We have been building an IT foundation for care management and population health for several years at Beth Israel Deaconess Medical Center. This groundwork has proven essential, particularly since our physician organization was named one of Medicare’s Pioneer Accountable Care Organizations (ACOs).
Based on our experience, I recommend five priorities for providers that aim to take on population risks.
Universal adoption of EHRs. Every clinician in an ACO needs to record data electronically, ideally using the same electronic health record (EHR) vendor. If clinicians cannot access the same EHR, then they need to use common pick lists and vocabularies, which enables data to be comparable across practices.
At Beth Israel Deaconess, we created a model office workflow to ensure data is recorded by individuals with the same roles during the same processes using the same value sets. For example, every physician records blood pressure and medication names in the same place in the same format so that the data can be easily aggregated for quality, safety, and efficiency analysis.
Health information exchange. Data needs to be shared among caregivers for care coordination and panel management. Approaches can include viewing data in remote locations, pushing summaries between providers, or pulling summaries from multiple sites of care.
We have created novel approaches to secure data sharing, and we participate in many federal and state heath information exchange pilots. Summaries are now sent electronically for all transitions of care among providers, hospitals, and payers.
Business intelligence/analytics. Once data is collected and shared, it needs to be analyzed—retrospectively to identify gaps in care and prospectively to ensure patients receive the right care at the right time.
Beth Israel Deaconness worked with the Massachusetts eHealth Collaborative to create a communitywide quality data center. This is used for all accountable care, meaningful use, and risk-contract quality reporting. We also piloted popHealth, which is sponsored by the Office of the National Coordinator for Health IT. An open-source, automated quality measurement system, popHealth allows providers to aggregate data from EHRs to generate clinical quality reports.
Universal availability of PHRs. By providing a platform for information exchange between patients and clinicians, personal health records (PHRs) help engage patients and families in their care, ensure the communication of care plans, and achieve seamless handoffs.
We have offered comprehensive PHRs to all of our patients since 1999. Patients can view their records, including their labs and medications. Patients can also schedule appointments, refill medications, and send secure messages to their providers. It works just as well on iPhones as it does on iPads and desktops.
Decision support services. Care management requires alerts, reminders, pathways, and guidelines. Ideally, all members of the care team will receive decision support inside their electronic record based on enterprise rule sets.
At Beth Israel Deaconness, we’ve used the concept of decision support service providers to turn data into knowledge and wisdom inside our EHRs and web applications. If all providers access the same evidence, we can standardize care throughout all our locations, reducing cost and improving quality.
Of these five tactics, the biggest challenge is defining the care management rules. In other words, what conditions, wellness measures, home care interventions, best practices, and evidence should be incorporated into the point of care and analytic systems?
Beth Israel Deaconess has hired a new senior vice president of care management to help answer these questions. He started in early May. It’s a good start.
John D. Halamka, MD, MS, is CIO, Beth Israel Deaconess Medical Center, Boston. This column is adapted with permission from his blog, Life as a Healthcare CIO.
J.P. Morgan: Managing Cybersecurity and Protecting Patient Data
Brian DiPietro, Managing Director, Commercial Bank Technology, JPMorgan Chase & Co., discusses the importance of evaluating your cybersecurity protocols to help prevent malicious data breaches.
TransUnion Healthcare: Smarter Revenue Cycle Solutions
Gerry McCarthy, President of TransUnion Healthcare, discusses industry trends contributing to higher bad debt and what to do about them. Gerry is responsible for the strategic direction of the healthcare business and expanding its footprint in the healthcare market overall. He has more than 20 years of experience in healthcare information technologies.
Deloitte: Creating Value with Effective Care Management
Scott Kolesar, principal and senior leader in Deloitte Consulting LLP's Value Based Care practice, and David Wennberg, MD, MPH, adjunct associate professor of The Dartmouth Institute and former chief executive officer, Northern New England Accountable Care Collaborative, discuss the challenges and competencies involved in creating a care management organization.
American Express: Streamlining Supplier Payments and Boosting Revenue
Andrew Jamison, vice president in the Global Corporate Payments division of American Express, discusses trends and opportunities in supplier payments.
Deloitte: Realizing the Potential of Your CDI Program
Suzanne Whitworth, director at Deloitte & Touche LLP, and LaVerne Romberger, MSN, CCM, CCDS, clinical operations manager-Seton Healthcare, share leading practices for maximizing the potential of clinical documentation programs under value-based care.
RevSpring: Customizing a Technology Platform to Drive Patient Payment
Martin Callahan, Senior Vice President, Healthcare Solutions, RevSpring, describes key industry trends affecting how patients engage with the revenue cycle and ways payment processes are changing as a result.
KPMG: Readying for Healthcare Today and Tomorrow
Dion Sheidy, a partner in KPMG's Healthcare Advisory practice, discusses healthcare's changing landscape and how having the right advisor can help organizations navigate challenges and opportunities.
Huron Healthcare: Readying Your Organization for Transformation
Gordon Mountford, executive vice president, Huron Healthcare, discusses business imperatives for undertaking transformative change.
Xtend Healthcare: A Custom Approach to Optimizing Revenue Cycle Performance
Tom O'Neill, CEO of Xtend Healthcare Advanced Revenue Solutions, discusses key areas where organizations risk revenue leakage and ways they can use outsourcing to better protect cash flow and support accurate payment.
KeyBank: Helping You to Realize Your Strategic Vision in Changing Times
Victoria Terekhova, senior strategist for Enterprise Healthcare at KeyBank, discusses key challenges when developing long-term strategy in a rapidly changing industry, and the role the right banking partner can play in helping healthcare providers navigate the opportunities before them.