1	Secondary Uses of Clinical Data at Partners Healthcare David W. Bates, MD, MSc Medical Director of Clinical and Quality Analysis, Partners Healthcare Chief, Division of General Medicine, Brigham and Women’s Hospital
2	Overview Description of Partners High-performance Health System Clinical audit Pay-for-performance Research
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4	Secondary Data at Partners Quality Data Warehouse Led by Jon Einbinder Research Patient Data Repository Led by Shawn Murphy Pay-for-performance done mostly through claims so far
5	LMR Quality Data Warehouse
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7	Identifying Smoking Status May be recorded on the Problem List Current Smoker Past Smoker Date entered May be recorded in the Health Maintenance section under “Smoking Status” Coded Response (sometimes) Free text comment Date entered
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9	Diabetes Report
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11	Quality Dashboard
12	Will Doctors Look at Reports?
13	A Research Database Containing Clinical Data
14	Research Patient Data Repository
15	Pay-for-Performance About 1-2% of funds at risk depending on contract Some pay-for-use, more pay-for process measures Moving towards pay-for-outcome Lots of focus on diabetes at onset Has been extremely effectively at getting leadership attention Is key strategic goal of Partners leadership
16	Why Are the Signature Initiatives So Important?
17	Signature Initiative #1 Investing in Quality and Utilization Infrastructure Why: Information systems have been inadequately applied to health care What: Build on our leadership position by accelerating deployment of: The electronic medical record (EMR) Computerized provider order entry systems (CPOE) Clinical decision aids Goal: Deploy a more fully developed EMR and CPOE across the system reaching a physician penetration of 55% for EMR and 75% for CPOE after one year - and 80% and 100% in 3 years
18	Issues that Have Arisen Clinical audit Identifying the right denominator Who is the PCP Fixing errors Making reports available to providers Getting them to use them Trust, truth Allowing drill-down
19	Issues that Have Arisen Research How much de-identification How secure to make access What to actually include in research database Pay-for-performance Moving to EHR extraction and getting payers to trust that Finding measures that can be extracted from EHRs
20	Broader Issue Getting IRB approval for studies done in the community Extraction methodologies Push, pull
21	Lessons Learned Providers need and want LOTS of reports Must be able to generate line lists to get clinical buy-in Denominators are tricky but very much needed Research repository is a huge win for organization Balance between security and confidentiality will remain tricky
22	Conclusions Many of the benefits from conversion to the EHR will actually result from secondary uses of data Lots of work around standardization needed Logistics still complex Pay-for-performance represents vital lever Many societal issues around what is permissible/what isn’t still need case law