1. Approaching Innovation with
Commercial EHRs
Andrew Karson MD MPH
September 30, 2013

2. Outline
 Partners HealthCare
 Partners eCare
 Structure
 Approach to Innovation
 Advancing core work
 Creating new and original solutions

3. About Partners HealthCare
 Integrated academic health care system founded by Massachusetts
General Hospital and Brigham and Women’s Hospital in 1994
 Largest private employer in Massachusetts
 Over 60,000 employees
3
Patient Care
• Among the sickest and most
complex patients
• Providing essential services
• Caring for the most vulnerable
Discovery
• Over $1.4B in research funding
• Discovering new treatments and
cures
• Testing new care delivery models
Community
• $205M in community benefits
• 21 Community Health Centers
• Over 100,000 Medicaid and
uninsured patients annually.
Teaching
• 200+ accredited physician residency
and fellowship programs
• Harvard and Tufts Medical
Students
• Nursing and Health Professional
programs

4. Partners Tradition in IT Innovations
 Long history of IT Innovations
 BWH
 Brigham Integrated Computing System (BICS)
 MGH
 Lab of Computer Science
 Partners HealthCare
 Longitudinal Medical Record (LMR)
 MGH Order Entry
 Chemotherapy Order Entry
 EMAR
 Enterprise Services
 Many “best in class” systems

5. Existing IT Environment
 “A patchwork quilt”
 Custom developed
 Best-of-Breed
 Supports niches of
healthcare delivery
 Can work against
integration and
coordination of
care delivery
 Expensive to
maintain
5
2010 BWH MGH DFCI NWH FH
NSMC
Charter SRH SRC SRNS SCape PHC PCHI McLean NER/TBC
Inp CPOE PHS PHS PHS Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A N/A Medtch C/S
Inp MAR -nonbar N/A N/A N/A N/A N/A N/A Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A Medtch C/S
Inp eMAR -bar code PHS PHS N/A Medtch Medtch Siemens Mdtch/CF Mdtch/CF Siemens Mdtch/CF N/A N/A TBD
Inp Nsg Assessment MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane
Inp Nursing Notes MVICU MVICU N/A Medtch Medtch Siemens Medtch Medtch Siemens Medtch N/A LMR Medtch C/S Keane
Flowsheets MVICU MVICU LMR TBD TBD TBD TBD N/A N/A LMR N/A N/A
Consult (Inpt)Notes MVICU MVICU TBD TBD TBD TBD TBD TBD N/A N/A TBD Keane
Inp Progress Notes MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD Keane
Inp H&P MVICU MVICU N/A TBD TBD TBD TBD TBD N/A N/A TBD N/A
Anesthesia Record MVOR MVOR N/A TBD TBD TBD TBD TBD N/A N/A N/A N/A
Amb Chemo CPOE N/A PHS PHS TBD PHS PHS N/A N/A N/A N/A N/A N/A
Amb CPOE - MEDs LMR
LMR,
OnCall LMR LMR, GE LMR, GE LMR TBD N/A
LMR,
GE TBD N/A
Amb Nursing Notes LMR
LMR,
OnCall LMR LMR, GE LMR, GE LMR LMR Cerner
LMR,
GE TBD N/A
Amb Visit Notes LMR
LMR,
OnCall LMR LMR, GE LMR, GE LMR LMR N/A
LMR,
GE TBD N/A
OncAmb eMAR N/A PHS (pln) PHS (pln) TBD TBD TBD N/A N/A N/A N/A N/A N/A
ED CPOE PHS PHS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A
ED visit notes TBD EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A
ED tracking BWH EDIS N/A PICIS Medtch MedHost N/A N/A N/A N/A N/A N/A
ResultsViewing and
Repository
BICS,
CDR/RV CDR/RV
BICS,
CDR/RV
Medtch,
CDR/RV
Medtch,
CDR/RV,
BICS
Siemens,
CDR/RV
Medtch,
CDR/RV
Siemens
,
CDR/RV Cerner CDR/RVMedtch C/S Keane
Op Notes, D/C Sum
BICS,
CDR/RV CDR/RV N/A
Medtch,
CDR/RV
Medtch,
CDR/RV,
BICS
Siemens,
CDR N/A N/A N/A N/A N/A N/A
Pt Computing PG PG PG PG PG PG TBD TBD TBD PG TBD TBD
LMR = Longitudinal Medical Record
KEY: PG = Patient Gatew ay MV = MetaVision fromiMDsoft
RV = Results View er Mdtch/CF - at SRH: Meditech and/or CareFusion for eMAR solution
EDIS = (MGH) Emergency Dept Information System
CDR = Clinical Data Repository

