iCare 2014 Detailed_pj

2014 EHR Certification

Meaningful Use 2014

Patient List

iCare (BQI) v2.3.3

Federal Leads:

Theresa Tsosie-Robledo

Kathy Ray, Clinical Lead, Navajo Area CAC

A Quick Look at the IHS

Provides a comprehensive health service delivery

system for approximately 1.9 million American Indians

and Alaska Natives.

Serves members of 562 federally recognized Tribes.

Indian Health Service staff consists of about 15,700

employees, which includes approximately 2,400

nurses, 800 physicians, 400 engineers, 500

pharmacists, 300 dentists, and 300 sanitarians.

Indian Health Service

Over 50% of programs are operated by tribes through tribally run compacted or contracted facilities

34 urban programs are contracted to provide care to AI/AN populations in metropolitan areas

Remaining care is provided through federally operated ‘direct’ programs (majority of the user population still receives care in direct programs)

Indian Health Care System

Hospitals Health

Centers

Alaska Village

Clinics

Health

Stations

IHS 31 63 N/A 30

Tribal 14 240 166 102

The IHS also supports 34 Urban Clinics across the nation.

IHS Programs are Located in Remote Reservation Areas and Urban Areas

Resource and Patient Management System

http://www.ihs.gov/RPMS

11 000101

001 0110 000

011 01110101 10

11001010 010 00 1

01 11100 0000111

10000111 10100

1100 0 0101 1

00 11110

RPMSDATABASE

Resource & Patient Management System

IHS Health Information Solution since 1984

RPMS is an integrated Public Health information system• iCare – Named 2011 “Laureate” by The Computerworld

Honors Program

• EHR – Certified in April of 2011 for both inpatient and outpatient

• Award Winning - Davies Award/ Best of Government IT award

• Composed of over 60 component applications

• Facilitates patient, provider, community and population health perspectives

• Patient and Population based clinical applications

• Patient and Population based practice management applications

• Financially-oriented administrative applications

Resource and Patient Management System (RPMS)

Note: Not all packages are represented here.

Typical RPMS Interface

Electronic Health RecordPatient Centric GUI

http://www.ihs.gov/ehr

Integrated Care Management

Population Management

Supporting Patient Care

http://www.eiseverywhere.com/ehome/CWHONORS2011/21134/

iCare’s Roll

How iCare Fits in the RPMS World

iCare

EHRPCC

RPMS

iCare Population Management

Provides an intuitive, integrated view into diverse patient data elements for populations as well as individuals

Facilitates the proactive identification and management of populations

Supports easy creation and customization of panels of patients

Nationally deployed in May 2007

Iterative, phased development

Active workgroup, change control board and Subject Matter Expert involvement

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iCare – Background Processes

Performed routinely - nightly, weekly and monthly

Allows for quick panel creation and data display

Provides Clinical Decision Support• Community Alerts

• Flags

• Reminders

• Performance Measures

• Best Practice Prompts

• Care Management Event Tracking

• Meaningful Use (Performance / Clinical Quality Measures)

• Improving Patient Care

iCare and PCMH 2011PCMH 1: Enhance Access and Continuity

• Provides method to designate PCP • Create care teams • Monitor appointment wait times and office visit times

PCMH 2: Identify and Manage Patient Populations

• Create defined panel lists• Create and distribute reminders• Use of disease/condition-specific registries • Use of diagnostic tags • Provides demographic information • Facilitates Community Health Rep outreach

PCMH 3: Plan and Manage Care • Access to RPMS data from various system components • Plan care through use of reminders• Provides risk factor assessment• Facilitation of care management • Monitor continuity of PCP and team care• Includes robust behavioral health care components • Care plan functionality under development

PCMH 4: Provide Self-Care Support and

Community Resources • Provide summary care pages and reports

• Referral to IHS online resources

• Facilitates Community Health Rep outreach

PCMH 5: Track and Coordinate Care

• Create care teams • Create defined panel lists• Create and distribute reminders• Monitor continuity of PCP and team care

PCMH 6: Measure and Improve Performance

• National Measures, GPRA, MU, IPC• Provider/team//facility-level measurements • Monitor ER and UC usage • Monitor local patient satisfaction

PCMH 4: Provide Self-Care Support and Community Resources

• Provide summary care pages and reports• Referral to IHS online resources

PCMH 5: Track and Coordinate Care • Create care teams and monitor coordination• Create defined panel lists• Create and distribute reminders

PCMH 6: Measure and Improve Performance• National Measures, GPRA, MU, IPC• Provider level and facility level measurements

iCare – Community Alerts

Splash Screen at first

login of the day

Anonymous

Related to Community

of Residence

Ready Access from

many views: Opening

View; Panel View;

Patient Record

User-defined display

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iCare – Opening View

Easy display of

user defined

patient panels.

