Tuesday, February 12, 2013

The "Post EHR" Era

Over the next few months, the majority of my time will be spent discussing topics such as care coordination, healthcare information exchange, care management, real time analytics, and population health. At BIDMC, we've already achieved 100% EHR adoption and 90% Meaningful Use attestation among our clinician community.    Now that the foundation is laid, I believe our next body of work is to craft the technology and workflow solutions which will be hallmarks of the "post EHR" era.

What does this mean?

I've written previously about BIDMC's Accountable Care Organization strategy, which can be summed up as ACO=HIE + analytics

In a "post EHR" era we need to go beyond simple data capture and reporting, we need care management that ensures patients with specific diseases follow standardized guidelines and protocols, escalating deviations to the care team.    That team will include PCPs, specialists, home care,  long term care, and family members.    The goal of a Care Management Medical Record (CMMR) will be to provide a dashboard that overlays hospital and professional data with a higher level of management.

How could this work?

Imagine that we define each patient's healthcare status in terms of "properties".    Data elements might include activities of daily living, functional status, current care plans, care preferences, diagnostic test results, and therapies, populated from many sources of data including every EHR containing patient data, hospital discharge data, and consumer generated data from PHRs/home health devices.

That data will be used in conjunction with rules that generate alerts and reminders to care managers and other members of the care team (plus the patient).   The result is a Care Management Medical Record system based on a foundation of EHRs that provides much more than any one EHR.

My challenge in 2013-2014 will be to build and buy components that turn multiple EHRs into a CMMR at the community level.

This will require philanthropic funding, in kind contributions from selected vendor partners, and a willingness to take a risk on creating something that has never been operated at scale in the past.

I wrote previously about the reluctance of healthcare to change and adopt new delivery models.

BIDMC is a unique learning laboratory because 65% of its patients are already in global captivated risk arrangements.

If the CMMR can be created anywhere, it's at BIDMC which strives to be agile and transparently share all its early experiences with the world.

I'm willing to lead the CMMR effort.   In my discussions with many stakeholders over the next few months, I'm hoping to create a guiding coalition that will join me.


Ashish Kachru said...

Hi John,

I appluad your vision for a care management/care coordination system. I don't know if everyone who is in risk bearing arrangements understands today that all of what you descrined will need to be done.
Ashish Kachru

Unknown said...

You report that 90% of your organization's physicians have achieved meaningful use. Does your denominator include pathologists, radiologists, anesthesiologists and hospitalists? Many consider those specialities to be excluded as hospital based, but it is suprising how many of them are determined to be eligible by CMS based on the place of service of their Medicare FFS billings. This is best discovered by registering them on the EHR Registration site and then checking their Status for their % hospital. About the only group that consistently shows up as 90%+ hospital on the EHR Registration site are ED physicians. Even that depends on whether they work in some kind of hospital out-patient part of the ED (urgent care, fast track).

GreenLeaves said...


I like your concept of the CMMR but it will require a level of HIE that I only dream about. Working on a green field hospital is exciting and is also a challenge because there is no functional HIE in greater Los Angeles. I can only see the HIEs surviving if we stop reinventing each individual HIE from the ground up and focus more positively identifying shared patients and moving data and treatment to where it needs to be for the patient to get well.