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Practice Management Design and build – Data table examples

Data tables Practice defaults-security settings Registration required fi elds Referring provider table Insurance table

HIPAA/AOB/RX hub consent Visit types

Appointment types Visit codes

Demographic fi elds Visit reasons

Telephone encounter reasons/actions Structured data fi elds Document names Patient folders Rx (Current/Hx)

will need to clarify the quality reporting requirements and develop a clear and concise data-acquisition strategy that can be executed at the practice EHR level. This will ultimately help synchronize practice outreach and case-management ef- forts and go a long way in reaffi rming the “Why are we doing this?” conversation between practices and providers. Once the priority quality measures have been defi ned, it is important to examine and catalog the specifi c data-capture points that will be required to support the quality reporting. You should defi ne exactly how and where the data (inclusion and exclusion information) will be documented in the EHR for each quality measure. These become highlights in the practice-level workfl ow and training plans. Keep in mind that if you are using a meaningful-use-

certifi ed EHR system and recording structured data to meet the core and menu-set objectives, it does not always mean you are capturing enough data to support the clinical quality measures (CQM). This is often an invalid assumption. In actuality, there could be a signifi cant amount of additional and/or non-routine data capture necessary to support the full spectrum of CQMs. Emphasis should be placed on increasing the documentation of labs (LOINC), e-prescriptions (Rx- Norm) and structured problem lists (ICD-9 or SNOWMED CT) to all patients seen in the EHR, not just the minimum thresholds required in Stage 1. The BIDMC-BIDPO integration strategy has been building incrementally throughout the EHR initiative and continues to be developed. Major items completed to date include: • Bidirectional lab and radiology interfaces with three local hospital systems.

• Bidirectional lab interfaces with two commercial refer- 20 April 2012

ICD-9/CPT Lab table

Diagnostic imaging

Clinical decision support Order sets Super bills

Lab requisition Imaging requisition

Alerts – Immunization, lab, radiology, Rx, Dx Meaningful use/PQRS/P4P items Reports

Progress note templates Patient letters Specialty forms

OB care items and OB fl ow ence lab systems.

• Master lab compendium – A singular, mapped compen- dium was developed. This allowed the providers to see one orderable for all applicable labs, and then make the routing determination.

• ED and discharge summaries (via CCD) from BIDMC are delivered as patient-assigned documents into provider-based queues within the EHR. • “Magic button” patient record viewers from EHR to the hospital systems. This is a view-only, Web-based application that is enabled from within the EHR, retain- ing patient context and enabling clinicians to see data – problems, medications, allergies, labs, radiology, tests, reports and notes in the hospital. These are temporary systems and were designed as an interim solution in advance of more robust health information-exchange (HIE) model options. • Provider to provider (P2P) is an exchange solution that allows for the sharing of patient-specifi c information. Developing the model offi ce approach at BIDMC- BIDPO enabled disparate providers to have pre-loaded, relevant content and decision-support tools to ease some of the initial paper-to-EHR transition diffi culties. It al- lowed the implementation team to develop scalable, best-in-practice workfl ows and more effective training plans that helped foster a consistent and quality patient experience across different practice locations. It allowed BIDMC-BIDPO to better measure performance at all of the practices, as if they were a single integrated entity, and it provided a foundation for a longer-term interoperability strategy.


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