1. !@ 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. 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. 3 EMR that crosses continuum 100% use of CPOE No paper charts

4. 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. 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%

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7. 7 Where are the answers? Demographics Billing Data Test Results Orders Health Maintenance Vital Signs Medication List Queries

8. 8 Template Redesign

9. 9 PQRI Exclusions & Exceptions

10. 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. 11 Data Extraction Process Hospital HCIS IHM VPN 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 Clean Normalize Map Report

12. 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.

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14. 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