Top Banner
Reliant Medical Group Atrius Health iHT2 Health IT Summit, Boston MA May 14 th , 2014 Larry Garber, M.D. Medical Director for Informatics Reliant Medical Group/SAFEHealth
67

Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

Aug 20, 2015

Download

Education

Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Page 1: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

ReliantMedical GroupAtrius Health

iHT2 Health IT Summit, Boston MA

May 14th, 2014

Larry Garber, M.D.

Medical Director for Informatics

Reliant Medical Group/SAFEHealth

Page 2: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

2

Building the foundation for transformation

Efficiency improvements

Quality improvements

Safety improvements

Return on investment

Page 3: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

3

Medical Director for Informatics x 16 years

Principle Investigator for $3.5M AHRQ and ONC grants for SAFE Health and IMPACT HIEs in Massachusetts

Chair, MAeHC

Member ONC HIT Policy Committee’s HIE Workgroup and Privacy & Security Tiger Team, and MA HIT Council

Internist at Reliant (AKA Fallon Clinic) x 28 yrs

Page 4: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

4

•300+ provider multi-specialty group practice

•30 specialties, including Occ Med & Behav Med

•23 sites in central Massachusetts

•200,000 patients with over 1 Million visits/year

•Not affiliated with any hospitals

•Not-for-profit, member of Atrius Health & ACO

•At financial risk for 80% of our patients

•Winner of HIMSS Davies Award for implementing HIMSS Stage 7 EHR

4

Page 5: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

5

Page 6: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

6

Electronic Health Record

Patient Engagement Tools (Personal Health Record, Home monitoring, etc…)

Health Information Exchange

Clinical Decision Support

Healthcare Analytics and Reporting Tools

Page 7: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

7

Completed rollout in 2007

100% utilization by all physicians and staff

Includes the MyChart Personal Health Record for patient engagement

Page 8: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

8

Prescriptions – 22 years

Lab Results – 16 years

Transcribed Visit and Imaging Notes–15 yrs

Immunizations, Health Maintenance, Disease Management – 15 years

EKGs (MUSE) – 15 years

Allergies – 10 years

Future Lab and Visit appointments – 1 year

Over 100 Million Records Preloaded into EHR

Page 9: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

9

Page 10: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

10

Page 11: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

11

Patients plug home health monitoring devices (e.g. BP, weight, sugar, O2, etc…) into home computer

Automatically loads into Epic EHR via Microsoft HealthVault

Batches readings, but sends critical ones

© 2014 Epic Systems Corporation

Page 12: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

12

Mckesson &

Patient References

5 Hospitals

and 8 SNFs

CareEverywhere to

Other Sites

Reliant’s EHR &

Data Warehouse

Home Health

Agency

Patients

Ancillaries

(Surescripts,

QS1, Quest Lab,

MUSE EKG,

Infinitt PACs +

Powerscribe)

4 Payers

Health Coach

Disease Management

Registry

Vignette Document

Imagingto

Community MDs

MA DPH

Immunization Registry

Transcription

and

Dragon

Clinician

References,

Intranet

CCDs

Appt Reminder IVR

Clark

Mailing

Service

Page 14: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

14

FCHP

Hospitals

RefLab

PBMImagingCenters

SoloMD’s

Reliant

Medical

Group

Page 15: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

15

FCHP Claims medication list and fill hx

FCHP and Fallon Clinic claims/billing:◦ Immunizations

◦ Health Maintenance Dates (e.g. Mammo, Colonoscopy, CPE, etc…)

◦ Disease Management Dates (e.g. HA1c, Retinal Exam, Smoking status, etc…)

◦ Past Medical Hx (filtered for chronic & signif. dxs)

◦ Past Surgical Hx (filtered for significant procedures)

◦ Visit Hx (OV, CPE, Consults, ER, Hospital, SNF, LTC)

Page 16: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

16

Page 17: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

17

Factor Criteria Points

DxCG Likelihood of Hospitalization Score (Model 71)

Individual Patient Score >= 0.25 (90th Percentile)

3

Hospital Admissions or ED Visits Three or More in past 12m 3

Behavioral Health (Psychiatric, Substance Abuse, Dementia)

Active Diagnosis (Enc or Prob List) 2

CHF or COPD or CKD Active Diagnosis (Enc or Prob List) 1

Poly-pharmacy (Exclude topical &supplies)

14+ active medications on current EPIC medication list

1

Maximum Score 10

Risk Level Flag Score % Total

Low 0 58%

Medium 1 - 2 26%

High 3 – 7 13%

Very High 8 - 10 2%

Page 18: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

18

Risk Score Calculated with 2011CY data

Outcome Window = 1st 6 months 2012

Page 19: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

19

Page 20: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

20

Have the right person do the work

Use the right tools

Re-use data whenever possible

Page 21: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

21

In order of preference:1. The computer (last note, history, results,

keyboard macros)2. The patient (patient portal or forms)3. The nurse triaging problem on phone4. The medical assistant that rooms patient5. The doctor assisted by speech recognition6. The doctor assisted by transcriptionist7. The doctor typing8. A scribe typing

Page 22: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

22

Chief Complaint(s)

Allergies/Medications (including OTC)

Preferred Pharmacy

Pends medications that need renewals

Full Social and Family History

Vital signs

Rooming note

Loads MD’s note template & pastes last CPE

Review of Systems and Health Risk

Page 23: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

23

© 2014 Epic Systems Corporation

Decision Support built into documentation:Payer/visit/patient-specific template

Page 24: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

24© 2014 Epic Systems Corporation 24

Page 25: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

25

Where do you start?

