“The Secrets of Accountable Care Revealed -- Right In Your

Very Own Organization”

a complimentary webinar from

healthsystemCIO.com,

sponsored by OTTR Chronic Care Solutions

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Objectives

•To learn from those who through trial and error have found success

•

which can immediately be put into practice

•

possible, so they may be applied in your facility

Agenda – Panelists

John Halamka, M.D., CIO, Beth Israel Deaconess Medical Center

Beth Lindsay-Wood, SVP/CIO, Tampa General Hospital

Agenda – Continued

A Word from our Sponsor – Paul Markham, COO, OTTR Chronic Care Solutions

Q&A With Panelists – Moderated by Anthony Guerra, Editor-in-Chief, healthsystemCIO.com

The Secrets of Accountable Care Revealed

John D. Halamka, M.D., CIO, Beth Israel Deaconess Medical Center

The 5 IT Components of an ACO

•Universal adoption of EHRs

•Healthcare Information Exchange

•Business Intelligence/Analytics

•Universal availability of PHRs

•Decision Support for Care Management

•

•First web version (webOMR) piloted in 2004

•webOMR rollout 2005-2007

•eClinicalWorks Community rollout 2008-2011

•

Rollout Approach

Phased Roll Out included the following standard steps:

1. Intense planning and customization with each department

2. Group and Individual Training

3. Presentations to Faculty by Physician Super Users-interactive presentation/discussion

4. On-line Tutorial and Self Help modules

5. On site support at Go-live for 2 weeks

6. Refresher training as needed

7. Governance groups developed - focus to improve and prioritize updates to electronic record for clinician users

WebOMR Users Group • Implemented March 2007 •Multidisciplinary membership - providers, practice

administrators, IS •Sets priorities for future development •WebOMR Advisory Group •Multidisciplinary team incorporating Legal and Compliance •Created by the user group guiding body for decision making

and policy development •Aligns providers, ambulatory administration, IS •Primary vehicle to ensure that webOMR meets the needs of

the clinicians and ensure good communication, education & support

Patient Profile Screen

Patient Profile Screen, cont’d

Problems

Medications

Medication History and Reconciliation

Reports

External Reports

Orders

Sheets

Care Plans

24

•View - CareWeb (1997)/webOMR lite (2005)/Magic Button (2009)

•Push - NEHEN (2009)/State HIE (2012)

•Pull - State HIE (2014)

eCW EHX NEHEN

SafeHealth MD

MD

MD MD

Fallon Clinic UMass

Memorial

Statewide HISP

PKI/certificate mgmt Web

portal

Provider/entity

directory

Audit

log

MD MD

MD

MD MD

MD

BIDMC Partners

Direct gateway

services

EOHHS NwHIN

MassHealth

DPH

Atrius

Project schedule Initiative Completion date

Submit IAPD and SMHP to CMS Complete

Submit updated SOP to ONC Complete

EHR/HIE Vendor Roundtable Complete

Network Users Roundtable – Eastern MA Complete

Network Users Roundtable – Western MA Complete

CMS approval of APD-U/SMHP (all signs indicate) Complete

ONC approval of SOP and SOP budget (expected) Complete

RFR for Phase 1 services released to Infrastructure Vendors Complete

Infrastructure Vendor selected Late April, 2012

Infrastructure Vendor under contract Late May, 2012

Go-live for phase 1 “Information Highway” (Direct Gateway) Oct 15, 2012

Go-live for Last Mile program Oct 15, 2012

Go-live for Impact program Oct 15, 2012

Go-live for phase 1 Public Health Gateway (CBHI, SS) Dec 14, 2012

Analytics via Expert Query

•Hospital Analytics group

•Community Practice Analytics group

•Includes data cleansing, validity checking and creating repeatable queries

•Databases and data marts governed by a multi-stakeholder governance committee

•Primarily for Care Management, Government reporting, and Population Health

Analytics via Self Service •Web-

Data Repository

•

(e.g., demographics, diagnoses, medications, lab tests, and procedures) from 1997 to the present

