Wednesday, September 14, 2011

BIDMC's Accountable Care Organization IT Strategy

No one really knows what an Accountable Care Organization is, but many provider organizations want to be one.

As a CIO, I've been asked to create the financial and clinical analytics needed to support high value care (low cost, high quality), population health, and care coordination across the community.  

I believe that Accountable Care Organizations will be based on healthcare information exchange and analytics.  BIDMC's approach is accelerate our health information exchange work and continue our existing work on financial and clinical data warehouses.

Here's how it will work.

There are over 1800 clinicians in the Beth Israel Deaconess Physicians Organization (BIDPO).    Some are owned, some are private.   The BIDPO Board of Directors mandated that a certified Electronic Health Record be in use at every BIDPO practice by December 2010 as a condition of participation in payer contracting efforts.   Those payer contracts require "clinical integration" - all clinicians must be knit together by IT.   To accomplish this goal, we implemented a cloud-based EHR which was offered to each practice that did not yet have a certified EHR.   We required all clinicians, owned and private, to send a standardized, structured summary of each visit to a central quality registry.  

As each encounter is completed and signed, eClinicalWorks, Altos Solutions, and webOMR, send a very specific Clinical Document Architecture (CDA) summary containing all the data necessary to compute quality and performance metrics to a statewide Quality Data Center, hosted at the Massachusetts Medical Society and operated by the Massachusetts eHealth Collaborative.

That warehouse is used to generate PQRI measures, the 44 meaningful use measures, and ad hoc reporting via web-based business intelligence tools.

For the financial data warehouse, all private payers claims from BIDPO patients are forwarded to a single financial data warehouse where Extract/Transform/Load tools are used to normalize the data into a single schema.

Data mining and reporting is done by Healthcare Data Services.

The interesting recent development is that all the clinical data transfers from heterogeneous EHRs pass through the New England Healthcare Exchange Network (NEHEN) gateway, such that the Quality Data Center is just a node on the HIE.   Anyone can send any data from any EHR using the standards mandated by Meaningful Use.

NEHEN also transmits summaries to the next provider of care, ensuring clinical integration.    We have live connections among Atrius, Childrens, BIDMC, and Northeast.   In a few weeks, Partners  Healthcare will go live with the ability to receive transactions.

As of last week, we have exchanged over 16,000 production clinical messages for care coordination and quality measurement.

All the Public Health transactions will soon be live on the NEHEN infrastructure.

Healthcare reform is causing hospitals, practices, payers, and government to align their healthcare IT efforts in support of the data sharing and analytics needed by new reimbursement models.

It's happening very fast in Boston/Eastern Massachusetts.

I'll continue to share all my lessons learned as BIDMC implements an entire suite of IT solutions on the road to Accountable Care nirvana.


InformRN said...

Thanks so much for sharing your wisdom. You are fortunate that many of the pieces needed (i.e. HIE, EHR's implemented) are in place in your state. Please continue to share your experiences for those of us who are not quite that far down the road.
In appreciation,
Sarah Tupper, MS, RN-BC

Chris Tonozzi, MD said...

Great to know how you're approaching this. One question: how are you doing case management of "covered lives?" Will you have separate software that interfaces with the data warehouse and/or EHRs? Or will practices be doing this through their EHRs? Or other?

Paul Newton MD said...

One of the critical elements to care coordination is the people we are serving, often referred to as patients. If we are not successful in engaging people by providing them the information and tools in a smart, comprehensinve way that pulls them in and keeps them connected, all the other efforts to coordinate care may be unsuccesful.