1. BETH ISRAEL DEACONNESS DATA WAREHOUSE PROJECT February 27, 2009

2. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BACKGROUND BIDPO/BIDMC would like to engage MAeHC to provide a quality data warehouse service to: Enable automated extraction and aggregation of selected clinical data from member physicians’ eCW and WebOMR EHR systems Develop selected clinical quality measures for BIDPO internal benchmarking, reporting to health plans and case management Create a demonstration of emerging HITEP II quality data set standards MAeHC quality data center (QDC) currently aggregates clinical data from participants in MAeHC pilot projects Automated, longitudinal, and patient-centric 20 core measures Current project will require Measure definition and specification according to BIDPO requirements Creation of HITSP-compliant CCD interfaces from eCW and WebOMR to MAeHC QDC

3. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA MAeHC QDC current status BIDMC/BIDPO goals Accomplishing our goals Roles and Responsibilities Timeline Next Steps

4. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. MAeHC ARCHITECTURE AND DATA FLOWS BrocktonNewburyportNorth Adams Community-level: HIE Outcomes analysis Benchmarking MAeHC-level: Analysis Provider-level: EHR MAeHC-level: QDC

5. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. QDC Reporting Server (Data Mart) QDC Database Server (Data Warehouse) eClinicalWorks Wellogic HL7 Messages Patient encounter message extraction Patient encounter message transformation Patient encounter message load Message data ETL audit data Staging source data Normalized message data Internet Physician feedback reporting HL7 Messages Quality measure calculation QDC Web Server Portal authentication and security Report download Physician feedback reports Patient Encounter Message Interface (from HIE vendor) Web browser Legend = EHR/HIE vendors / CSC = CSC = MHQP = MHQP / MAeHC = Existing = Drill down option Patient encounter messages originating from the participating providers’ EHR systems and routed by the HIE systems are collected and uploaded real time Physician feedback reports are published quarterly for Web access and download. HL7 Messages Patient Encounter Message Interface (from HIE vendor) Calculated measure data HL7-based visit, procedure, diagnosis, patient medication, vaccination, lab CURRENT ARCHITECTURE

6. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. DATA BEING SENT TO THE MAEHC QDC TODAY QDC went into production in summer 2008 -Over 200,000 records collected to date across all three communities Clinical data being collected -Problems -Procedures -Allergies -Medications -Demographics (encrypted identifiers) -Smoking status -Visits -Diagnosis -Lab results -Rad results -Future -- inpatient data to include surgical history

7. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CURRENT MEASURE DESCRIPTIONS Coronary Artery Disease (CAD) CAD: LDL-Cholesterol Test Performed -The percentage of adults, ages 18 to75, who had evidence of a hospital discharge for an acute cardiovascular event during the first 10 months prior to the measurement year (acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty), or who had a diagnosis of ischemic vascular disease (IVD) in both the measurement year and the previous year and received an LDL-C screening test in the measurement year. CAD: LDL-Cholesterol in Good Control(<100 mg/dL) -The percentage of adults, ages 18 to 75, who had evidence of a hospital discharge for an acute cardiovascular event during first 10 months prior to the measurement year (acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty), or who had a diagnosis of ischemic vascular disease (IVD) in both the measurement year and the previous year and whose LDL-C was screened and controlled to less than 100 mg/dl for the most recent LDL-C result in the measurement year. CAD: Drug Therapy for Lowering LDL Cholesterol -The percentage of adults, ages 18 to 75, with coronary artery disease (CAD) who were prescribed a lipid- lowering therapy (based on current ACC/AHA guidelines) anytime in the 12-month measurement period as of the last day of the measurement year. CAD: Antiplatelet Therapy -The percentage of adults, ages 18 to 75, who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), or percutaneous transluminal coronary angioplasty during the first 10 months prior to the measurement year, or who had a diagnosis of ischemic vascular disease (IVD) during the measurement year and the previous year and were prescribed antiplatelet therapy. Note: Antiplatelet therapy is considered any one of the following: aspirin, clopidogrel, or a combination of aspirin and dipyridamole.

8. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CURRENT MEASURE DESCRIPTIONS (II) Diabetes DM: HbA1c Test Performed -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had a hemoglobin A1c (HbA1c) test during the measurement year. DM: HbA1c in Poor Control(>9% or Not Tested) -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had poorly controlled HbA1c (level > 9.0%) during the measurement year. Note: For this measure, a lower rate indicates better performance (i.e., a low rate of poor control indicates better care). Eligible adults who did not receive an HbA1c test during the measurement year will be considered in poor control. DM: Blood Pressure in Good Control(<140/80 mmHg) -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes whose most recent blood pressure measurement during the measurement period was <140/80 mmHg. DM: LDL-Cholesterol Test Performed -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had a serum cholesterol level (LDL-C) screening during the measurement year. DM: LDL Cholesterol in Good Control(<100 mg/dL) -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes whose most recent cholesterol level (LDL-C) measurement during the measurement year was < 100 mg/dL. DM: Retinal Eye Exam Performed -The percentage of adults, ages 18 to 75, with type 1 or type 2 diabetes who had an eye exam (retinal or dilated) performed during the measurement year (or during the previous year if the patient is at low risk for retinopathy). Note: A patient is considered low risk if the following three criteria are met: (1) the patient is not taking insulin; (2) the patient has an A1c < 8.0%; and (3) the patient showed no evidence of retinopathy during the year prior to the measurement year and within six months after the last eye exam during that year.

9. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CURRENT MEASURE DESCRIPTIONS (III) Asthma Asthma: Appropriate Medications Prescribed -Part A: The percentage of children, ages 5 to 17, identified as having persistent asthma who were prescribed acceptable medication for long-term control of asthma during the measurement year. Part B: The percentage of adults, ages 18 to 56, identified as having persistent asthma who were prescribed acceptable medication for long-term control of asthma during the measurement year. Hypertension HTN: Blood Pressure in Good Control(<140/90 mmHg) -The percentage of adults, ages 18 to 85, with diagnosed hypertension whose most recent blood pressure measurement during the measurement year was 140/90 mmHg or lower. Note: Both the systolic pressure and diastolic pressure must have been at or under these thresholds for blood pressure to be considered controlled. Pediatric Appropriate testing for Pharyngitis -The percentage of children, ages 2 to 18, who were diagnosed with pharyngitis, prescribed an antibiotic, and received a group A streptococcus test at the same outpatient visit during the measurement year. Note: This measure assesses the adequacy of clinical management of pharyngitis episodes for patients who receive an antibiotic prescription. Appropriate treatment for Upper Respiratory Infection (URI) -The percentage of children, ages 3 months to 18 years, who, during the measurement year, were diagnosed with URI and were not dispensed an antibiotic prescription on or within three days after the episode start date.

10. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CURRENT MEASURE DESCRIPTIONS (IV) Prevention PREV: Influenza Vaccination(>=50yrs) -The percentage of adults, 50 years or older at the beginning of a flu season, who received an influenza vaccination during the one-year measurement period. PREV: Pneumonia Vaccination(>=65 yrs) -The percentage of adults, 65 years or older, who have ever received a pneumococcal vaccination. PREV: Colorectal Cancer Screening(50-80 yrs) -The percentage of adults, ages 50 to 80, who had an -appropriate screening for colorectal cancer. Appropriate screening is considered one or more of the following: ·Fecal occult blood test (FOBT) during measurement year; ·Flexible sigmoidoscopy during the measurement year or the four years prior to the measurement year; ·Double contrast barium enema (DCBE) during the measurement year or the four years prior; or ·Colonoscopy during the measurement or the nine years prior. PREV: Breast Cancer Screening(42-69 yrs) -The percentage of women, ages 42 to 69, who received a mammogram during the measurement year or the previous year. PREV: Documentation of Smoking Status -The percentage of adults, 18 years or older at the start of the two-year measurement period, who were asked about their tobacco use one or more times during the two-year measurement period.

11. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. PEER COMPARISON REPORT (I)

12. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. PEER COMPARISON REPORT (II)

13. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. DRILL-DOWN REPORT

14. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BENCHMARK SUMMARY

15. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA MAeHC QDC current status BIDMC/BIDPO goals Accomplishing our goals Roles and Responsibilities Timeline Next Steps

16. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BIDPO/BIDMC GOALS Clinical source systems eCW through eHX WebOMR Data measures BID Clinical Standards Group approved measures HITEP II measures Access and reporting BIDPO-defined enterprise-level and physician-level reports, as required BIDPO enterprise-level access, query, reporting, exporting

17. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BID CLINICAL STANDARDS GROUP MEASURES

18. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BID CLINICAL STANDARDS GROUP MEASURES (II)

19. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. HITEP OBJECTIVES HITEP Goals The intent is to provide a method to encode clinical data obtained during the routine practice of medicine that would then be available to match against the encoded quality measure to determine if the patient or population of patients met any of these specified quality criteria. In so doing, the hope is to provide feedback to clinicians, administrators, policy makers and public health authorities for the purpose of improving the quality of healthcare provided to U.S. patients. HITEP Measures 1. Controlling high BP (logic: could bring in VSs from EHR) 2. Colon cancer screening (logic: complex measure due to multiple modalities and currently requires hybrid review) 3. Overuse measures for adults and children - (logic: requires meds and diagnoses and gets to overuse) a. Avoid antibiotics for child with URI b. Avoid antibiotic use for adult with bronchitis

20. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA MAeHC QDC current status BIDMC/BIDPO goals Accomplishing our goals Roles and Responsibilities Timeline Next Steps

21. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. ACCOMPLISHING OUR GOALS Gap analysis from existing MAeHC core measures BIDPO measures HITEP II measures HITSP/HITEP Specification Review Measure definition and specification Transport specification -- upgrade from HL7 2.x to CCD, in conformance with HITSP specifications Reporting Report requirements/specifications Access Authentication Authorization (User roles)

22. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. BIDPO-QDC DATA FLOWS

23. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. CAN WE LEVERAGE MA-SHARE WORK ON CCD-EXCHANGE TO FACILITATE WEBOMR INTEGRATION?

24. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA MAeHC QDC current status BIDMC/BIDPO goals Accomplishing our goals Roles and Responsibilities Timeline Next Steps

25. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. ROLES AND RESPONSIBILITIES ACTIVITY MAeHC (CSC, MHQP) BIDMC/BIDPOMA-Share Program/Projec t Management Measure Gap Analysis/Spec Report Design App/dB Dev Interface/ Connectivity Testing/Validati on Communication Training/ Optimization

26. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA MAeHC QDC current status BIDMC/BIDPO goals Accomplishing our goals Roles and Responsibilities Timeline Next Steps

27. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. HIGH-LEVEL SCHEDULE DevelopTEST Imple ment Measure Spec/Analysis Update Database Design/Schema Design I II III IV DEV/TEST SYS Prep Upgrade Data Transport Method Internal Testing PROD SYS Prep First Pilot Project phases Month 0 Month 3 Month 6 Month 9 Month 12 Key dates Project Kickoff Measure Acceptance Go-Live Signoff Application/Reports Design Development Completed Enable Live Data Feed Data Validation Modify APP/dB Install dB/App

28. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. AGENDA Current status Goals Accomplishing our goals Roles and Responsibilities Budget Timeline Next Steps

29. - Massachusetts eHealth Collaborative Slide title © MAeHC. All rights reserved. NEXT STEPS Confirm measures TCNY, HITEP, etc. Detailed gap analysis Prioritization HITSP Specification/Requirements Detailed Gap analysis Roadmap for implementation Determine access and reporting requirements Confirm roles & responsibilities MAeHC Statement Of Work Legal Framework