karson approaching innovation with commercial ehrs
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Approaching Innovation with Commercial EHRs
Andrew Karson MD MPHSeptember 30, 2013
Outline
Partners HealthCare Partners eCare Structure Approach to Innovation Advancing core work Creating new and original solutions
About Partners HealthCare Integrated academic health care system founded by Massachusetts
General Hospital and Brigham and Women’s Hospital in 1994 Largest private employer in Massachusetts
Over 60,000 employees
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Patient Care• Among the sickest and most
complex patients• Providing essential services• Caring for the most vulnerable
Discovery• Over $1.4B in research funding• Discovering new treatments and
cures• Testing new care delivery models
Community• $205M in community benefits• 21 Community Health Centers• Over 100,000 Medicaid and
uninsured patients annually.
Teaching• 200+ accredited physician residency
and fellowship programs• Harvard and Tufts Medical
Students• Nursing and Health Professional
programs
Partners Tradition in IT Innovations
Long history of IT Innovations BWH
Brigham Integrated Computing System (BICS) MGH
Lab of Computer Science Partners HealthCare
Longitudinal Medical Record (LMR) MGH Order Entry Chemotherapy Order Entry EMAR Enterprise Services
Many “best in class” systems
Existing IT Environment
“A patchwork quilt” Custom developed Best-of-Breed Supports niches of
healthcare delivery Can work against
integration and coordination of care delivery
Expensive to maintain
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2010 BWH MGH DFCI NWH FHNSMC Charter SRH SRC SRNS SCape PHC PCHI McLean NER/TBC
Inp CPOE PHS PHS PHS Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A N/A Medtch C/S
Inp M AR -nonbar N/A N/A N/A N/A N/A N/A Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A Medtch C/S
Inp eM AR -bar code PHS PHS N/A Medtch Medtch Siemens Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A TBD
Inp Nsg Assessment MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane
Inp Nursing Notes MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane
Flowsheets MVICU MVICU LMR TBD TBD TBD TBD N/A N/A LMR N/A N/A
Consult (Inpt)Notes MVICU MVICU TBD TBD TBD TBD TBD TBD N/A N/A TBD Keane
Inp Progress Notes MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD Keane
Inp H&P MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD N/A
Anesthesia Record MVOR MVOR N/A TBD TBD TBD TBD TBD N/A N/A N/A N/A
Amb Chemo CPOE N/A PHS PHS TBD PHS PHS N/A N/A N/A N/A N/A N/A
Amb CPOE - M EDs LMRLMR, OnCall LMR LMR, GE LMR, GE LMR TBD N/A
LMR, GE TBD N/A
Amb Nursing Notes LMRLMR, OnCall LMR LMR, GE LMR, GE LMR LMR Cerner
LMR, GE TBD N/A
Amb Visit Notes LMRLMR, OnCall LMR LMR, GE LMR, GE LMR LMR N/A
LMR, GE TBD N/A
OncAmb eM AR N/A PHS (pln) PHS (pln) TBD TBD TBD N/A N/A N/A N/A N/A N/AED CPOE PHS PHS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/AED visit notes TBD EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A
ED tracking BWH EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A
Results Viewing and Repository
BICS, CDR/RV CDR/RV
BICS, CDR/RV
Medtch, CDR/RV
Medtch, CDR/RV, BICS
Siemens, CDR/RV
Medtch, CDR/RV
Siemens, CDR/RV Cerner CDR/RVMedtch C/S Keane
Op Notes, D/C SumBICS, CDR/RV CDR/RV N/A
Medtch, CDR/RV
Medtch, CDR/RV, BICS
Siemens, CDR N/A N/A N/A N/A N/A N/A
Pt Computing PG PG PG PG PG PG TBD TBD TBD PG TBD TBD LMR = Longitudinal Medical RecordKEY: PG = Patient Gatew ay MV = MetaVision from iMDsoft RV = Results View er Mdtch/CF - at SRH: Meditech and/or CareFusion for eMAR solution EDIS = (MGH) Emergency Dept Information System CDR = Clinical Data Repository
Drivers of Change at Partners
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Shift from volume to value-based care
Risk sharing requiring tighter coordination and integration of care delivery
Personalized medicine
Heightened demands for healthcare reform from all sectors of the US economy
Partners eCare Principles
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One Patient, One Record, One Team, One Partners Statement
Clinical Systems: Initial Implementation
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Partners eCare (Epic)• Provider Order Entry• EMAR• Clinical Documentation• Ambulatory EMR• Radiant• Stork • Willow Inpatient• Kaleidoscope• MyChart• Phoenix
Partners eCare(Epic add’l development)• Beacon • ASAP • OpTime/Anesthesia• Home Health• AMC Radiology
Non-Epic (Partners eCare/
Other) • Ambulatory Pharmacy• Radiation Oncology• Gastroenterology•PACS (Image Archive and Communication)•Others
Partners eCare Non-Epic Enterprise-wide
• Blood Bank• Laboratory System
Partners eCare Structure
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Partners eCare Structure
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PeC Clinician Team Sub-groups
Clinical Process Redesign Clinical Content Clinical Informatics Clinical and Biomedical Devices Clinical Deployment
Clinical Process Redesign
Project Prioritization Criteria Alignment with Partners Strategy Patient Safety Quality of Care Regulatory Value/ROI Usability Standardization / Systemness Facilitation of Epic build Measurable (metrics/KPI) Timed appropriately for PeC timelines
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Clinical Process Redesign
Initial Process Redesign Areas Include:
Admission Discharge
Transitions in Care/Hand-offs Medication Reconciliation
Peri-operative Services Plan of Care
Preventive Care Patient Centered Medical Homes (10 Care)
High Risk (iCMP) / High Cost Patients
Patient Engagement/MyChart
PeC Clinician Team Sub-groups
Clinical Process Redesign Clinical Content Clinical Informatics Clinical and Biomedical Devices Clinical Deployment
Clinical Informatics
Clinical Decision Support (CDS)
Knowledge Management
Terminologies
Partners Enterprise: Multiple Types of CDS
Drug-Drug Interactions Drug-Pregnancy Drug-Laboratory Drug-Disease Drug-Utilization Duplicate Therapy Food-Drug Interactions Nephros (Renal Dosing) Gerios (Geriatric Dosing) Insulin Ordering
Chemotherapy (includes oral and investigational)
Order sets Clinical Reminders Health Monitoring Critical Lab Results Relevant Lab Results Immunization Schedules Family History Problem list refinement
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Planned approach to CDS
Define CDS priorities based on Partners programs and initiatives: governance E.g., MU, Safety, Quality, Care Redesign, ACOs, etc.
