!@

March - April 2003

Boston Children’s Hospital

e

Standardization and Automatic Extraction of Quality Measures in an

Ambulatory EMR

Denni McColm, CIO, Citizens Memorial Healthcare

2

• 74 acute care beds• Emergency Services• Home Health, Hospice,

Home Medical Equipment, Health Transit Services

• Long Term Care Facilities (5)

• Residential Care Facility (1)• Physician Clinics (16

locations, 60 providers)• Outpatient Services

3

• EMR that crosses continuum

• 100% use of CPOE• No paper charts

4

Ambulatory Quality and Safety Project

• Standardize and integrate data capture for quality measurement into the normal documentation of care within the ambulatory EMR

• Implementation of an automated system for data extraction including valid, reliable reports that provide actionable insight for the measurement, analysis and improvement of care

5

Broad Approach – All PQRI measures applicable

• First period, July 1, 2007 – December 31, 2007• Renewed for 2008, January 1 – December 31

• 1 ½% bonus for Medicare fee schedule services for reporting at least 80% of the time on 3 or more measures during the period

• 47 measures proposed initially• 74 measures actually used in 2007• 119 measures in use for 2008• 175 proposed for 2009 (bonus 2% plus ePrescribing bonus

2%

6

7

Where are the answers?

• Demographics• Billing Data• Test Results• Orders• Health Maintenance• Vital Signs• Medication List• Queries

8

Template Redesign

9

PQRI Exclusions & Exceptions

10

The Institute for Health Metrics (IHM) is:

• A non-profit that helps hospitals leverage electronic systems for quality improvement

• Assists hospitals in extracting data from the MEDITECH system for use in:

• Physician & Departmental Profiling• Quality of Care Reporting: JCAHO Core Measures, IHI, AHRQ, etc.• Performance Improvement• Benchmarking

11

Data Extraction Process

Hospital HCIS

IHMVPN

Web Based Reports

IHM• NO Software to Install and maintain• No IT resources outside initial VPN set up• All CMS, JCAHO requirement updates performed by IHM• All new indicators added by IHM

• Nightly data extracts

• Monthly reports delivered within hours of discharge codes completed

CleanNormalizeMapReport

12

AIES: (Automated Indicated Extraction System) Automatically delivers quality performance indicators for over 300 quality measures to expedite hospital reporting and improve care.

PQMS: (Physician Quality Management System) Provides hospital management with on-going department and physician information for reviews and credentialing across 102 procedures and 26 diagnoses.

CPMV: (Core Measures Patient View) Preps data for submission to core measures vendor.

Daily Infection Alert: This new daily report alerts the hospital staff to identify patients at risk for hospital acquired infections and to proactively intervene.

13

14

Challenges

• Designing to be time neutral for providers• Speech recognition• Medication reconciliation / updating• Nurse support training• MUSE

• Make a personal connection• Understand the patient’s concerns and priorities• Sit, see, and show the screen• Engage the patient as a partner in healthcare

• Patient Portal• Hospital based providers & measures• Sharing templates