Kirk Kirksey, Vice President for Information Resources
UT Southwestern Medical Center, Dallas
kirk.kirksey@utsouthwestern.edu
“Computer analysis lets us
see the effects of many
variables and their
interactions. This is a
picture that we could not
have achieved before. It is
superior to the experiencebased knowledge of an
operator . You might say
truth replaces knowledge.”
Six Sigma Quality Roadmap
Data Based
Analytics
The Dawn of the Electronic
Medical Record
Data integration from multiple
systems
Singular view of treatment proccess
Interface (e.g. HL7, SOA, CCOW,
etc) intensive
Patient centric
Treatment and process focused
Lousy platform for analytics
d
d
d
d
d
d
d
d
d
d
d
d
d
Level 1
Function Clusters
Level 2
Communications
Level 3
Integration
Level 4
Linked Repositories
Administrative
Interface Engine
Master Patient Index
Medical Entities Dictionary
Standards (HL7, SOA), DICOM)
Clinical
Analytics
Financial
Today
ANCILLARY GLUCOSE
ANCILLARY GLUCOSE
ANCILLARY, GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE
GLUCOSE ISTAT ICUSL
GLUCOSE ISTAT SSL
GLUCOSE, PLASMA
GLUCOSE, SERUM
GLUCOSE,PLASMA
GLUCOSE,PLASMA
GLUCOSE 1 HOUR
GLUCOSE, 1 HOUR
GLUCOSE, 1 HOUR
GLUCOSE, 1-HR 50 MG
GLUCOSE,1HOUR
GLUCOSE 1 HOUR
U GLUCOSE QUAL 1 H FOR GTT
GLUCOSE, URINE 24HR
GLUCOSE 2 HOURS
GLUCOSE, 2 HOUR
GLUCOSE, 2 HOUR
GLUCOSE,2HOUR
GLUCOSE 2 HOURS
GLUCOSE 2 HOUR POST PRANDIAL
U GLUCOSE QUAL 2 H FOR GTT
GLUCOSE 1/2 HOUR
GLUCOSE, 0.5 HOUR
U GLUCOSE QUAL .5 H FOR GTT
GLUCOSE 3 HOURS
GLUCOSE 3 HOURS
GLUCOSE, 3 HOUR
GLUCOSE,3HOUR
GLUCOSE, 3 HOUR
U GLUCOSE QUAL 3 H FOR GTT
GLUCOSE 4 HOURS
GLUCOSE, 4 HOUR
U GLUCOSE QUAL 4 H FOR GTT
GLUCOSE, 5 HOUR
BEDSIDE GLUCOSE
BEDSIDE GLUCOSE
GLUCOSE BY METER
GLUCOSE WHOLE BLOOD
GLUCOSE, WHOLE BLOOD
GLUC-WHOLE BLOOD
WB GLUCOSE
WB GLUCOSE
WV GLUCOSE
CEREBROSPINAL FLUID GLUCOSE
CEREBROSPINAL FLUID GLUCOSE
GLUCOSE (CSF)
GLUCOSE (CSF)
GLUCOSE, CSF
FASTING GLUCOSE
GLUCOSE FASTING FOR GTT
GLUCOSE, FASTING
GLUCOSE, FASTING
GLUCOSE,FASTING
U GLUCOSE QUAL FASTING FOR GTT
GLUCOSE, BODY FLUID
GLUCOSE, BODY FLUID
GLUCOSE, FLUID
GLUCOSE, FLUID
GLUCOSE,FLUID
GLUCOSE,FLUID
GESTATIONAL GLUCOSE
DIABETES SCREEN
GLUCOSE, GESTATIONAL SCREEN
GLUCOSE, GESTATIONAL SCREEN
GLUCOSE,P INTERPRETATION
MEAN BLOOD GLUCOSE
MEAN BLOOD GLUCOSE
GLUCOSE PP (50 GRAM)
GLUCOSE PP(50 GRAM)
GLUCOSE TOLERANCE 1
GLUCOSE TOLERANCE 2
GLUCOSE TOLERANCE 3
GLUCOSE TOLERANCE 4
GLUCOSE TOLERANCE 5
GLUCOSE TOLERANCE 6
ANC .URINE GLUCOSE
ANC. URINE GLUCOSE
GLUCOSE, RANDOM URINE
GLUCOSE, URINE
GLUCOSE, URINE RANDOM
96 different glucose procedur
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Analytics organization of the data
Workflow based on analytics
Data normalization and rationalization
(vocabularies and data dictionaries)
Transformation
Meta data
Organization and processes dedicated to
analytics
Dedicated integration function
New skills
Level 1
Function Clusters
Level 2
Communications
Level 3
Integration
Level 4
Linked Repositories
3
Meta Data
(instruments,
reagents)
Administrative
4
1
Data
Normalization
and Business Rules
(What is gender?)