6. Drivers of Change at Partners
6
Shift from volume to value-based care
Risk sharing requiring tighter coordination and
integration of care delivery
Personalized medicine
Heightened demands for healthcare reform from all
sectors of the US economy

7. Partners eCare Principles
7
One Patient, One Record, One Team, One Partners Statement

8. Clinical Systems: Initial Implementation
8
Partners eCare (Epic)
• Provider Order Entry
• EMAR
• Clinical Documentation
• Ambulatory EMR
• Radiant
• Stork
• Willow Inpatient
• Kaleidoscope
• MyChart
• Phoenix
Partners eCare
(Epic add’l development)
• Beacon
• ASAP
• OpTime/Anesthesia
• Home Health
• AMC Radiology
Non-Epic
(Partners eCare/
Other)
• Ambulatory Pharmacy
• Radiation Oncology
• Gastroenterology
•PACS (Image Archive
and Communication)
•Others
Partners eCare Non-
Epic Enterprise-wide
• Blood Bank
• Laboratory System

9. Partners eCare Structure
9

10. Partners eCare Structure
10

11. PeC Clinician Team Sub-groups
 Clinical Process Redesign
 Clinical Content
 Clinical Informatics
 Clinical and Biomedical Devices
 Clinical Deployment

12. Clinical Process Redesign
Project Prioritization Criteria
 Alignment with Partners Strategy
 Patient Safety
 Quality of Care
 Regulatory
 Value/ROI
 Usability
 Standardization / Systemness
 Facilitation of Epic build
 Measurable (metrics/KPI)
 Timed appropriately for PeC timelines
12

13. Clinical Process Redesign
Initial Process Redesign Areas Include:
Admission Discharge
Transitions in Care/Hand-offs Medication Reconciliation
Peri-operative Services Plan of Care
Preventive Care Patient Centered Medical Homes (10 Care)
High Risk (iCMP) / High Cost
Patients
Patient Engagement/MyChart

14. PeC Clinician Team Sub-groups
 Clinical Process Redesign
 Clinical Content
 Clinical Informatics
 Clinical and Biomedical Devices
 Clinical Deployment

15. Clinical Informatics
 Clinical Decision Support (CDS)
 Knowledge Management
 Terminologies

16. Partners Enterprise: Multiple Types of CDS
 Drug-Drug Interactions
 Drug-Pregnancy
 Drug-Laboratory
 Drug-Disease
 Drug-Utilization
 Duplicate Therapy
 Food-Drug Interactions
 Nephros (Renal Dosing)
 Gerios (Geriatric Dosing)
 Insulin Ordering
 Chemotherapy (includes oral
and investigational)
 Order sets
 Clinical Reminders
 Health Monitoring
 Critical Lab Results
 Relevant Lab Results
 Immunization Schedules
 Family History
 Problem list refinement
16

17. Planned approach to CDS
 Define CDS priorities based on Partners programs and
initiatives: governance
 E.g., MU, Safety, Quality, Care Redesign, ACOs, etc.
 Understand features and content available in Epic:
learning
 Compare with features and content available at Partners:
recommendations
 Define implementation strategies: gradual deployment
with long-term maintainability
17

18. PeC Clinician Team Sub-groups
 Clinical Process Redesign
 Clinical Content
 Clinical Informatics
 Clinical and Biomedical Devices
 Clinical Deployment

