Using EHRs, HIE, & Data Analytics to Support Accountable Care. Jonathan Shoemaker June 2014

(1)

Using EHRs, HIE, &

Data Analytics to

Support

Accountable Care

Jonathan Shoemaker

June 2014

(2)

• Allina Health overview

• ACO framework- setting the stage

• Health Information Technology and ACOs

• Role of Interoperability and HIE in ACOs

• Other relevant interoperability work

• Opportunities and Constraints

(3)

(4)

• Epic EMR since 2004 (branded Excellian)

• “One patient, one record”

–

All hospitals, clinics, ambulatory care centers, and

retail pharmacies

–

A dozen affiliated hospital and clinic organizations use

Excellian as their EMR product

• 3,000,000 Patient Records

• 33,000 Excellian Users

• 335,000 MyChart Users (PHR)

• Completed Meaningful Use Stage 1, Years 1 & 2

• Over 4 GB of data added per day

(5)

Allina ACO Strategy and Work

Health Promotion Family Health Manager Lifetime Fitness Community Prevention/Heart of New Ulm

Optimal Access Nurse Advice Minute Clinic Ambulatory Clinic Urgency Emergency Chronic Illness Management Congestive Heart Failure Diabetes COPD Complex Care Navigation VPCI Neurological Cardiovascular Senior Care Navigation Services Geriatric Medical Group Senior Homes Integration

End of Life Care

Home Residential

A healthy, lifelong relationship based upon trust and empowerment.

Primary Care Physician, Care Guide, Care Team, Family Nurse

Integration Initiatives

Accountable Care, AIM Network, Data, Analytics, Clinical Service Lines

Allina’s Aim

(6)

Allina ACO Goals & Initiatives

The Quality Roadmap:

Goal Initiative(s)

1) Perform under payment for quality and value

models Accountable care pilots- Pioneer ACO, Commercial partnerships 2) Align incentives across employed and

affiliated providers Allina Integrated Medical Network 3) Give providers the data and information

needed to improve outcomes Advanced analytics infrastructure Enterprise data warehouse 4) Provide consistently exceptional care without

waste Primary care team model redesign Care management/patient engagement Clinical service lines programs

5) Support transformation with new skills

(7)

Leveraging HIT- ACO Components

• Integration in EHR • May be

multiples

• Centralized data access for reporting • May be

multiples

EHR Analytics/Reporting

Portals/Decision Support Data Warehouse

(8)

ACO Clinical Intelligence Tools

“Potentially Preventables”

Census Dashboard

Enterprise Data

Warehouse Workbench Reporting

Retrospective

PPR Dashboard

Sp

eci

fic

Ge

ne

ral

Readmissions Model

Modeling of Potentially Preventable Events

(9)

• Definition: HIE is defined here as the

capability to move or consolidate information

from across disparate information systems,

while maintaining the meaning of the

information.

–

May mean Peer to Peer or building a clinical EDW

–

Can vary in content- summary information, full

data sets, or specific unique elements

–

Often drive by use cases

(10)

• Clinical Value

–

Share data real-time across systems

–

Create efficient transition of care workflows

–

Retrospective and prospective analytics will ultimately leverage

outside data

–

Harmonize clinically relevant information for use in decision making

and the point of care experience

–

Develop best practice information and rules across a clinically

integrated network

• Technical Means and Components

–

Privacy/consent management

–

Data messaging (interfaces)

–

Data aggregation and normalization

–

Information portals

–

Centralized Data Repository

–

Master patient index

(11)

Rings of Growth for Interoperability

Ancillary Data Sharing

(fax replacement) Lab tests. Rad results

Partial picture of patient

Shared Summaries of care

Summary of the patient Unparsed CCD

Push/Pull triggers Batch

Retrospective data

Full Clinical Data Exchange

Discrete and Full EMR data Real-time

Native EMR access Retrospective data Prospective data

Best practice rules/alerts Decision support data

(12)

Blueprint for HIE in ACOs

(13)

1. Defining populations in one dataset

2. Decision support

–

Disease management –testing values and trending

–

Specialist assessments

–

Complete patient history

3. Predictive models

–

Algorithms for best practice shared across networks and data

–

Ex- alerts based on risk factors, condition, time prompt clinicians

regardless of EMR or organization

4. Care coordination

–

Referral management

–

Care transitions

5. Cost Containment

–

Reduce test duplication

–

Reduce HIM resource time (calls, faxing, scanning, etc)

–

Reduce time delays- data is available when you need it

(14)

• State HIO and MNehealth work

• State and Federal activities

• Grant activities

• DIRECT

• Healtheway

• Meaningful Use

(15)

15

1. Vendor capabilities

2. Maturity of EMR use, analytics and decision support

3. Expertise

4. Competing integration work (external)

5. Competing priorities (internal)

6. Understanding the drivers and need

Critical for long term success for meeting goals of the triple

aim- top priority:

1. Consumer engagement

2. Cost/quality equation

3. Interoperability and analytics

15

(16)

(17)

Appendix

– Patient Name

– Demographic Information – Insurance

– Current Problem List – Current Med List – Current Allergy List – Procedures

– Immunizations – Results

– Vital Signs

– Referring Providers Name & Office Information – Reason for Referral

– Care Plan Including Goals & Instructions – Advance Directives

– Encounters

– Encounter Diagnosis – Family History

– Social History – Functional Status – Cognitive Status

(18)