Clinical
Workflow
Requirements
(race/ethnicity,
problem lists)
5
Organization and
Analysis
Analytics
Financial
2
Data
Dictionaries
(What’s a clinic?)
The Analytics
Organization
Data Integrity
Data Definitions
Meaningful Analytics
Feedback and Monitor
Emerging high speed network
standards
LTE (Long Term Evolution) over
Winmax as
a global standard
An Internet of devices
Latency reduced by 75%
Verizon and AT&T to build LTE
networks
Use the Meaningful Use Quality Reporting
measures as a starting point for quality
reporting and monitoring across UT System
health institutions.
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Health institution presidents approved 10
quality measures prior to MU finalization
Money
Leverage Meaningful Use Definitions
EMR position at UT System health institutions
To qualify for Medicare incentive payments, Medicare Eligible Professional (EP)
successfully demonstrate meaningful use for each year of participation in the
program.
Payment
First Year Medicare EP Qualifies as Meaningful User
2011
2012
2013
2014
2011
$18,000
2012
$12,000
$18,000
2013
$8,000
$12,000
$15,000
2014
$4,000
$8,000
$12,000
$12,000
2015
$2,000
$4,000
$8,000
$8,000
2016
$0
$2,000
$4,000
$4,000
Total
$44,000
$44,000
$39,000
$24,000
2015+
$0
To qualify for Medicaid incentive payments, Medicaid EPs must implement or
demonstrate meaningful use of certified EHR in the first year of participation and
demonstrate meaningful use in years 2-6.
Payment
First Year Medicaid EP Qualifies to Receive Payment
2011
2012
2013
2014
2015
2016
2011
$21,250
2012
$8,500
$21,250
2013
$8,500
$8,500
$21,250
2014
$8,500
$8,500
$8,500
$21,250
2015
$8,500
$8,500
$8,500
$8,500
$21,250
2016
$8,500
$8,500
$8,500
$8,500
$8,500
$21,250
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
$8,500
2017
2018
2019
2020
2021
$8,500
$63,750
$63,750
$63,750
$63,750
$63,750
$63,750
Population criteria
Initial Patient Population =
AND: Inpatient encounter
Denominator =
AND: Principal Diagnosis of Ischemic stroke
AND
AND
AND
AND
AND
AND
AND
OR: LDL-c >=100 mg/dL
OR: LDL-c NOT Measured Within the First 48
Hours of Hospital Arrival
OR: LDL-c NOT Measured Within 30 Days Prior to
Hospital Arrival
OR: Pre-Arrival Lipid-Lowering Agent
NOT:
NOT:
NOT:
NOT:
NOT:
NOT:
Age < 18 at time of Admission
Length of stay > 120 days
Comfort Measures Only
Clinical Trial (Problem List)
Clinical Trial (Discharge Dx)
AND: Elective Carotid Intervention
AND: Elective Surgery Procedure
Stroke 6 - Ischemic stroke patients prescribed
statin medication at hospital discharge
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Population criteria
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Denominator = (continued)
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AND NOT:
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AND NOT:
AND NOT:
AND NOT:
AND NOT:
diagnosis)
AND NOT:
reason)
AND NOT:
reason)
DischargeTransfers
Patient condition deceased
Patients with a Reason For Not Prescribing Statin Medication at Discharge (problem list)
Patients with a Reason For Not Prescribing Statin Medication at Discharge (discharge
Patients with a Reason For Not Prescribing Statin Medication at Discharge (With patient
Patients with a Reason For Not Prescribing Statin Medication at Discharge (With medical
Numerator =
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17
AND: Elective Carotid Intervention
AND: Elective Admission Encounter
AND: Statin Medication Prescribed at Discharge
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Four EHRs in use at UT health institutions.
◦ Epic – UTMB, UTHSCSA, UT Southwestern
◦ MediTech – UTHSC Tyler
◦ AllScripts – UTHSC Houston
◦ In house developed – MD Anderson
Use remaining HIT Fellowship dollars ($1M) to assist components
achieve meaningful use
Insure data definitions are consistent allowing collective
reporting and comparisons
Hospital registration for MU January 2011
Physician practice reporting period begins October 1, 2011
$30-40M across UT System????
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Quickly form MU/Quality Measures Task Force
Appoint full time project manager
Prepare Statement of Work for MU Gap Analysis. Must be parallel
analysis
Determine other quality measures to be included
Deliverables:
◦ Gap by institution (what is being collected correctly what is not)
◦ Identify templates/techniques in use now that could be leveraged
◦ Estimate remediation costs (workflow changes likely to be most
expensive) for 2011 and 2012
◦ Design common reporting process and technical platform for UT
System