Sonya Burroughs, MD Manager, Children s IQ Network. Caroline S. Brozak Program Lead Population Health. Stacey Gregory Quality Assurance Coordinator

Transcription

1 Sonya Burroughs, MD Manager, Children s IQ Network Caroline S. Brozak Program Lead Population Health Stacey Gregory Quality Assurance Coordinator CIQN PM Conference June 13, 2018 Advancing Population Health Through Data Sharing and Disease Related Registries

2 Children s National Health System 2 Cerner Corporation. All rights reserved.

3 Children s National Overview Licensed Beds 313 Outpatient Visits 450,080 Surgeries 16,718 Our Patients 218,958 patients seen Member Team 6,000+ Pediatrics Residents and Fellows 290 Research Projects 600+

4 Children s Integrated Quality Network (CIQN) Represents over 50% of the community pediatricians in the DC Metro Area Approximately 2,000,000 patients represented on the eehx.

5 Map of CIQN Practices

6 What Are Our Transactional Data Connections?

7 Goals of CIQN s Population Health Initiative Improved health of pediatric population, through information sharing and data analytics Facilitation of improvements in patient care and experience through interoperability tools Reduced costs and duplication of services

8 HealtheIntent Data Platform

9 Population Health Technology Strategy HealtheIntent Cloud-based EDW Aggregates health data across the continuum of care Data Origin Agnostic HealtheAnalytics Analytic tools to visualize data Intuitive & graphical Exposes opportunities for performance & quality improvement HealtheRegistries Comprehensive disease & wellness registry solution Leverages essential clinical & financial data across the continuum of care Identifies gaps in care Presents data to providers in an actionable manner right in their workflow

10 Source Systems from Many Vendors Cerner Millennium eclinicalworks Greenway EPIC Dentrix Billing Systems Cloud-based Platform Enterprise Data Warehouse Applications for Consuming Data HealtheAnalytics HealtheRegistries HealtheRecord HealtheCare HR Systems

11 Cerner HealtheIntent HealtheIntent is Cerner s Population Health Platform eclinicalworks integrates with HealtheIntent with two interfaces: Outbound feed of raw data Inbound data to display on a new Right Chart Panel Tab titled PopHealth

12 IG5 FY18: Outcomes in Population Health Definition: Advance quality outcomes in selected population health diagnoses across the continuum of care through electronic health registry data. Rationale: Through 6 population health registries: asthma, cardiomyopathy, diabetes, inflammatory bowel disease, epilepsy, and sickle cell, improve the outcome in each registry by 10% (absolute) from baseline in 2 or more metrics for each health condition. Interventions will require collaboration spanning inpatient, ambulatory and community health to achieve improvements. FY18 Incentive Goal Term Metrics Accountable Executive: Brian Jacobs, Rahul Shah, Kathy Gorman & David Wessel Threshold Improve outcomes of care using 3 registries. Target Improve outcomes of care using 4 registries. Maximum Improve outcomes of care using 5 registries.

13 Pediatric Registries Asthma Cardiomyopathy Diabetes Action Plan Complete Medication Management Lung Function Testing Asthma Control Test Influenza Vaccination Current Season Tobacco Use Screening and Cessation Tobacco Exposure Screening Outpatient Visit Emergency Department Visit Hospital Visit Echocardiogram Outpatient Vital Signs Outpatient Electrocardiogram Routine Holter Monitor Routine Labs Blood Pressure Control Blood Pressure > 130/90 mm Hg Body Mass Index Outpatient Visit Emergency Department Visit Hospital Visit HbA1C Screening HbA1C < 7.5% HbA1C < 9.0% HbA1C > 10.0% Lipid Panel LDL < 100 mg/dl LDL > 130 mg/dl Microalbumin Screening Thyroid Function Screening Celiac Screening Blood Pressure Measurement Blood Pressure > 130/90 mm Hg Body Mass Index Pneumonia Vaccination

14 Pediatric Registries IBD Epilepsy Sickle Cell Nutrition Assessment/Counseling Tuberculosis (TB) Testing Hepatitis B Vaccination Varicella Vaccination Eye Exam Adolescent Depression Screening Blood Pressure Measurement Routine Labs Body Mass Index Routine Urinalysis 6 MP and Imuran Labs Methotrexate Labs Contraceptive Education Outpatient Visit High Risk Outpatient Visit Low Risk Emergency Department Visit Hospital Visit Bone Mineral Testing Brain MRI DMV Notification Diastat Prescription Electroencephalogram Emergency Department Visit Emergency Seizure Action Plan Felbamate Labs Hospital Visit Motor Vehicle Education Outpatient Visit Reproductive Education Routine Labs Surgical Referral Antibiotic Prophylaxis Blood Pressure < 140/90 mm Hg Chronic Transfusions Audiology Exam Chronic Transfusions Ferritin Chronic Transfusions Labs Chronic Transfusions Neuro Testing Chronic Transfusions T2 Level Chronic Transfusions Viral Testing Eye Exam Genetic Counseling 12 Years Genetic Counseling New Condition Hydroxyurea Treatment Hydroxyurea Treatment Education Meningococcal Vaccination Pain Assessment Pain Assessment Follow Up Pneumococcal Vaccination Proteinuria Screening RBC Phenotyping Spirometry Evaluation Stroke Prevention Well Visit

15 Well Child Registry Measures Outpatient Blood Pressure Measurement Body Mass Index Percentile Nutrition Assessment or Counseling Physical Activity Assessment or Counseling Screen Time Assessment or Counseling Tobacco Exposure Screening Childhood Immunization Meningococcal Vaccination Influenza Vaccination Full Season Influenza Vaccination Partial Season Influenza Vaccination Current Season Well-Child Visits in the First 18 Months of Life Well-Child Visits in the 2 nd,3 rd,4 th,5 th and 6 th Years of Life Development Questionnaire Assessment Age 1-3 Years Vision Screening Hearing Screening Lead Testing Routine Hemoglobin Domestic Abuse Screening Autism Screening Tdap Vaccination Human Papillomavirus Vaccination

16 Well Adolescent Registry Measures Depression Screening Depression Follow Up Plan Outpatient Blood Pressure Body Mass Index Nutrition Assessment or Counseling Physical Activity Assessment or Counseling Screen Time Assessment or Counseling Tobacco Exposure Screening Tobacco Use Screening and Cessation Meningococcal Vaccination Tdap Vaccination Influenza Vaccination Full Season Influenza Vaccination Partial Season Influenza Vaccination Current Season Human Papillomavirus Vaccination Vision Screening Alcohol Screening and Follow Up Domestic Abuse Screening Illicit Drug Screening STI Screening Chlamydia Screening in Women Hearing Screening New Measure

17 Future Pediatric Registries Scoliosis Complex Care Childhood Wellness Adolescent Wellness Epilepsy Autism Spectrum Down Syndrome Cystic Fibrosis

18 CIQN Clinical Information and Population Health Moving data from ecw into HealtheIntent for analysis leading to improved patient outcomes Implementing integration with ecw and HealtheIntent so registry information will be present in right chart panel

19 Cerner HealtheIntent

20 In Summary CIQN and Population Health Registries: Network of providers actively sharing pertinent patient clinical information via ehx and data extraction from individual EHR s Providers actively engaged in population health, actively working towards populating and using registries for improved patient outcomes Working with community providers to implement standard documentation with initial registries Working to implement general pediatric registries based on need Positioned to reduce cost and improve quality of care

21 ? Questions?