Getting Patient Data Back from External Sources and Adding It to Your Electronic Health Record in a Retrievable Format

1. Getting Patient Data Back from External Sources and Adding It to Your Electronic Health Record in a Retrievable Format

2. ThedaCare has a 100 year history in NE Wisconsin. ThedaCare is a community based healthcare system. TC Mission: to improve the health of our communities TC Vision: to always set and deliver the highest standard of healthcare performance in measurable and visible ways ThedaCare is committed to providing world class healthcare Our clinics are located in Tigerton in the northern most to Ripon in the South. We have a clinic in Hilbert in Calumet County and another addition in Darboy which is near Kimberly WI ThedaCare� is a community health system consisting of four hospitals: Appleton Medical Center, Theda Clark Medical Center, New London Family Medical Center and Riverside Medical Center in Waupaca. ThedaCare also includes ThedaCare Physicians, ThedaCare Behavioral Health, ThedaCare Laboratories, and Ingenuity First�. ThedaCare also has a Home Care and Senior Services Division that includes ThedaCare at Home, The Heritage Residential Living Community, Heritage Woods Assisted Living, and Peabody Manor skilled nursing facility. ThedaCare is the third largest healthcare employer in the state and is the largest employer in Wisconsin�s second largest economic market, Northeast Wisconsin, with nearly 5,400 employees. ThedaCare has a 100 year history in NE Wisconsin. ThedaCare is a community based healthcare system. TC Mission: to improve the health of our communities TC Vision: to always set and deliver the highest standard of healthcare performance in measurable and visible ways ThedaCare is committed to providing world class healthcare Our clinics are located in Tigerton in the northern most to Ripon in the South. We have a clinic in Hilbert in Calumet County and another addition in Darboy which is near Kimberly WI ThedaCare� is a community health system consisting of four hospitals: Appleton Medical Center, Theda Clark Medical Center, New London Family Medical Center and Riverside Medical Center in Waupaca. ThedaCare also includes ThedaCare Physicians, ThedaCare Behavioral Health, ThedaCare Laboratories, and Ingenuity First�. ThedaCare also has a Home Care and Senior Services Division that includes ThedaCare at Home, The Heritage Residential Living Community, Heritage Woods Assisted Living, and Peabody Manor skilled nursing facility. ThedaCare is the third largest healthcare employer in the state and is the largest employer in Wisconsin�s second largest economic market, Northeast Wisconsin, with nearly 5,400 employees.

3. Our Quality Journey Initial state Individual clinics Health Plan No formal quality program Touchpoint Health Plan NCQA accreditation What you don�t measure, you can�t improve NCQA forced us to put a focus on quality Not that we didn�t want quality improvement, but had no organized way to measure and improve Doctors all felt they were performing well on measures, until we measured it!! Reality we were not as good as we thought we were, or as it feltNCQA forced us to put a focus on quality Not that we didn�t want quality improvement, but had no organized way to measure and improve Doctors all felt they were performing well on measures, until we measured it!! Reality we were not as good as we thought we were, or as it felt

4. Accreditation-What it meant to us Focus on quality Service Clinical Identify areas of opportunity Required improvement year to year Required rigorous root cause analysis Targeted interventions on those root causes

5. Quality Journey, cont. Baseline data showed room for improvement What are we going to do about it? Established P4P Supplied clinics with basic worksheets Entered info in to Access database Used database to calculate rates End of year report to physicians w/payout P4P brought issues higher on the priority list Worksheets contained basic demographic information, based on claims data thru the health plan. So we didn�t have A1c results, or actual BPs etc. Clinics wrote on the worksheets and returned them to us at the health plan, and health plan staff entered them in to the database. Eventually, we allowed the clinics to enter directly in to the database themselves. This was over 10 years ago�not all clinics had computers, they had to mail them back. Quality Staff did on-site chart audits for everyone (TC Clinics as was all independent) to pull the actual results for outcome measures. The rates were calculated by dropping the information into excel and manipulating the data to create a �rolled up� summary of the information. As the process was streamlined over the years the reporting was available semi-annually, then quarterly. P4P brought issues higher on the priority list Worksheets contained basic demographic information, based on claims data thru the health plan. So we didn�t have A1c results, or actual BPs etc. Clinics wrote on the worksheets and returned them to us at the health plan, and health plan staff entered them in to the database. Eventually, we allowed the clinics to enter directly in to the database themselves. This was over 10 years ago�not all clinics had computers, they had to mail them back. Quality Staff did on-site chart audits for everyone (TC Clinics as was all independent) to pull the actual results for outcome measures. The rates were calculated by dropping the information into excel and manipulating the data to create a �rolled up� summary of the information. As the process was streamlined over the years the reporting was available semi-annually, then quarterly.