Site level tabs

provide facility

level reporting.

Share your

panels with

other users to

help manage

the workload.

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iCare – Panel Creation

Quickly define

the patients you

are interested in.

Numerous

options to filter

your search.

iCare – Diagnostic Tags

Currently 13 Diagnostic tags

available. Users are encouraged to

help define additional tags to be

implemented in future releases.

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iCare – Panel View/Patient List

Quick look at

your patients.

Customize

the view to

suit your

needs.

Share your

panels and

custom

layouts with

others.

Clinical Decision Support –Reminder Views

Users select

Reminders

display

Aggregate

View

Clinical Decision Support –National Measure Views

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Users select

Nat’l Measure

Display

Aggregate

View

iCare – Population to Individual

National GPRA

measures.

View patient’s

measures and

determine best

practices to

ensure health

and wellness.

iCare – Patient Record / National Measures

26

Through out

iCare’s grid

views you can

filter results.

Quickly focus in

on the data you

are looking for

using the drop

down filters.

iCare – Patient Record

27

The Snapshot

and Cover

Sheet provide

a wealth of

information.

Know more,

with less

effort.

Links to

detailed visit

details.

iCare v2.1 Introduced CMET

CMET = Care Management Event Tracking

Provides ability to track certain pre-defined events• Breast

• Cervical

• Colon

• Skeletal health

Workflow includes four steps• Event (a mammogram, for example)

• Findings (Bi-Rad 3)

• Recommendations for Follow-up (repeat mammogram in six months)

• Patient Notification (documentation that the patient has been informed of the Findings and Recommendations).

• CMET generates “ticklers” or reminders to ensure that the next step is followed

• CMET work flow is available from all iCare views: Main View, Panel View, and Patient View.

Main View CMET - Events

Filters allow

users to hone in

on specific

areas of

interest.

Events:

-Breast

-Cervical

-Skeletal

-Colon

Main View CMET: Tracked Events

Keep track of

patient status.

Organized work

flow using

“CMET

Worksheet”.

Feather

“Ticklers” let you

know when

something is

“Past Due”.

Main View CMET: Follow-up Events

Know who

needs a follow

visit and when it

is due.

Easy linking

back to the

preceding

event.

HIV Management System (HMS)–Main View

HIV/AIDS

specific Care

Management

Windows are

designed for the

specific care of

HIV patients

HIV Management System –Reminders View

HIV/AIDS specific

Reminders are

presented for

easy assessment

Patients can be

copied into

focused patient

panels for

specific

management

HIV Management System –Quality of Care Report

iCare v2.2 Introduced the Meaningful Use (MU) Tab

iCare v2.3 Improved the MU Tab!

Provides an easy display of MU measures

Supports Certification and MU

Broken down into 5 sub-tabs

• Provider Performance

• Hospital/CAHs Performance

• Provider Clinical Quality

• Provider Clinical Quality Reports

• Hospital Clinical Quality

Displays measures for up to 100 providers at a time

Main View: Meaningful Use TabProvider Performance Measures

Weekly

background

jobs gather MU

Performance

data based on

the previous

year or 90 day

time frames.

Date presented

is by provider.

Main View: Meaningful Use TabHospital/CAHs Performance

Performance data

is also presented

at the hospital

level

Hover help

through out iCare

ensures little effort

is needed to

determine what

the measure

definition is.

Main View: Meaningful Use TabProvider Clinical Quality

Display of

provider Clinical

Quality

Measures.

Filters can be

set to focus in

on specific

measures

Site Level National Measures

Get an easy

view of site

level National

Measures

iCare v2.3Released April 2012

Introduction of Improving Patient Care

(IPC) view

Creation of teams/microsystems

Four IPC specific tabs available

• Patient Detail

• Provider Detail

• Provider Aggregated

• Facility Aggregated

IPC Goals

Optimization of IPC workflow

• Automation of data reporting

• Reduction in errors

Compatibility with IPC Data Portal

In line with GPRA reporting

• Supports National Goals

Additional Enhancements

Panel creation based on Labs

• Can also filter on what labs a patient does

not have

Panel creation based on Medications

IPC Site ParametersDesignation of IPC panels

IPC Site Parameters• IPC Data Collection

• IPC data aggregation will be automatically performed on the day of the month defined here during the iCare nightly job. The default value is the 1st of the month. Depending on the timeliness of data entry at your site, this can be changed up to the 7th of the month.