•Aggregate counts (e.g., preliminary data for grant proposals, population studies, etc.) do not require an IRB protocol

•With IRB approval, data sets can be obtained with help from the Decision Support team

Self Service Web Interface

Analytics via Repeatable Reports

•Parameter driven web-based reports in Performance Manager

•Acceleration of business intelligence capabilities with SQL Reporting and Analysis Services

•Dedicated expert consultant devoted to implementation

•Primarily for clinical and administrative operational support

Analytics via Outsourced Community Quality Repository

and Claims Registry

•Combines BIDMC, HMFP, BIDPO, APG, API data into a single clinical care respository

•Used for all our Meaningful Use Measures, PQRS reporting, and AQC contract

•Also creates data marts of clinical data to support all payer claims data warehouse run by HDS

•Primarily for Pioneer ACO and Managed Care efforts

- -

Patient-Level Information Assets

BIDPO

QDC

- -

Provider Metrics and Measures Measure sets:

• 35 Contract Incentive Measures

• 44 NQF Meaningful Use Measures

• 24 PQRS Measures

• 31 Pioneer ACO Measures

Qualified registry for the CMS 2010 PQRS program

Certified as an ONC-ATCB (CCHIT) certified as a modular EHR for Eligible Providers for all 44 MU Stage 1 measures

- - Massachusetts eHealth Collaborative

Slide title © MAeHC. All rights reserved.

Provider Measure Scorecard

Analytics via Innovative Pilots

•Natural Language Processing for intelligent searching of free text

•QueryHealth

•PopHealth

Universal Availability of PHRs

•Tethered (Patientsite and eCW Patient Portal)

•Non-Tethered (Healthvault and others)

•OpenNotes

Required PHR Functionality •Secure Messaging with Provider

•Access to all records

•Convenience Transactions

–Request Appointments

–Medication Refills

–Referrals to Specialists

•Education

–Disease specific content

–Links to medication information

–Diagnostic test explanations

Decision Support Service Providers

10 17

Questions?

jhalamka@caregroup.harvard.edu

http://geekdoctor.blogspot.com

mailto:jhalamka@caregroup.harvard.eduhttp://geekdoctor.blogspot.com

Beth Lindsay-Wood, SVP/CIO,

Tampa General Hospital

The Secrets of

Accountable Care

Revealed Right In Your

Very Own Organization

About Tampa General Hospital •Private, Not-For-Profit

•1,018 licensed beds

•Level 1 Trauma Center

•Serves population of over 4 million in West Central Florida

•Approximately 6,900 employees, over 1,000 Medical Staff

•Primary teaching affiliate of the University of South Florida College of Medicine.

•Tampa General Medical Group (TGMG) is a growing employed group of providers made up of primary care and specialty physicians.

Our Transplant Story • TGH rated #4 overall busiest transplant center in the U.S.

•Our Organ Procurement partner, Lifelink, is next door –Did have a physician group of Hepatologists, Nephrologists, Cardiologists,

and Transplant Surgeons

• How is transplantation programs like Accountable Care Organizations? –Data Across the Continuum of Care

•Must track extensive data, upload subset to the UNOS database to place patient on transplant list.

•Pre-Transplant patients suffer from chronic conditions that amass large amounts of clinical data to be collected and trended over time. Analysis of this data can determine whether the patient is eligible for transplantation

• Transplant patients often live in other states. Collection of data pre- and post-transplant is often manual but must be in one repository for patient monitoring and outcomes reporting.

–Bundled payment structure requires all care environments to work closely together

The Perfect Storm • 9/2009: The TGH Strategic plan identified the need for automation,

both in Transplantation and across the Hospital. –Approval to purchase and implement comprehensive EMR solution across

hospital and clinics (~$120m over 5 years) in less than 2 years from contract signing.

–Need to replace self-developed transplant database. Lifelink physicians would also use this product with us creating a more robust database (hospital and practice data combined).

• 1/2010: Determined need for separate best of breed solution for Transplantation – TGH EMR Transplant solution immature and would not meet needs –Approval to purchase and implement a separate Transplant database

solution ($1m) and use for both Lifelink and TGH in order to move to one system across the continuum of care.

