
CREATING INFRASTRUCTURE TO FACILITATE MEANINGFUL USE
Regional Health IT Extension Centers
• Non-profit implementation assistance organizations to facilitate meaningful use among “priority primary care providers”
• 70 will be set up across the country– 3 cycles of funding– 12/09, 4/10, 9/10
• Awards of $1M to $30M – does NOT pay for hardware, software, or interfaces
• Must commit to getting at least 1000 priority PCPs to meaningful use in 2 years
• Matching funds required:– Years 1 & 2: 10%– Years 3 & 4: 90%
State-level HIE
• Each state given planning and implementation grants to implement HIE
• 50 awards across the country– Awards announced 12/09
• Awards of $4M to $40M
• Managed by States or non-profit state-designated entities (SDEs)
• Must implement state plans aligned with federal goals
•State-level directories•eligibility and claims•eRX & medication histories•Lab ordering and results•Public health reporting•Quality reporting•Clinical summary exchange
• Matching funds required:– FY 2010: 0%– FY 2011: 10%– FY 2012: 25%– FY 2013: 12.5%
$564 million$598 million
- 19 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
http://www.maehc.org
Micky Tripathi, PhD MPPPresident & CEO