• Primary Care Clinics• This is the list of primary care clinics that are used for

the Continuity of Care to a Provider measure. The default list of clinics defined upon installation is: GENERAL (01), FAMILY PRACTICE (28), INTERNAL MEDICINE (13) and PEDIATRIC (20).

• Microsystem Providers• This is the list of providers who are to be defined as

your site’s microsystem. Monthly data aggregation will automatically be calculated for any provider who has been designated as a Primary Care Provider and has at least one patient assigned to them.

Site Managers: set the day of the

month to run data collection

IPC TabsPatient Detail• For a panel designated as an IPC

panel, this displays all patients with the values of their IPC measures. The values are the values calculated based on the last time the iCare nightly job or weekly National Measures job last completed.

Panel Detail• For a panel designated as an IPC

panel, this displays aggregated data for all patients in the panel for all IPC measures by provider. The values are the values calculated based on the last time the iCare nightly job or weekly National Measures job last completed.

IPC TabsProvider Aggregated

• As each month is processed, this provides a view of all providers who are Primary Care Providers for all IPC measures. These values are not refreshed once calculated. They are a snapshot for the previous month calculated the next month on the day specified in the IPC site parameter for data collection.

Facility Aggregated• This provides a view on a month-by-

month basis for all IPC measures for all providers who are Primary Care Providers. These values are not refreshed once calculated. They are a snapshot for the previous month calculated the next month on the day specified in the IPC site parameter for data collection.

Click “Export” to populate your

provider templates within a couple of

clicks!

Why the Focus on IPC?Short Answer: They Asked for Help…

iCare is already proven it’s worth in RPMS data collection. But there is still a lot more that can be done to help sites.

The IPC program already had established procedures to collect data and report out to a central resource. This process proved to be time consuming requiring a significant amount of man hours to collect.

Through the realization that most of the data already resided in RPMS, a solution was sought out that would help automate this data collection.

The IPC Workflow Before iCareAreas in bold red text were automated.

Open iCare – set up panel for the

designated PCP in the microsystem. If

more than one DPCP in the micro-

system, create IPC team (micro-

system) that combines all the DPCP

panels into one IPC panel.

Open microsystem panel in iCare – open

National Measures Aggregate tab – find

Diabetes Comprehensive, Tobacco

Users, Tobacco Counseling numerator

and denominator .

Open the DPCP/microsystem panel – open

National Measures tab and modify panel to add

measures for the Health Risk Screening Bundle ,

Cancer Screening Bundle, and Outcome

Screening Bundle

* Most sites make three separate iCare panels –

one for each bundle measure

Enter data on to the Data Portal Template from

the:

1) iCare national measures tab (DM Comp,

Tobacco Use/Counseling)

2) Excel macro (bundle measures)

3) iCare panel (total # pts in panel) 4) Cycle

time worksheet

5) Staff satisfaction

6) Patient experience

7) Self-management support (RPMS)

8) Third next available (RPMS/PIMS)

9) % Empanelled/Continuity (RPMS)

Open Excel Macro – click on

green box – upload Excel

workbook for each bundle

measure (Health Risk

Screening, Cancer

Screening , Outcome

Screening) separately (3

Excel files) - macro will run

calculations and save in

Excel file

Log into Knowledge Portal

[www.improvingindianhealth. org] - IPC

– Team Resources – Resources –

Measurement and Reporting folder and

then to Data Reporting Tab

Download from Measurement and Reporting

folder in Knowledge Portal:

1) “2011 IPC Measures Manual” – review instructions

for all measures (Word doc)

2) 2011 Macro for Bundles (Excel sheet )

3) Cycle time workbook (Excel sheet)

4) Patient experience survey (Word doc)

5) Staff satisfaction survey (Word doc)

Download from Data Reporting tab:

1) Data Portal template for site/ provider

Open National Measures tab

for each bundle (health risk

screening, cancer and

outcome) – select “edit”

then “select all” (to select

all rows/patients for the

panel) – click on Excel icon

in iCare and save to an

Excel workbook on

desktop, or My

Documents/IPC folder, etc.