Understand features and content available in Epic: learning
Compare with features and content available at Partners: recommendations
Define implementation strategies: gradual deployment with long-term maintainability
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PeC Clinician Team Sub-groups
Clinical Process Redesign Clinical Content Clinical Informatics Clinical and Biomedical Devices Clinical Deployment
Partners eCare Leadership Team
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Innovation Council Guiding Principles
Definition• Innovation is the application of new solutions
that meet new requirements, inarticulate needs, or existing market needs. The term innovation can be defined as something original and new that "breaks in to" the market or into society. Innovation differs from improvement in that innovation refers to the notion of doing something different rather than doing the same thing better.
Where Innovation Will Occur • Sites vs. at Partners centrally
Types of Innovation• External (including publication, patents and
potential commercialization)• Internal (for use at PHS exclusively)
Endpoints/Goals of Innovation• Where do the innovative ideas take PHS as an
organization as related to the Health IT and EMR desired future state?
Dimensions to Address Regarding InnovationPrioritization• Managing competition between innovators
Other Process Issues to Address• How to address conflicts of interest?• How to support initiatives?• How will the “bake-off” rules work?
Funding• Internal• Entity, PHS• External• Government, foundations, industry
Dissemination of Innovation• How to communicate and foster an
environment to promote innovation?• Support of cross-collaboration between
institutions w/in PHS and external to PHS
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Guiding Principles to Foster Innovation Subgroup
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Fostering Innovation Guiding Principles Draft Overview
Objective Create guiding principles that would inform how to facilitate innovation across the
Partners organization and promote an innovative environment. These principles go beyond the Partners eCare project and will influence health IT as a whole.
Innovators Innovators need access to others with different skill sets, and to resources that
will enable them to refine their ideas.
Prioritization of Partners Support for Innovation Innovations will have higher priority if they are aligned with Partners strategic
initiatives, and there will be an explicit set of criteria for prioritization.
Whether Innovation Should Be Done In or Outside Epic Applications should leverage Epic functionality when available and can be built
inside Epic but can also be built outside of Epic when such functionality is inadequate or unavailable If something is built inside Epic, then there are intellectual property
considerations.
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Fostering Innovation Guiding Principles Draft Overview (cont’d)
How Partners Should Support Innovation Leverage existing site support for innovation If commercialization potential to engage Research, Venture, and Licensing
group. To enable investigators, ideas and concepts will require “sandbox” environments
to develop and test approaches. Funding to support innovation: institutions, private donors, government, internal
Partners, others.
Dissemination of Innovations within Partners Innovations that improve care in some important way should get support for
spread across Partners.
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Prioritization Framework Subgroup
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Prioritization Framework Draft Overview
Objective Create a framework that will allow for the Innovation Council to evaluate
innovative projects with a standard set of criteria and build/prioritize a portfolio of innovations.
Development Approach Using the “PIRC” model as a starting point, group tailored a number of focus
areas and questions within each category to determine how closely an innovation would align to the framework criteria.
Once the focus areas were defined, group will develop a process utilizing a scoring system to prioritize innovative ideas for the Innovation Council to review and approve projects.
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Sample: “PIRC” Prioritization Framework
Priority ReadinessImpact
1. Value Creation (Evidence Based, Scalable)
2. Generalizable3. Measurable
impact on quality, access, and revenue
4. Volume
1. Business Model/Value
2. Clinical Champion with Engaged Team
3. Project Manager and Technology Lead
4. Potential Clients
Complexity
1. Data Transfer Needs2. Workflow impact
(videoconferencing, etc..)3. Documentation4. Credentialing and/or
Licensing
1. Supports Mission2. Supports Strategic
Initiatives3. Site Sponsorship
and Resources4. Innovation
A selected group of Steering Committee members and subject matter experts will evaluate and approve future pilot programs.
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Conclusion
Partners is in the early stages of our engagement with a commercial EHR
We are attempting to innovate in multiple dimensions: Advancing core work Clinical Process Redesign Clinical Informatics
Creating new and original solutions Currently developing frameworks
Foster Innovation Prioritize Innovative ideas
