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