Log on to the Data Portal

(through the Knowledge Portal)

– and upload the completed

Data Portal template

Complete cycle time worksheet – add

data to cycle time worksheet to get total

minutes/visits

Complete staff satisfaction surveys and

total results

Patient experience survey – report

question #7

Run next third-available report, self

management report, % empanelled and

continuity to DPCP in RPMS

The IPC Workflow with iCare Areas in bold red text were automated.

Open iCare – set up panel for the

designated PCP in the microsystem.

Enter data on to the Data Portal Template from

the:

4) Cycle time worksheet

5) Staff satisfaction

6) Patient experience

8) Third next available (RPMS/PIMS)

Log into Knowledge Portal

[www.improvingindianhealth. org] - IPC –

Team Resources – Resources –

Measurement and Reporting folder and

then to Data Reporting Tab

Download from Measurement and Reporting

folder in Knowledge Portal:

1) “2011 IPC Measures Manual” – review

instructions for all measures (Word doc)

3) Cycle time workbook (Excel sheet)

4) Patient experience survey (Word doc)

5) Staff satisfaction survey (Word doc)

Download from Data Reporting tab:

1) Data Portal template for site/ provider

Complete cycle time worksheet – add

data to cycle time worksheet to get total

minutes/visits

Complete staff satisfaction surveys and

total results

Patient experience survey – report

question #7

Run next third-available report.

Log on to the Data Portal

(through the Knowledge Portal) –

and upload the completed Data

Portal template

Provider AggregatedIPC Template Population - Export

1. Select the IPC:

Provider Aggregated

tab

2. Download your

Provider Template,

click the IPC Data

Portal button (links to

portal site)

3. Click IPC Export

4. Select the Month

and Provider(s)

5. Select your

template

Employee Health PanelSet the Employers Site Parameters• This is the list of employers that

should be used for Employee Health Care Management at your site. This is a table of all employers in your RPMS system which may have many different spellings.

Create a panel based on Employer• If you have been assigned the

proper security key, you will see this selection in the Patient filters of the Panel Definition. By checking “Employer” (Filter Patients by Employer), a panel can be created or filtered by the list of Employers defined in iCare Site Parameters.

Add the one or many “employers” that define your site.

Check this box to create an

“employee” panel

Employee Health

Employee Health Care Mgmt Group

• Displays

• Flu

• Hep A

• Hep B

• PPD

• TDAP

• ILI

• MMR

Panel Definition Enhancements

Enhanced panel

management

through creation of

Categories and

color

Designate a panel

as an IPC panel

Check to designate as

IPC Panel

Click to select or create a Category


Patients Assigned To• Patients NOT Assigned to

a DPCP• This is a tool to help identify

patients who have not yet been assigned a Primary Care Provider.

• **WARNING** - Creating a panel based on this selection could yield a large number of patients. It will include all patients unless you apply additional filters such as only ‘Living’ patients or a specific community.

Identify patients not assigned to

a DPCP


Multiple Providers• The ability to pick multiple

providers has been added. This is a feature to help in creating panels where several providers may share a group of patients.

Teams• You may also create teams of

providers and use that “team” to create a panel of patients. Only patients whose DPCP is a team member will be added to the panel.

• Teams can be created in the Scheduling Menu => Primary Care Provider Menu => Set Up Primary Care Teams menu in RPMS.

Create a panel based one or

multiple providers

Define based on Primary Care Team


PCC• Panels can now be created or

filtered by patients having a selected lab or medication during a timeframe or NOT having a selected lab or medication during a timeframe.

• User can select a specific lab test or medication or use an existing taxonomy.

• An example of the use of these new selections:

• Patients with an Asthma tag who do not have a Controller medication

• Patients with the new Pregnancy tag who have not had an HIV screening.

New Pregnancy Diagnostic Tag

Create a panel based on Pregnancy tag• The definition has a choice of two methods of calculation. The

method can be modified from the iCare Site Parameters. The default method upon installation of 2.3 is ILI Logic.

• ILI Logic• Is based on the ILI Export Pregnant flag logic.

• iCare Logic• Choice of 1 to 9 month time period

If Pregnancy Tag Status is ‘Pending’, changing the Site Parameter value may change the tag to ‘NLV’ (No Longer Valid).

If Pregnancy Tag Status is ‘Accepted’, the tag will stay around until the patient has a birth or other pregnancy ending visit then the tag status will automatically become ‘No Longer Valid’.

