University of Pennsylvania Health System

1. University of Pennsylvania Health System • Three urban hospitals • Medical school & residency training • Sub-specialty practices • Primary care network • Urban & suburban offices • Disease management • Extensive rules-based algorithms

2. Electronic Medical Record • Penn wanted a platform to integrate the health system with sufficient data capability to support disease management • Free textvsdiscrete data • Discrete data is searchable and can trigger real-time provider alerts • Epic is preferred product for large integrated health systems distributed across extensive geographic regions

3. Early Implementation • Minimize impact on productivity • EMR sought to emulate paperwork flow • Gradual introduction

4. UPHS retreated from Disease Management • Early 2000s new Epic roll outs were halted • Continued to provide support for the practices already on Epic • We had six years “on our own” to refine our use of the product • Observe physicians before and after • Habits don’t change!

5. Scanning • Paper first • Provider sees results on paper and report is scanned after clinical action has taken place. • Scan first • Result is scanned on same day • Provider sees results electronically • Built-in quality control

6. UPHS Recommitted to EMR • 2006 new roll outs resumed • Slow at first “Don’t damage productivity” • Later conclusion: Faster is better • “Steeper learning curve gets to ROI sooner” • Instead of trying to emulate every paperwork flow, teach an electronic process that already works elsewhere • Allow practices to modify after they are up and running

7. Abstraction • Problem list • Medication list • Immunizations • Cancer screening • GIGO: legibility & completeness of paper record requires attention before Go Live

8. Health Maintenance - Basic • Colonoscopy • Mammography • Pap smear • PSA • Lipid screening • Immunizations

9. Health Maintenance - Advanced • Disease specific monitoring • Diabetes • Criteria are added automatically based on Dx • Patient lists • Population management • Allows one to track a group of patients based on clinical parameters

10. Meaningful Use • E-prescribing • Electronic lab • Clinical summaries • Quality measures

11. E-prescribing • Electronic transmission • Formulary compliance – real time • Rx hub

12. Electronic Lab • Place order from within EMR • Receive results back in EMR • Trend and graph results • Discrete data triggers health maintenance

14. Quality Metrics • Completed documentation • Review of test results • Structured documentation of patient medications • Med reconciliation • Problem list • Vital signs • Medicare screening questions • Allergies • Clinical history documented in standard location • Health maintenance

15. Lessons Learned • Paper chart prep before go live enables higher quality abstraction • Rapid implementation puts pain up front but leads to faster turn around • Discrete data is what powers EMR • Lean charting is the goal • Best practice documentation metrics may encourage meaningful use