Measuring Quality and Clinical Performance Indicators at Partners HealthCare System

1
Measuring Quality and Clinical Performance
Indicators at Partners HealthCare System

• Blackford Middleton, MD, MPH, MSc
• Corporate Director, Clinical Informatics RD
• Chairman, Center for Information Technology
  Leadership
• Partners HealthCare System, Inc.
• Brigham Womens Hospital
• Harvard Medical School

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Overview

• Partners Healthcare System, Boston
• High Performance Medicine
• The HPM-X Informatics Infrastructure
• Reporting in an EMR
• LMR Report Central
• Quality Dashboards
• Early experiences with Quality Dashboards
• QA

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Partners HealthCare System

• Ten hospitals, 7000 physicians
• 6.4B in revenues
• 4M outpatient visits and 160,000 admissions/year
• 1B in biomedical research annually
• Teaching affiliate of the Harvard Medical School
• Founded by the Brigham and Womens Hospital and
  the Massachusetts General Hospital

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Information Systems Descriptive Numbers

• Operating budget (FY07) 158M
• Capital budget (FY08) 45M
• Number of users 54,000
• Devices on the network 71,000
• Locations on the Partners network 140
• Electronic Medical Record physician users 3,800
  (gt 90 of AMC PCPs 50 of Specialists)

• Patients with data in the clinical data
  repository 4,000,000
• Medical images on line 450,000,000
• Orders entered hourly through Computerized
  Provider Order Entry (across Partners) 1,000
• LMR (ambulatory EMR) transactions per day 1M
• Calls to the Help Desk each month 18,000

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What is High Performance Medicine?
HPM comprises five System-wide projects with one
common goal

• To deliver better care to patients.
• Care that is
• Safer
• Better coordinated
• More reliable in delivering proven interventions
• Systems that support providers in doing the
  right thing.

Dr. Jim Mongan
http//www.partners.org/about/hpm.htm
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What are the High Performance Medicine
Initiatives?

• Investing in quality and utilization
  infrastructure
• Information systems applications
• Informatics Infrastructure (data, knowledge,
  services)
• Enhancing patient safety by reducing medication
  errors system-wide
• Enhancing uniform high quality by measuring
  performance to benchmark for select inpatient and
  outpatient conditions
• Expanding disease management programs by
  supporting activities for certain patients with
  chronic illnesses
• Improving cost effectiveness through managing
  utilization trends and analysis of variance

Infrastructure
Quality
Initiative Focus
Efficiency
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Discrete vs. Shared Data, Knowledge, Logic

• Many Partners applications utilize discrete
  data, logic and knowledge or rules most are not
  integrated across sites creating islands of
  information and supporting varying levels of
  functionality.

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The Future Shared Data, Knowledge, and Logic
Partners SOA Strategy
Future clinical applications will take advantage
of shared repositories of enterprise data,
knowledge, and logic, in a services-oriented
architecture
Common Shell or Clinical Portal
Shared Logic, Dictionaries, and Rules (Enterprise
Clinical Services, Medication Services and
Knowledge Management)
Dictionaries And Rules Data (Knowledgebases)
Enterprise Repository (s) Problems, Meds,
Allergies, Labs, Orders, Notes, etc.
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Automatic Reminders
Summary Flowsheets
Intuitive Chart Summary
Coded Clinical Data
Customizable Desktop
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SFQD RD TeamAcknowledgements

• Clinical Informatics
• Jonathan Einbinder, MD, MPH
• Julie Greim, MSc
• Tonya Hongsermeier, MD, MBA
• Qi Li , MD, MBA
• Maya Olsha-Yehiav
• Matvey Palchuk, MD, MSc
• Alan Rose, MSc
• Clinical and Quality Analysis
• Julie Fiskio
• Andrea Melnikas
• Svetlana Turovsky, MD
• Lana Tsurikova, MA, MSc
• Lynn Volk, MA
• Tony Yu, MD, MSc
• Clinical Investigators
• Jeff Linder, MD, MPH
• Jeff Schnipper, MD, MPH
• John Orav, PhD

• Application Development
• Irene Galperin
• Nina Plaks
• Anatoly Postilnik
• Boris Rudelson
• Michael Vashevko
• Clinical Systems Management
• Lynn Klokman
• Eunice Jung
• Other
• Steve Flammini, CTO
• Joanne Tremblay
• Cindy Spurr
• Cindy Bero
• Liz Mort, MD
• Alan Cole, MD

AHRQ R01HS015169 Blackford Middleton, PI
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CAD / Diabetes Smart Form

• Integrated into a visit note
• Customized views tailored to medical condition(s)
  of the patient
• Guided data review
• Central note-writing section
• Multiple ways to document a note
• Formlets for selected coded data entry
• Tailored Decision support section
• Patient View
• Activates patient around goals of care

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CAD/DM Smart Form
Smart View Data Display
Assessment, Orders, and Plan
Documentation Window
Assessment and recommendations generated from
rules engine

• Lipids
• Anti-platelet therapy
• Blood pressure
• Glucose control
• Microalbuminuria
• Immunizations
• Smoking
• Weight
• Eye and foot examinations

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CAD/DM Smart Form
Medication Orders
Lab Orders
Referrals
Handouts/Education
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What is a Quality Dashboard?

• Physician feedback system
• Clinician-level view of performance on
  problem-oriented quality indicators
• Comparison to
• Clinic peers
• National benchmarks
• Drill-down capability
• Summary measures ? List of Individual Patients ?
  Patient Charts/Smart Form

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ARI Quality Dashboard
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CAD Quality Dashboard
Targets are 90th percentile for HEDIS or for
Partners providers
Red, yellow, and green indicators show adherence
with targets

• Zero defect care
• Aspirin
• Beta-blockers
• Blood pressure
• Lipids

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CAD Quality Dashboard
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CAD Quality Dashboard
Prioritize by deficiency points
Sort
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CAD Quality Dashboard
Filter. For example, patients with blood pressure
not at goal who have had 0 or 1 visit in the past
year
Clicking on name opens patients Smart Form
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Lessons Learned Quality Dashboards

• Biggest barriers to use are related to the health
  care system
• What are the drivers (carrots and sticks) to QD
  use?
• Pay for performance
• Reimbursement for case management
• For chronic diseases, QD may be more effective as
  a case management tool

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Lessons Learned Quality Dashboards

• Other major barrier is related to quality of the
  data
• Absolute need to tie patients to providers, edit
  panels, deal with missing data
• Wont change behavior unless the data are
  believable
• Big societal trends will drive quality
  measurement
• Can providers be proactive? (EHR data better than
  billing data)

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Conclusions

• Smart Forms and Quality Dashboards offer new
  workflow and decision support methods to manage
  acute and chronic medical conditions using EHR
  technology
• Both have potential to improve care, demonstrate
  EHR value to providers, and drive EHR use
• Much work remains to be done

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Where Are We?
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Thank you!Blackford Middleton,
MDbmiddleton1_at_partners.org