19. Partners eCare Leadership Team
19

20. Innovation Council Guiding Principles
Definition
• Innovation is the application of new solutions
that meet new requirements, inarticulate
needs, or existing market needs. The term
innovation can be defined as something
original and new that "breaks in to" the
market or into society. Innovation differs
from improvement in that innovation refers to
the notion of doing something different rather
than doing the same thing better.
Where Innovation Will Occur
• Sites vs. at Partners centrally
Types of Innovation
• External (including publication, patents and
potential commercialization)
• Internal (for use at PHS exclusively)
Endpoints/Goals of Innovation
• Where do the innovative ideas take PHS as an
organization as related to the Health IT and
EMR desired future state?
Dimensions to Address Regarding Innovation
Prioritization
• Managing competition between innovators
Other Process Issues to Address
• How to address conflicts of interest?
• How to support initiatives?
• How will the “bake-off” rules work?
Funding
• Internal
• Entity, PHS
• External
• Government, foundations, industry
Dissemination of Innovation
• How to communicate and foster an
environment to promote innovation?
• Support of cross-collaboration between
institutions w/in PHS and external to PHS
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21. Guiding Principles to Foster Innovation
Subgroup
21

22. Fostering Innovation Guiding
Principles Draft Overview
Objective
 Create guiding principles that would inform how to facilitate innovation across the
Partners organization and promote an innovative environment. These principles
go beyond the Partners eCare project and will influence health IT as a whole.
Innovators
 Innovators need access to others with different skill sets, and to resources that
will enable them to refine their ideas.
Prioritization of Partners Support for Innovation
 Innovations will have higher priority if they are aligned with Partners strategic
initiatives, and there will be an explicit set of criteria for prioritization.
Whether Innovation Should Be Done In or Outside Epic
 Applications should leverage Epic functionality when available and can be built
inside Epic but can also be built outside of Epic when such functionality is
inadequate or unavailable
 If something is built inside Epic, then there are intellectual property
considerations.
22

23. Fostering Innovation Guiding Principles
Draft Overview (cont’d)
How Partners Should Support Innovation
 Leverage existing site support for innovation
 If commercialization potential to engage Research, Venture, and Licensing
group.
 To enable investigators, ideas and concepts will require “sandbox” environments
to develop and test approaches.
 Funding to support innovation: institutions, private donors, government, internal
Partners, others.
Dissemination of Innovations within Partners
 Innovations that improve care in some important way should get support for
spread across Partners.
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24. Prioritization Framework
Subgroup
24

25. Prioritization Framework Draft Overview
Objective
 Create a framework that will allow for the Innovation Council to evaluate
innovative projects with a standard set of criteria and build/prioritize a
portfolio of innovations.
Development Approach
 Using the “PIRC” model as a starting point, group tailored a number of focus
areas and questions within each category to determine how closely an
innovation would align to the framework criteria.
 Once the focus areas were defined, group will develop a process utilizing a
scoring system to prioritize innovative ideas for the Innovation Council to
review and approve projects.
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26. Sample: “PIRC” Prioritization Framework
Priority ReadinessImpact
1. Value Creation
(Evidence Based,
Scalable)
2. Generalizable
3. Measurable
impact on quality,
access, and
revenue
4. Volume
1. Business
Model/Value
2. Clinical Champion
with Engaged
Team
3. Project Manager
and Technology
Lead
4. Potential Clients
Complexity
1. Data Transfer Needs
2. Workflow impact
(videoconferencing, etc..)
3. Documentation
4. Credentialing and/or
Licensing
1. Supports Mission
2. Supports Strategic
Initiatives
3. Site Sponsorship
and Resources
4. Innovation
A selected group of Steering Committee members and
subject matter experts will evaluate and approve future pilot
programs.
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27. Conclusion
 Partners is in the early stages of our engagement with a
commercial EHR
 We are attempting to innovate in multiple dimensions:
 Advancing core work
 Clinical Process Redesign
 Clinical Informatics
 Creating new and original solutions
 Currently developing frameworks
 Foster Innovation
 Prioritize Innovative ideas

28. Thank you
Andrew Karson MD MPH
akarson@partners.org
617-724-8262