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