Richard Lopez, MD

Chief Medical Officer

Atrius Health

1

Using HIE to Improve the Quality of Care

Atrius Health

• Non-profit alliance of six leading independent medical groups

– Granite Medical

– Dedham Medical Associates

– Harvard Vanguard Medical Associates

– Reliant Medical Group

– Southboro Medical Group

– South Shore Medical Center

• Provide care for ~ 1,000,000 adult and pediatric patients in almost 50 ambulatory sites

• 1000 physicians, 1450 other healthcare professionals across 35 specialties

• Largest physician-based “Accountable Care Organization”

Atrius Health

• 100% on EMR combined with corporate

data warehouse, used for managing

quality and cost. Patient portal.

• Long history with global payments,

currently managing 50% of our patients

with global payments across commercial,

Medicare and Medicaid populations.

• Strong infrastructure to manage risk

• One of first to sign BCBSMA Alternative

Quality Contract (AQC)

• One of 32 Medicare Pioneer ACOs

nationally

Our Focus is on Achieving Quality

The Triple Aim IOM Definition

• Patient-centered

• Safe

• Effective

• Efficient

• Equitable

• Timely

• And sustainable

Improve

Experience

Of Care

Reduce

Per

Capita

Cost

Improve

Population

Health

Source: IHI.org

How Does Health Information Exchange Bring Us

Closer to Achieving the Triple Aim?

• Improve Quality/Safety

– Supports transition of care

– Provides continuity in the ambulatory setting

– Ensures that data is not lost that

might compromise patient safety,

i.e. medication changes, pending test results

• Reduce the per capita cost of care

– Reduces duplication of testing

– Enhances efficiency of care

• Improve Patient Care Experience

– Knowledge of Patient

Hospital HIE: Practical Issues

• Hospital-centric or Provider-centric?

• Multiple hospitals poses a challenge

• IT Costs/Resources

• Confidentiality/HIPPA

• EMR

• Hospital identification of provider’s

patients

• Ease of Use for Clinicians

Hospital Information Exchange: Atrius Health Approach

1. Notifications – alerts clinicians of important

events real time and scanned into EMR within 24

hours. – Emergency Room Admission

– Hospital Admission

– Discharge

2. Document Exchange – provides for

permanent storage of patient information in EMR – Admission and Discharge Notes

– Reports (consults, images, path, testing, op reports, etc)

Hospital Information Exchange: Atrius Health Approach

3. Web Portal and Reverse Web

Portal – enables clinician to access

current and historical information not

otherwise available; – Immediate window into Hospital clinical systems

– Allows tracking inpatient activity

– Ease of use; avoids new logins and passwords

4. Concurrent Inpatient Tracking – Tracks all inpatient admissions by all payers

concurrently

– Critical for care management of ACO

1. Hospital Information Exchange: Notifications

• Partners Health Care

– Use of EMPI (Enterprise-Wide Master Patient Index) to identify Atrius Health

patients for 6 hospitals; contains demographic data on joint patients

– Notifications of ED visit, hospital admission, and hospital discharge sent via e-fax

when patient is recognized in EMPI; placed in EMR and routed to provider inbasket.

– Expensive to build and maintain; not viable solution for each hospital (Atrius Health

has over 35 hospitals with 100+ admissions)

• South Shore Hospital

– CHAPS (Community Hospitals and Physicians Practice Systems) allows for patient

matching by 5 data elements and clinical summary “pull” of our data by South

Shore Hosp (community affiliate) ER

– ER notification and summary populate our EMR inbasket

– Discharge summary also populates inbasket on discharge

– Live for 3-4 years and well-liked but likely not supportable over time for multiple

hospitals and match rate only 60%

• All Other Hospitals

– Match done by PCP; each hospital maintains updated PCP list provided by us

– Notifications sent by e-fax and placed in EMR same day by Atrius Health medical

records staff – populates EMR inbasket.

2. Hospital Information Exchange: Documents

• Some limited document exchange currently

performed via e-fax, paper fax, or secure email and

entered into EMR

• Statewide HIE initiatives will greatly improve this

process

• While valuable for enduring documentation such as

a discharge summary, import of documents into the

EMR has the potential to make retrieval of

information difficult over time by cluttering the record.

• As a result, we are balancing this approach with the

web portal concept

3. Hospital Information Exchange: Web Portals

• Web portals enable direct patient match on 3 elements and web-view

of hospital chart directly from the patient’s ambulatory EMR record.

• Currently active with

– Beth Israel Deaconess Medical Center

– BIDMC-Needham

– BIDMC-Milton

– Partners hospitals

– Mt Auburn

– Beverly

– New England Baptist

– Boston’s Children’s Hospital

• Reverse web portal implemented using Epic CareWeb at BIDMC and

allows similar functionality for hospital based clinicians

• Requires hospital system to have a “web services layer” to their IT

infrastructure.

4. Hospital Information Exchange: Concurrent

Inpatient Tracking

• In development now

• Will allow for daily census information to

be directly transmitted to the EMR

• Hospital feeds either via an ADT feed or

manual

• Care managers will have access for daily

care coordination activities