© 2014 Epic Systems Corporation

Page 26: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

26

Page 27: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

27© 2014 Epic Systems Corporation

Page 28: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

28© 2014 Epic Systems Corporation

AutomaticallyPopulates

Page 29: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

29© 2014 Epic Systems Corporation

Page 30: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

30

10 – 12% of Radiology orders at Reliant were ordered incorrectly and required changing

Page 31: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

31© 2014 Epic Systems Corporation

Page 32: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

32

Page 33: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

33

Page 34: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

34

Page 35: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

35

The total economic burden of diabetes in the United States is estimated at $245 billion, a 41% increase from 20071

Reliant’s Diabetes HbA1c Screening Rate and Control Rate did not change significantly with EHR implementation

1. American Diabetes Association. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care.

2014;36(4):1033–1046.

Page 36: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

36

No Clinical

Decision

Support

No change

with the

EHR!

Page 37: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

37

EHR guidelines automatically suggest testing based on age, gender, diagnoses, meds, smoking history, and existing orders/results

Staff draft orders & physician signs if they agree

© 2014 Epic Systems Corporation

Page 38: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

38

Last date Next order

But doesn’t ask for an order if it’s not due or already ordered

© 2014 Epic Systems Corporation

Page 39: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

39

Barometer of

Actionable

Deficiencies

Page 40: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

40

Page 41: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

4141

Page 42: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

4242

Page 43: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

43

Hypertension Control was 69%, significantly below 90th Percentile of 73% for nation

Page 44: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

44

Page 45: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

45

Graph of BP readings revealed peaks every 10 mmHg

Staff were rounding up to the next higher multiple of 10

Abnormal readings were not rechecked

Page 46: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

46

Digital Cuffs

Real-time alerts for abnormal readings

Monitoring compliance with repeating abnormals

Nurse Blood Pressure Clinics

Pharmacist review of patients with poor BP control and diabetics not on ACE/ARB

Report cards showing site-specific performance

Page 47: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

47

Page 48: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

48

Page 49: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

49

Page 50: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

50

Reliant had two patients where lung nodules were incidentally found on abdominal CT scans at other institutions for diverticulitis and appendicitis, and were not followed-up until metastatic cancer was diagnosed 1-2 years later

Page 51: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

51© 2014 Epic Systems Corporation

Page 52: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

52© 2014 Epic Systems Corporation

Page 53: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

53

More than 1200 patients currently tracked in Pulmonary Nodule Registry

Certified reminder letters for overdue patients, those that refuse testing, and patients who leave our network

No patients with follow-up failures in 4 years

Page 54: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

54

• 90,000 preventable life-threatening or fatal ADEs in the elderly yearly nationwide

• Warfarin is the most common cause of preventable life-threatening or fatal ADEs

• 1.4% of Reliant’s levels overly thin(Gurwitz JH, Garber LD, Bates DW, et al. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA 289:1107-1116. 2003.)

Page 55: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

55

3 Days after hospital discharge, medication claims data are reviewed along with past and future labs

Alerts sent to PCP’s InBasket suggesting dose checking, monitoring or discontinuation

Page 56: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

56© 2014 Epic Systems Corporation

Page 57: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

57© 2014 Epic Systems Corporation

Page 58: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

58© 2014 Epic Systems Corporation

Page 59: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

59

Automatically generated

Automatically sent to Anticoag Clinic InBasket

Anticoag clinic makes sure follow-up INR ordered

© 2014 Epic Systems Corporation

Page 60: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

60

IVR calls to remind patients of upcoming lab tests just prior to “expected date”

Alerts when patient calls or is seen that they have overdue labs that have been ordered already

Letters to patients who no-show labs◦ If 25% overdue (e.g. 1 month late on a 4 month

f/u or 3 months late on a 1 year f/u)

◦ Letter automatically sent to patient from EHR

Page 61: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

6161

Page 62: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

62

Page 63: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

63

Page 64: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

64

Page 65: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

65

Avg. Massachusetts FFS: $13,000+

Avg. Massachusetts ACO: $12,000+

Atrius Health ACO: $10,700

Annual Cost Per Patient (Age 65+)

(12 months ending March 2014)

© 2014 Atrius Health, Inc. All rights reserved.

Page 66: Health IT Summit Boston 2014 – Case Study “Beyond MU Stage 2: Maximizing the value of your HER” with Larry Garber, Medical Director of Informatics, Reliant Medical Group

66

With thoughtful use of the EHR, HIEs, clinical

decision support, and analytics, you can

improve the quality, outcomes, safety, and efficiency of healthcare

delivery