Changes in the Site Parameters will not change any ‘Accepted’ Pregnancy tags.

Templates

New functionality has been added so that a user can define multiple template layouts. Templates can also be created and added so that anyone can download and use the templates.

Tools=>Manage Templates• “Your Templates”

• List of all a specific user’s defined templates and what layout is contained in that template.

• “Public Templates”• List of all templates at the site

available to be downloaded to the list of “Your Templates”.

Additional Site Parameters

Inactivity Timeout

• iCare has implemented inactivity timeout functionality. This site parameter determines how long before the application will timeout and shutdown due to user inactivity.

iCare Functionality

iCare is a reporting and case management

tool for clinical decision support

Panel definitions allow users to create custom

patient lists based on users needs

Definitions are applied to all patients in RPMS

Lists are utilized to:

• Manage care for groups of patients

• Report on site measures

• Report on provider measures

iCare Feature Highlights

iCarePatient

List

IPC

CMET

Women’s

Health

Care Mgmt

HIV Mgmt

iCare’s Role in MU2014Patient List

MU Objective

Generate lists of patients by specific conditions to

use for quality improvement, reduction of

disparities, research, or outreach.

2014 Edition EHR Certification Criteria

§ 170.314(a)(14) (Patient list creation)

Core Measures

Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Measure: Generate at least one report listing patients of the EH or CAH with a specific condition.

No exclusion.

Eligible Hospital (EH) and Critical

Access Hospital

(CAH)

Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.

Measure: Generate at least one report listing patients of the EP with a specific condition.

No exclusion.

Eligible Professional

(EP)

Patient List

Core Measures (Continued)

Objective: Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference.

Measure: More than 10 percent of all unique patients who have had 2 or more office visits with the EP within the 24 months before the beginning of the EHR reporting period were sent a reminder, per patient preference when available.

Exclusion: Any EP who has had no office visits in the 24 months before the EHR reporting period.

Eligible Professional

(EP)

Preventive Care

Certification Criteria

§ 170.314(a)(14) Enables a user to electronically

and dynamically select, sort, access, and create

patient lists by date and time based on each one

and at least one combination of the following data:

i. Problems

ii. Medications

iii. Medication allergies

iv. Demographics

v. Laboratory tests and values/results

vi. Ambulatory setting only - patient

communication preferences

Subject Matter Experts Engaged

Kathy Ray (Navajo

Area CAC)

Catherine Moore -

Lab

(Fed Lead)

Clinical End Users

Care/Case Managers

User Interface Workflow

General Statement About Defining Panels

When defining panels you are effectively

narrowing down the list of patients you will

be presented with

Each additional filter applied to your

definition will further narrow your results

reducing the number of patients in the list1 Filter

Patient

Patient

Patient

2 Filters

Patient

Patient

3 Filters

Patient

Screen Mockups

i. Problems

ii. Medications

iii. Medication allergies

iv. Demographics

v. Laboratory tests and values/results

vi. Ambulatory setting only – patient

communication preferences

Patient Notification Reminders

i. Problem – Panel Definition

ii. Medications - Panel Definition(Existing Feature)

iii. Medication Allergies – Panel Definition(Existing Feature)

iv. Demographics - Panel DefinitionPreferred Language

iv. Demographics - Panel DefinitionEthnicity and Race

iv. Demographics - Panel DefinitionCause of Death

(v) Labs - Panel DefinitionResults / Values

(vi) Preferred Communication Method -Panel Definition

Reminders

Viewing Patient Lists

Definition Details Tab

iCare uses an addition tab/view to display more complex patient data conceived due to the potential large amount of data that may be presented to a user based on how a pane is defined

• Labs

• Medications

• Problems

Certification Tester’s First Unanticipated Question

Tester wanted to be presented with a list

which displayed all data elements

simultaneously.

• IHS provided an accepted rebuttal based on

test documentation referring to a

“combination of 2 or more data elements”

• iCare is able to display lists containing

multiple data elements than can be sorted

by clicking on the column headers

Example of Combination List

Certification Tester’s Second Unanticipated Question

Tester wanted to be able to export

patient list

• iCare is able to export patient lists and data

elements as present on screen out to Excel

Reminders WorkflowPreventative Care

Reminders - Batch Processing

For more information, please visit our web site. Training classes are conducted regularly as well as posted recordings of classes and demonstrations.

http://www.ihs.gov/icare/

Thank you for your interest in iCare

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