View
215
Download
0
Category
Tags:
Preview:
Citation preview
June 20, 2008Alliance for Health ReformJanet Wright MD FACC
IC3 Program:Challenges, Lessons, and
Hope
Yes53%
No47%
12% Epic 7% Logician (Centricity) 7% Next Gen 7% Powerchart (Cerner) 6% Hospital/Practice Own 5% GEMMS 4% Allscripts 3% Meditech 2% CIS 2% Misys 2% Primesuit 1% AHLTA 1% Carecast41% Other
Popular EMR/EHR
• Most cardiologists report using an EMR/EHR at their practice.
• National CV Data Registry• Guidelines Applied in Practice or GAP
– Acute MI in Michigan: 1=> 5=> 33 hospitals– Heart Failure in Oregon– Stable Angina in Alabama– National Door to Balloon (D2B) Initiative
– Highlight team-care, care coordination, data collection and utilization to improve outcomes
First NCDR™ ambulatory registry – Longitudinal data
– Practice/physician level data
– Assess physician adherence to ACC/AHA Performance Measures
– Vehicle to transform performance measurement to quality improvement
Improving Continuous Cardiac CareImproving Continuous Cardiac Care
Philosophy of the IC3 Program
Make it easier for busy clinicians to do the right thing for the right patient at the right time
– Track key performance measures
• Internal QI and P4P reporting @ practice level
– Make care more efficient
– Coordinate care
Program Conditions
• Coronary Artery Disease• Heart Failure• Hypertension• Atrial Fibrillation• Diabetes
Pitch to Practices
• Tools to improve care– Real-time reporting of office-based quality indicators
• Trusted mechanism for measuring performance– Support evolving CMS outpatient quality measures and
regulatory reporting initiatives– Support Pay-for-Performance programs with payers
Sample QI Strategies
Comparative Benchmark Reports
Guideline adherence
& decision support– Reminder Systems– Visit-based summaries
of treatment plans
Sample QI Strategies
• Patient education resources
• Opportunity for personalized information: Ix
• Health management tools
Strategic Partnerships
• EMR Vendors
• Centra Healthcare System
• Payers
• Professional Societies• Alliances: MedAxiom, Spirit of Women
• DocSITE: web-based data collection tool
Data Collection and Exchange
Outpatient Visit
ACC NCDR IC3 Program®
Ongoing data submission to
ACC
Periodic data reports to practice
Payers
CMS/PQRI United BC/BS Others
Annual reports to payers
ACTION-GWTGRegistry
Key Challenges
• IT infrastructure
• Program integration into clinical practice
• Quality improvement
• Alliances / Business case
• Incentives for participants
Data Collection Methodology
• EMR integration– GEMMS, NextGEN, GE, and ALLSCRIPTS
interested in participating in pilot– Developing functional specs for all EMR
vendors to become certified IC3 vendors
• Paper forms– Piloting in 2009
IC3 Program Contracted Site Data Collection Methods
3%
37%
21%
15%9%
6% 3%
3%
3%
9%
NextGen
No EMR (DocSite)
Allscripts
GE
GEMMS
"Home Grown" EMR
Penchart
Misys
Epic
Challenges-IT
Compared to hospital-based registries
– No data collection form– No traditional data dictionary– No traditional DQR– No traditional on-site audit
Challenges-IT
• Vendors have software applications that…– Maintain patient demographics– Manage problems lists (any number of coding schemes)– Manage medication lists (any number of coding schemes)– Manage allergy and adverse reaction list– Document patient history– Record patient instructions– Create prescriptions– Order tests/manage test results– Manage patient advance directives– Support for standard care plans, guidelines, protocols
Challenges-Practice Integration
• Workflow redesign issues pervasive..
– Organizational culture
– Provider preferences and behavior
– Patient preferences and behavior– Change management theory (and practice!)
Lessons Learned-QI• Platform needs to be flexible
– Add new modules quickly to test new PMs– Facilitate testing appropriateness criteria– Support research network
• Quarterly reporting may not be best– Sub-optimal to improve physician adherence
• POC decision support tools critical to improve adherence to guidelines
Lessons Learned- Incentives
• Meet practices where they are
• Hassle reduction once program in place
• Enhanced patient and family satisfaction
• Health plan uptake
• PQRI
• ABIM-Maintenance of certification
Lessons Learned
• Establishing Ambulatory Registry is Transformational– Performance measurement – Health IT – Doctor/patient communication – Quality improvement
• Multi-pronged data collection approach is optimal…– Web-based data tool is not optional in world of advancing HIT– EMR strategies are not necessarily seamless– Cost issues associated with paper-based solutions
IC3 Program Enrolled Sites- May 30th
335 offices across the country… 41 states
Recommended