6. Electronic Medical Record EMR Epic Actual clinical data (outcomes) Registry began Converted Access database to on-line registry Still required manual entry for Non-TC sites Issues Patient identity (claims vs. encounter info) Claims dx not in EMR In 2001, we began using the electronic medical record to pull information. This allowed us to pull the results from our labs, but we still used the manual entry for labs that were documented from outside the system. At this point we are still a health plan and have independent physicians as well as Thedacare. We were combining our data with theirs. A registry was built that would allows us to capture the electronic data and merge it with the manually entered data. The clinics could do manual entry but we still had the quality staff do chart audits on those entries. Still labor intensive to clean up, validate information. With the EMR came the issues of matching the patients from the health plan with what was in our system. The identity process and merging patient information became a struggle. Health plan may have a different SSN, address, DOB, etc. Claims information may have provided us with a dx that wasn�t recorded in our system for patients (seen another provider outside the EMR). In 2001, we began using the electronic medical record to pull information. This allowed us to pull the results from our labs, but we still used the manual entry for labs that were documented from outside the system. At this point we are still a health plan and have independent physicians as well as Thedacare. We were combining our data with theirs. A registry was built that would allows us to capture the electronic data and merge it with the manually entered data. The clinics could do manual entry but we still had the quality staff do chart audits on those entries. Still labor intensive to clean up, validate information. With the EMR came the issues of matching the patients from the health plan with what was in our system. The identity process and merging patient information became a struggle. Health plan may have a different SSN, address, DOB, etc. Claims information may have provided us with a dx that wasn�t recorded in our system for patients (seen another provider outside the EMR).

7. Differences in Care Health Plan patient focus EMR allowed us to track all TC patients Huge disparity in control levels between THP and non-THP How do we bridge this gap? Didn�t feel right to physicians/quality that we should do this for all of our patients, not just the health plan.Didn�t feel right to physicians/quality that we should do this for all of our patients, not just the health plan.

8. Quality Journey, cont. Touchpoint sold to United Healthcare Same processes New issues Additional source of information Patient Identity No longer had control over some interventions Opportunity to focus on all TC patients Many mailings from UHC were more formal, structured. We had more hoops to jump through and couldn�t just run with interventions (gift cards for the Diab all-or-none measure)Many mailings from UHC were more formal, structured. We had more hoops to jump through and couldn�t just run with interventions (gift cards for the Diab all-or-none measure)

9. ThedaCare All Patient All Payer All data from the EMR Registry only used by Quality not clinics Enter exclusions for worksheets only WCHQ doesn�t allow these exclusions Data entry for outside lab results

10. Parameter options allows them to pull controlled/uncontrolled BP�s only By Doc/Location Disease statesParameter options allows them to pull controlled/uncontrolled BP�s only By Doc/Location Disease states

11. 1997 Health Plan patients, smaller population, and at 33% 2006 We moved to APAP at this time. Health plan numbers were higher than all TC patients. Didn�t want another 10 years to improve our data. Needed to get all patients the care we provided the health plan patients.1997 Health Plan patients, smaller population, and at 33% 2006 We moved to APAP at this time. Health plan numbers were higher than all TC patients. Didn�t want another 10 years to improve our data. Needed to get all patients the care we provided the health plan patients.

12. Cancer Screenings VA data Blood Pressures Eye Exams Immunizations Health Risk Assessments (employer) Missing Data Continued with worksheets Electronically, more volume less manual Not everything can be pulled electronically How do we capture that data? Continued with worksheets Electronically, more volume less manual Not everything can be pulled electronically How do we capture that data?

13. Missing Data, cont. No Scanning Manual process Not easy to find Not electronically retrievable Manual entry into registry (Quality staff). Clinics send actual lab/form to Quality to do a manual entry/chart review of data. Manual entry into registry (Quality staff). Clinics send actual lab/form to Quality to do a manual entry/chart review of data.

14. Letters Two Purposes Use electronic data to identify patients due for services Use letter feedback for entry into registry Types of letters Reminder letters (A1c, LDL, Mammo, etc) New patient letters Just health plan data � smaller population it would come directly to Quality. Now with the full population much of the letters are generated by the clinics and handled through them. Just health plan data � smaller population it would come directly to Quality. Now with the full population much of the letters are generated by the clinics and handled through them.

