HealthBridge – Healthcare Transformation Conference Scott Callahan, MD FAAP Medical Director Children’s Health Care Batesville, Indiana

Practice Site Children’s Health Care is a pediatric primary care office located in Batesville Indiana between Cincinnati and Indianapolis. It is a 6 physician (4 full time, 2 part-time) and 2 nurse practitioner group. Hospital employed by Cincinnati Children’s Hospital Medical Center for over 10 years.

Children’s Health Care EMR Journey Milestones 1. December, NextGen chosen as EMR. 2. September, NextGen contract signed. 3. October, NextGen installed.

Electronic Milestones 4. January, EPM goes live. 5. February, 2006-EMR goes live. 6. May, 2008-Margaret Mary live with HealthBridge

Electronic Milestones 7. September, 2008-HealthBridge EMR interface goes live. 8. October, 2009-IHIE to HealthBridge to EMR live. 9. August, 2009-Margaret Mary EMR transmits data to PHO for asthma collaborative.

Electronic Milestones 10. January, 2010-NextGen patient portal live. 11. Currently working on registry for Children with Special Health Care Needs collaborative.

Quality Improvement Participation in the Tristate PHO Asthma Collaborative.

PHO Network: Asthma Process Measures (as of May 16, 2011) Population-Based Measures (Network all-payor asthma population = 12,668) PHOLiterature % of asthma population with flu shot: flu season flu season flu season flu season flu season (delayed vaccine delivery) flu season flu season flu season (baseline) 67% 66% 60% 54% 62% 40% 22% 10-40% % of asthma population with management plan94%50% % of population with “persistent” asthma on controller medication* 96%97% % of asthma population with severity classified96%50% % of asthma population receiving “perfect care”**93%not available * “Persistent” asthma defined per NHLBI severity classification criteria. ** “Perfect care”: composite measure of severity classification, written management plan, and controller medications (if patient has “persistent” asthma) Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

PHO vs. Comparison Group: Asthma Admission Rate (monthly data) Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

PHO vs. Comparison Group: % Difference in Asthma Admission Rate (monthly data) Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

PHO vs. Comparison Group: Asthma ED/Urgent Care Visit Rate (monthly data) Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

PHO vs. Comparison Group: % Difference in Asthma ED/Urgent Care Visit Rate (monthly data) Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

PHO Network: Asthma Outcome Measures Population-Based Measures (Network all-payor asthma population = 12,668) Baseline 8/04 - 7/05 Current 4/10 - 3/11 %∆ % parents missing ≥ 2 work days due to child's asthma over prior 6 months 18.0%10.2%43%↓ % parents rating confidence in managing child's asthma < 7/ %5.8%48%↓ % asthma population missing ≥ 2 school days due to asthma over prior 6 months 26.5%18.6%30%↓ % activity limitation reported as “not at all” or “a little of the time” Not captured as these questions were initiated in June % n/a % receiving oral steroids within prior 12 months20.1% % parents rating asthma as “well” controlled93.7% % physicians rating asthma as “well” controlled90.2% % parent and physician agreement on rating degree of asthma control 92.2% Tri State Child Health Services, Inc.; Ohio Valley Primary Care Associates, L.L.C.

Eligible Professonal Meaningful Use Menu Set (10) 1. Implement drug formulary checks. 2. Incorporate clinical lab tests results into EHR as structured data. 3. Generate lists of patientsby specific conditions to use for quality improvement, reduction of disparities, research, or outreach. 4.Send reminders to patients per patient preference for preventative/follow up care.

5. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, and allergies) within 4 business days of the information being available to the EP. 6. Use EHR technology to identify patient- specific education resources to the patient if appropriate.

7. The EP who receives a patient from another setting of care or provider of care should perform a medication reconciliation. 8. The EP who transitions their patient to another setting of care should provide a summary care record for each transition of care or referral. 9. Capability to submit electronic data to immunization registries or immunization information systems and actual submission according to applicable law and practice.

10. Capability to submit electronic syndromic surveillance data to public health agencies and actual submission to applicable law and practice.

Scott R. Callahan, MD FAAP 508 S. Mulberry St Batesville,IN (812)