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.
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