15. Scanning Outside data is scanned into EMR Specific code used Health Maintenance alerts satisfied Displayed under �Scanned Documents� tab Labs can be enter/edit to capture value Includes EMPLOYER SPONSORED HRA labs, cancer screenings **also add information into the medical/surgical history Scanned in with a specific code - screenings Code will satisfy the Health maintenance modified. Enter/edit labs will display the EXTERNAL SCANNED lab and value in the labs tab, NOT burried in encounter notes Includes EMPLOYER SPONSORED HRA labs, cancer screenings **also add information into the medical/surgical history Scanned in with a specific code - screenings Code will satisfy the Health maintenance modified. Enter/edit labs will display the EXTERNAL SCANNED lab and value in the labs tab, NOT burried in encounter notes

16. CLIA Certified Labs CLIA certified lab only Some are enter/edit where the clinics can enter the value of the scanned results so it is pulled electronically (NMR, LDL, etc) Not CLIA certified Scanned but not allowed to be true lab Enter these values into the registry to capture value TC made decision to not scan non CLIA lab info � legal reasons TC made decision to not scan non CLIA lab info � legal reasons

17. VA data Issues identifying who they are Getting labs Sign releases Phone contacts Struggle with who is managing Unable to scan labs (CLIA) Enter/Edit purposes For results to be included: Clinics send Quality a copy of the lab, Quality enters into reigstry, registry data pulled into rates/worksheetsFor results to be included: Clinics send Quality a copy of the lab, Quality enters into reigstry, registry data pulled into rates/worksheets

18. Blood Pressures Outside Clinician Blood Pressure Specialist, Health Fair Abstract encounter Home BP Not used for reporting Not an abstract encounter (lost in notes)

19. Eye Exams Diabetic Eye Exam Clinics obtained actual eye exam report Manually satisfy Health Maintenance If Diabetic exam, use Override Comments with root word �retin� �retin� triggers the electronic pull of data Specific diabetic scan code When we reported to HEDIS we had to prove it was a diabetic eye exam. Free text comments are very difficult to pull electronically. We set a process that there was a common word to look for to be able to pull electronically Variation in the scan of the diabetic eye � some use specific code some are generic eye exam scans � use the override process (depends on the scanners ability?)When we reported to HEDIS we had to prove it was a diabetic eye exam. Free text comments are very difficult to pull electronically. We set a process that there was a common word to look for to be able to pull electronically Variation in the scan of the diabetic eye � some use specific code some are generic eye exam scans � use the override process (depends on the scanners ability?)

22. Immunizations Wisconsin Immunization Registry (WIR) Clinics manually pull data Enter historical immunizations Letters sent to parents Part of standard rooming process when rooming a child Any immunizations we give are sent to WIRPart of standard rooming process when rooming a child Any immunizations we give are sent to WIR

23. Health Risk Assessments Same external lab process Share data with employer groups Only employees that take the HRA, would not have data on all employees

24. Future State Continuous Daily Improvement New Delivery model Engage the whole care team Patient satisfier Wish List Epic to Epic Epic to Non-Epic We�ve learned a lot along the way. Not sure we would do anything different due to those learnings. Each day is a new day to see an opportunity.We�ve learned a lot along the way. Not sure we would do anything different due to those learnings. Each day is a new day to see an opportunity.

25. Key Issue: How do organizations develop an effective business case for business intelligence and performance management? The first question that needs to be answered is how do we get to pervasive BI? To answer the question, it is important to assess where you are along the BI continuum. Many organizations are already using BI to measure and drive decisions within their organizations. During the past two or three years, many organizations have adopted corporate performance management (CPM) and have used the integration with their BI platform to drive alignment between strategy and execution. The expanding role of analytics driving process optimization is being enabled by predictive analytics and data mining in concert with traditional BI capabilities tightly coupled with a business rules engine to make the insight actionable within the process context and needed process decision timeframes. The future state will see BI as an augmentation of business processes � human and machine activity will be affected. In this future state, human action is enhanced, modified and even provided with implied reactive and proactive steps within the business environment by BI analysis that is intimately participating in continuous evaluation of even distantly related processes. The future worker, spurred by consumer behavior, social connectivity and an arsenal of personal devices, will create a work environment of infinitely varied options. Ninety percent of companies are already lagging the thinking and skills of the future worker. During the next five years, as business intelligence becomes integrated into applications and tools, more diverse users (including partners and customers) will use the benefits of BI to lead, decide, measure, manage, innovate and optimize performance, and drive business transformation. Action item: Assess where you are along the BI continuum and lay the foundation to expand the role of BI in driving business transformation. Organizations should do a self assessment to understand the breadth and depth of how they support business intelligence functionality within their IT environment. And, consider how BI can be supported within future IT environments Key Issue: How do organizations develop an effective business case for business intelligence and performance management? The first question that needs to be answered is how do we get to pervasive BI? To answer the question, it is important to assess where you are along the BI continuum. Many organizations are already using BI to measure and drive decisions within their organizations. During the past two or three years, many organizations have adopted corporate performance management (CPM) and have used the integration with their BI platform to drive alignment between strategy and execution. The expanding role of analytics driving process optimization is being enabled by predictive analytics and data mining in concert with traditional BI capabilities tightly coupled with a business rules engine to make the insight actionable within the process context and needed process decision timeframes. The future state will see BI as an augmentation of business processes � human and machine activity will be affected. In this future state, human action is enhanced, modified and even provided with implied reactive and proactive steps within the business environment by BI analysis that is intimately participating in continuous evaluation of even distantly related processes. The future worker, spurred by consumer behavior, social connectivity and an arsenal of personal devices, will create a work environment of infinitely varied options. Ninety percent of companies are already lagging the thinking and skills of the future worker. During the next five years, as business intelligence becomes integrated into applications and tools, more diverse users (including partners and customers) will use the benefits of BI to lead, decide, measure, manage, innovate and optimize performance, and drive business transformation. Action item: Assess where you are along the BI continuum and lay the foundation to expand the role of BI in driving business transformation. Organizations should do a self assessment to understand the breadth and depth of how they support business intelligence functionality within their IT environment. And, consider how BI can be supported within future IT environments

