massachusetts ehealth collaborative december 2008
TRANSCRIPT
MASSACHUSETTS eHEALTH COLLABORATIVE
December 2008
- 2 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MASSACHUSETTS SPENDS MORE ON HEALTH PER CAPITA THAN ALMOST EVERYONE IN THE UNIVERSE…
Average spending on healthper capita ($US PPP)
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
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...AND WE GET GENERALLY HIGHER QUALITY AS A RESULT, BUT THE COSTS ARE UNSUSTAINABLE
- 4 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
THE EHR MARKET IS MOVING, SLOWLY, BUT ALSO CREATING A DIGITAL DIVIDE IN THE PROCESS
1-9 physicians
CAGR = 8.2%
%50+ physicians
CAGR = 8.6%
801 million110 million
911 million visits in 2004
%
50+ physicians
1-9 physicians
Growing at about 1.5 percentage points per year
Source: CDC; Center for Health Systems Change; National Ambulatory Care Survey
- 5 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC ROOTS ARE IN MOVEMENT TO IMPROVE QUALITY, SAFETY, EFFICIENCY OF CARE
• Company launched September 2004
– Non-profit registered in the State of Massachusetts
• CEO on board January 2005
• Backed by broad array of 34 MA health care stakeholders
- 6 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC BOARD OF DIRECTORS
Health plans and payer organizations
• Blue Cross Blue Shield of Massachusetts
• Fallon Community Health Plan
• Harvard Pilgrim Health Care
• Massachusetts Association of Health Plans
• Tufts Associated Health Maintenance Organization
Healthcare purchaser organizations
• Associated Industries of Massachusetts
• Massachusetts Business Roundtable
• Massachusetts Group Insurance Commission
Non-voting members
• Center for Medicare & Medicaid Services
Hospitals and hospital associations
• Baystate Health System
• Beth Israel Deaconess Medical Center
• Boston Medical Center
• Caritas Christi
• Fallon Clinic, Inc.
• Lahey Clinic Medical Center
• Massachusetts Hospital Association
• Massachusetts Council of Community Hospitals
• Partners Healthcare
• Tufts-New England Medical Center
• University of Massachusetts Memorial Medical Center
Governmental agencies
• Executive Office of Health and Human Services
Healthcare professional associations
• American College of Physicians
• Massachusetts League of Community Health Centers
• Massachusetts Medical Society
• Massachusetts Nurses Association
Consumer, public interest, and at-large
• Health Care for All
• Massachusetts Coalition for the Prevention of Medical Errors
• Massachusetts Health Data Consortium
• Massachusetts Taxpayers Foundation
• Massachusetts Technology Collaborative
• MassPRO, Inc.
• New England Healthcare Institute
• Massachusetts Health Quality Partners
• Tufts University Medical School
• UMass Medical School
- 7 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
CEO
Operations
Contract admin & HR
Evaluation coordinator
Project Mgmt
Data manager
Communication
MAeHC ORGANIZATION DESIGNED TO SCALE UP FOR STATEWIDE PROGRAM
Practice Services
Practice consultants
Other
Legal
Evaluation
Technology & Vendor Mgt
Health information exchange
Support
Shared services
• Design, deployment, & support
• Community coordination
• Project management
• Program integrity
Program LeaderBrockton
Program LeaderNewburyport
Program LeaderNorth Adams
More communities
- 8 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
PILOT PROJECT COORDINATION
Community PhysicianCouncil
Privacy &Security
Work Group
Community Consumer
Council
Co-Chairs: Senior Pilot Exec & Community Advocate
Members: Physicians, Hospital, Consumers
Pilot SteeringCommittee
- 9 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAEHC SELECTED THREE PILOT SITES FROM 35 APPLICANTS: BROCKTON, NEWBURYPORT, NORTH ADAMS
- 10 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC PILOT PROJECT EXPENDITURES2005-2008
$MMAeHC G&A 1.7 3%
Professional fees 2.9 6%
CPOE readiness 4.0 8%
Evaluation 5.9 12%
HIE 5.9 12%
MAeHC businessservices 9.8 19%
EHR 20.2 40%
$50.4 $M %
- 11 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
ACTUAL COST PER PHYSICIAN FOR EHR
$K
Support (6 mos) 2.8 7%
MAeHC support 9.3 22%
EHR software 7.9 18%
EHR hardware 22.8 53%
$42.8K
$K %
- 12 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC ARCHITECTURE AND DATA FLOWS
Brockton Newburyport North Adams
Community-level:HIE
Outcomes analysis
BenchmarkingMAeHC-level:Analysis Negotiated reporting
to plans• P4P• Chart review
Provider-level: EHR
MAeHC-level:QDC
- 13 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
FIRST PRACTICE LAUNCHED IN MARCH 2006
Docs link up to new record styleBy Jennifer Heldt PowellTuesday, March 14, 2006
The end of the paper trailBy Ulrika G. Gerth/ [email protected], March 17, 2006
Setting a new record: Local doctors pilot electronic patient history system By Stephanie Chelf Staff Writer
- 14 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
OVER 550 CLINICIANS LIVE IN 18 MONTHS
# practices
2006 2007
North Adams(15)
Newburyport(37)
Brockton(89)
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CLINICAL USE OF DEPLOYED EHRs% of Encounters Documented Clinically in EHRs (Q2 2006 – Q2 2008)
Community 1 Community 2 Community 3
%
- 16 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
CLINICIAN ATTITUDE TOWARD EHRs
The EHR system has helped streamline our processes
AgreeDisagree
Already has
Will in the future
Our patients are benefiting from new processes
Already has
Will in the future