• 9/2010: TGH acquisition of Lifelink Physician Practice –Maintain existing systems for 1 year on TGH infrastructure –Convert to TGH Transplant database in early 2011 –Scramble to Convert to TGH EMR in October, 2012

What Happened

•In 18 months: –Complete all elements of physician acquisition –Design and implement Transplant system to

include some EMR functionality that existed in -

–Design an EMR and Revenue Cycle solution at the same time –Design new workflows for all staff multiple times

to accommodate different system go lives – -

with EMR at go live

Lessons Learned for Us, Possible Guiding Principles for Others

•Avoid the perfect storm if you can

•Ensure strong project management

•Establish a robust Data integrity process (involve Clinicians!)

•Redefine workflows for day to day work

Next Steps for TGH

•Complete stabilization and optimization of our technologies and our workflows. This is a journey.

•Begin to use more sophisticated tools for outcomes reporting

•Begin advanced data modeling efforts to support contracting with payors based on capitation model –What is the cost per phase of care?

–What is best system design to accomplish aggregation of all data related to Transplantation (Product Modeling).

–How do we use this model for other chronic care patients?

Paul Markham, COO,

OTTR Chronic Care Solutions

•The Changing Marketplace

•The Accountable Care Company

•The Transplant Difference

•The Flexible Solution

•The Future

The Changing Marketplace • Government –Accountable Care a necessity not a fad 15.9% GDP –Patient Centered Portable Health Records driving meaningful use –Critical Interoperability and Disease Management driving Quality of Care

• Business – Payers

•.

• needs of ACOs extend beyond an electronic medical record system that links a hospital and physician (Linares, 2012)

– Providers • “Accountable Care asks how organizations can take on risk that encourages them to focus

on caring for the population, reaching beyond just providing healthcare to look at the needs of the community and support initiatives that can improve the overall health of the population. Jack Wolf, Chief Information Officer. (Wolf, 2012)

– Vendors • addition to an electronic health record that spans the continuum of care, the

following six key technologies will enable the core accountable care CEO Health Services (Glaser, 2012)

• Community – Facebook meets EMR

OTTR The Accountable Care Company

•Heritage Back to the Future –20 years of national patient centered digital records

•Corporate Mission Oceans 13 –Committed to changing Healthcare Outcomes

•Strategic Vision Education not marketing –Coincidence of disease state management and needs of customers

•Customer Segment Got OTTR ? –80 large-scale complex environments

•Technological Fit Change is constant –Flexible software platform

Transplant The Guiding Light in Accountable Care • Accountable Care Software since inception

• Highly regulated environment

• Patient Centered Technology Model

• National Health Information Technology

• National Lab interoperability

• Available to all other CMS Accredited Programs some examples

–CHF Advanced Heart Failure

–BSC Advanced Bariatric Surgery

–LVC Advanced Lung Volume Reduction

–PSC Advanced Primary Stroke Care

–COPD Chronic Obstructive Airway Disease

–VAD Advanced Ventricular Assist Device

–BMT Bone Marrow Stem Cell

The Future Towards Predictive Healthcare

•Beyond Transplant –Towards Disease Management Solutions

•VAD/BMT/CHF/LVR/BMT/BSC etc

•Beyond Episodic EMR –National Interoperability Gateway (EMR/Ambulatory/Lab)

•Beyond Provider –Payers based Accountable Care Agents nodes protecting programs

•Beyond Data Aggregation –Population Based Management

Q&A Click on the QA panel located in the lower right corner of your screen, type in your questions in

John Halamka, M.D., CIO, Beth Israel Deaconess Medical Center

Beth Lindsay-Wood, SVP/CIO, Tampa General Hospital

Anthony Guerra, Editor-in-Chief, healthsystemCIO.com

Closing

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Thank You!

We hope you will join us for more

healthsystemCIO.com Webinars in the future

Questions/Comments Anthony Guerra

aguerra@healthsystemCIO.com 201-638-2727

mailto:aguerra@healthsystemCIO.com