26. BI Continuum � Link Strategy Evolution to Business Value Key Issue: How do organizations develop an effective business case for business intelligence and performance management? The first question that needs to be answered is how do we get to pervasive BI? To answer the question, it is important to assess where you are along the BI continuum. Many organizations are already using BI to measure and drive decisions within their organizations. During the past two or three years, many organizations have adopted corporate performance management (CPM) and have used the integration with their BI platform to drive alignment between strategy and execution. The expanding role of analytics driving process optimization is being enabled by predictive analytics and data mining in concert with traditional BI capabilities tightly coupled with a business rules engine to make the insight actionable within the process context and needed process decision timeframes. The future state will see BI as an augmentation of business processes � human and machine activity will be affected. In this future state, human action is enhanced, modified and even provided with implied reactive and proactive steps within the business environment by BI analysis that is intimately participating in continuous evaluation of even distantly related processes. The future worker, spurred by consumer behavior, social connectivity and an arsenal of personal devices, will create a work environment of infinitely varied options. Ninety percent of companies are already lagging the thinking and skills of the future worker. During the next five years, as business intelligence becomes integrated into applications and tools, more diverse users (including partners and customers) will use the benefits of BI to lead, decide, measure, manage, innovate and optimize performance, and drive business transformation. Action item: Assess where you are along the BI continuum and lay the foundation to expand the role of BI in driving business transformation. Organizations should do a self assessment to understand the breadth and depth of how they support business intelligence functionality within their IT environment. And, consider how BI can be supported within future IT environments Key Issue: How do organizations develop an effective business case for business intelligence and performance management? The first question that needs to be answered is how do we get to pervasive BI? To answer the question, it is important to assess where you are along the BI continuum. Many organizations are already using BI to measure and drive decisions within their organizations. During the past two or three years, many organizations have adopted corporate performance management (CPM) and have used the integration with their BI platform to drive alignment between strategy and execution. The expanding role of analytics driving process optimization is being enabled by predictive analytics and data mining in concert with traditional BI capabilities tightly coupled with a business rules engine to make the insight actionable within the process context and needed process decision timeframes. The future state will see BI as an augmentation of business processes � human and machine activity will be affected. In this future state, human action is enhanced, modified and even provided with implied reactive and proactive steps within the business environment by BI analysis that is intimately participating in continuous evaluation of even distantly related processes. The future worker, spurred by consumer behavior, social connectivity and an arsenal of personal devices, will create a work environment of infinitely varied options. Ninety percent of companies are already lagging the thinking and skills of the future worker. During the next five years, as business intelligence becomes integrated into applications and tools, more diverse users (including partners and customers) will use the benefits of BI to lead, decide, measure, manage, innovate and optimize performance, and drive business transformation. Action item: Assess where you are along the BI continuum and lay the foundation to expand the role of BI in driving business transformation. Organizations should do a self assessment to understand the breadth and depth of how they support business intelligence functionality within their IT environment. And, consider how BI can be supported within future IT environments

27. QUESTIONS

28. Contact Information Kimberly Wildes, RN kimberly.wildes@thedacare.org (920) 831-6863 Katie Roseman katie.roseman@thedacare.org (920) 831-6878