We are already able to provide higher quality care
Already has
Will in the future
Overall I have already adopted the EHR
I would recommend EHRs to other practices
n = 195, 2/08
61%
% agree
80%
70%
87%
65%
87%
80%
81%
91%
93%
The HIE will help streamline our processes
Our quality will improve from the HIE
- 17 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
STAFF ATTITUDE TOWARD EHRs
The EHR system has helped streamline our processes
AgreeDisagree
Already has
Will in the future
Our patients are benefiting from new processes
Already has
Will in the future
Overall I have already adopted the EHR
I would recommend EHRs to other practices
86%
% agree
95%
96%
83%
94%
96%
91%
88%
n = 524, 2/08
The HIE will help streamline our processes
Our quality will improve from the HIE
- 18 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
PILOT COMMUNITIES WILL BE THE FIRST IN THE COUNTRY TO BE COMPLETELY “WIRED” FOR HEALTHCARE
Ethel Roy, 81, visited earlier this month with Dr. Stephen St. Clair, her urologist, at his office in North Adams. (Stephen Rose for the Boston Globe)
- 19 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC HEALTH INFORMATION EXCHANGE ARCHITECTURE AND STATUS
Community Indexes
Terminology
Entity
Clinician
Patient
Clinical repository
Communityrecord
Automated delivery servicesLab/radresults
Hospitalreports
EHRdata
Publichealth
On-demand portal services
• View/download records• Secure messaging• Electronic referrals• Patient communication• Forms routing
• View/download records• Physician communication• Appointment request• Forms routing
Physician portal Patient portal
Infrastructure
Communities
• Three stand-alone HIEs
• Over 500K patients
• ~600 clinicians, 200+ clinical sites
• 4 hospitals, 1 community health center
Systems connected
• Ambulatory EHRs (eCW, NextGen, GE, Allscripts)
• Hospital systems (Meditech) , including EHR, lab systems, rad systems, transcription systems
Data exchanged
• Problems, procedures, allergies, medications, demographics, smoking status, diagnosis, lab results, rad reports
• Standards used: HL7, CCR/CCD, NCPDP Script 8.1, LOINC, CPT4, ICD9, RxNorm
Transactions to date (as of Nov 2008)
• Over 60K patients opted-in to date (91% opt-in rate)
• 300K+ clinical records exchanged to date
• 20K+ matched patient records in HIE
- 20 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
The eHealth Summary:• Medication List• Problem List• Procedures• Social History• Allergies• Past Medical History• Family History• Lab Results• Radiology Results• Immunizations
Doctor’s Office Record:• Private Office Notes• Consultation Letters• Scanned Reports• Non-consented items
- 21 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
OPT-IN PERMISSION MODEL
Jane Jones
Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity
Patient visits clinical entity for care and is provided option at first visit to opt-in all clinical data from EACH entity
1
Visit
YY Y YN
2
Patient chooses which entity’s records to make available to network
Patient chooses which entity’s records to make available to network
Consent
Jane Jones
3
Pre-defined data sent to central server
Pre-defined data sent to central server
Send
Physician views data prior to or during patient visit
Physician views data prior to or during patient visit
4 Retrieve
Community Network
Jane Jones eCommunity RecordJune 9, 2006
Visit historyxxxxxx
Active problem listxxx Dr. Jane Brody
Current medicationsxxx Seacoast Cardio
Current allergiesxxx Dr. Jane Brody
Recent laboratory resultsxxx AJ Hospital
Recent radiology resultsxxx AJ Hospital
Otherxxx XXX
- 22 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
NORTH ADAMS HIE SCREEN SHOT
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NEWBURYPORT & BROCKTON HIE SCREEN SHOT
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Reason for A
ccess Required:
- 25 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
DATA BEING SENT TO THE MAEHC QDC TODAY
• Problems
• Procedures
• Allergies
• Medication
• Demographics[de-identified]
• Social/Family hx if it can be sent in discrete data
• Smoking status- if it can be sent over in discrete data
• Visits
• Diagnosis
• Lab results
• Rad results
• Future[ inpatient data to include surgical history]
- 26 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
MAeHC QDC MEASURES
CAD - 1- LDL-C test ordered
- 2- LDL-C level <100
- 3- Lipid-lowering therapy prescribed
- 4- Antiplatelet therapy prescribed
Diabetes - 5- HbA1c test ordered
- 6- HbA1c level <9
- 7- BP level <140/90
- 8- LDL-C test ordered
- 9- LDL-C level <100
- 10- Eye exam performed
11- Asthma (appropriate Rx prescribed)
12- Hypertension (BP controlled)
Common pediatric conditions 13- Appropriate testing for pharyngitis
14- Appropriate treatment for URI
15- Prenatal care (screening for HIV)
Prevention
16- Flu vax
17- Pneumovax
18- Colorectal cancer screening
19- Breast cancer screening
20- Tobacco use
Phase 1 Measures Phase 2 Measures
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MAEHC QDC LOG-IN SCREENSHOTS
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MAEHC QDC REPORT SCREENSHOTS
Peer comparison report (1)
Drill-down reportBenchmark summary report
Peer comparison report (2)
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THE GRID AND THE LAST MILE
Inter-community connectivity
MA-SHARE
Intra-community connectivity
- 30 -Massachusetts eHealth CollaborativeSlide title © MAeHC. All rights reserved.
www.maehc.org
Micky Tripathi, PhD MPPPresident & CEO