Adult Immunization Best Practices Learning Collaborative Case Study

UMass Memorial Medical Group

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Organizational Profile UMass Memorial Health Care (UMMHC), a non-profit 501(c)(3), is one of the largest and most respected healthcare systems in New England. As clinical partner to the UMass Medical School, UMMHC has access to the latest technology, research, and clinical trials.

The massive UMMHC system encompasses:

• Fourmemberhospitalsonsevencampuses,includingthenationally recognized UMass Memorial Medical Center

• Sixaffiliatedhospitals

• TheChildren’sMedicalCenter,theonlychildren’shospitalinCentralMassachusetts

• Fiveurgentcarecenters

• 1,700physiciansonitsactivemedicalstaff,includingmorethan 500 primary care providers (PCPs)

• 3,000registerednurses

• 12,000totalemployees

• 1,125bedsinitshospitals

• Threerehabilitationfacilities

• 25nursinghomes

UMMHC’snetworkofemployedphysicians—bothPCPsandspecialists—arepartofamanagedcarenetwork(MCN)thatincludesphysiciansintheUMassMemorialMedicalGroupandcommunity-basedphysicians(employedandindependent)in22communitiesinCentralandWesternMassachusetts.

UMassMemorialMedicalGrouphas2,200employees,including1,100specialistsandPCPswhoserveasbothpracticingphysiciansandmembersoftheUMassMedicalSchoolfaculty.Ofthe500PCPsintheUMMHCnetwork,180areemployedasfull-timePCPsatUMassMemorialMedicalGroup(hereinafterUMass).Themedicalgroupalsoemploys25 advanced practice providers (APPs).

UMass serves one million patients in Central New England and handlesthreemillionvisitseachyear.Groupmembersworkin80community-andfacility-basedinterventionsites,includingthethreeWorcestercampusesofUMassMemorialMedicalCenter.

UMasswasformedin1998andtodayisthelargesthealthcaredeliverysysteminCentralandWesternMassachusetts,withover$450millioninrevenueannually.

Executive SummaryLikemanyprovidersintoday’shealthcarelandscape,UMasswantedtomaximizethenumberofadultsreceivingannualimmunizationsforcommonpreventablemaladies.Adultimmunizationsareproventopreventlife-threateningdiseaseand costly hospitalizations.

UMassjoinedtheAMGAAdultImmunization(AI)BestPracticeLearningCollaborative(AICollaborative)asawaytolearnandsharebestpracticestodriveimmunizationrates.Increasingtherateofadultimmunizationscouldimprovequalitywhileloweringcosts.Becauseofcontractswithseveralpayers,UMassneededawaytotrackqualitymeasurestoseeanyupsideundervalue-basedreimbursement.TheworkoftheAICollaborativewasalignedwiththeworkthatUMasswasalreadydoing.ThepopulationhealthdivisionasawholeatUMMHCwasworkingonsomethingsimilar—includingHEDISmetrics—andhadjustinitiatedACO/GPROmetricsforimmunization,sotheAICollaborativewasagoodfit.

AsoneofsevencareprovidergroupsfromaroundthecountryparticipatingintheAICollaborative,theUMassAICollaborativetargetedpneumococcalandinfluenzaimmunizations,withanemphasisonhigh-riskpopulations,asdefinedbytheCentersfor Disease Control and Prevention (CDC).

LeadershipfortheUMassAICollaborativestudycamefromanexistingPopulationHealth/ClinicalIntegration(PH/CI)groupatUMMHCresponsibleforallsystem-levelpopulationhealthinitiatives,includingthoserelatedtocommercialriskcontracts,aMedicareACO,andMedicaidpaymentreformprograms.

ThePH/CIgroup,ledbySeniorMedicalDirectorDr.ThomasScornavacca,consistedofnon-physiciancolleagueswhoprovideddata,analytics,andperformancereportingsupport;practiceandqualityimprovementfacilitation;patientoutreach;clinicaldocumentationsupport;caremanagement;andintegrated information technology enhancement.

AtUMass,thisPH/CIgroupistaskedwiththedevelopmentofqualityimprovementclinicalpathways.Dr.Scornavaccaandhisgroupalsooverseeapodstructurewhichencompasses

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employed and independent physicians in the UMass Memorial managedcarenetworkandphysiciansintheUMassMemorialACO.

TheleadershipteamoftheUMassAICollaborativestudy(AITeam)includedthefollowingstaffpulledfromDr.Scornavacca’sPH/CIgroup:

• Thomas Scornavacca, D.O., Senior Medical Director, UMassMemorialPopulationHealth,OfficeofClinicalIntegration

• Francis Wanjau,Manager,PracticeImprovement,whooverseesallpracticeimprovementfacilitatorworkasaresourcetothepractices

• Pat Ramos,Supervisor,Outreach&Coding,whooverseesateamofoutreachcoordinatorsin-housetocallpatientsonbehalfofpracticesfortargetmeasuregaps

• Tracey Wilkie,Director,PopulationHealthReporting&Analytics, who oversees all performance reporting and analyticstodrivestrategyandquantifysuccess

Asafirststep,theUMassAITeamreviewedcurrentpracticesatUMassregardingadultimmunizationandidentifiedopportunitiesforimprovementinprocessflow.Theydevelopedanactionplantoimprovedeliveryofimmunizationsacrossallpopulations,withspecialattentiontohigh-riskpatients.

AttheendoftheAICollaborativeinterventionperiod,UMasshadimprovedbothpneumococcalandinfluenzaimmunizationrates in all categories.

Program Goals and Measures of Success Collaborative GoalsBeforeestablishinggoals,baselinedataforeachgroupwasreviewedbyOptumAnalyticsandimmunizationrateswerecalculated.Afterreviewingnationalgoalsandavailablenationaldata,andwithinputfromtheCollaborativeadvisors,goalsweresetfortheAICollaborative.

TheminimumgoalwasbasedontheCDCNationalHealthInterviewSurvey(NHIS)estimatesofnationalimmunizationratesfor2012-2014timeperiods(themostrecentavailableatthetime).PneumococcalimmunizationratesintheNHISwere59.9%foradultsaged≥65years.Foradultsaged19-64who

weredeterminedtobeathighriskfordevelopinginvasivepneumococcaldisease,NHISrateswere20.0%.1Forinfluenza,NHISimmunizationratesforadultsaged≥19yearswerereportedtobe43.2%.2

HealthyPeople2020goalsfromthefederalOfficeofDiseasePrevention and Health Promotion (HP2020)3 were selected as challenge goals or goals on the high end. HP2020 goals are:Adultsaged≥65yearsPneumococcal90%,High-RiskPneumococcal60%,andInfluenza70%.

A“stretch”goalwasestablishedbetweeneachgroup’sbaselineandHP2020.Thestretchgoalwassetat50%ofthegapbetweenbaselineandHP2020.Whereonestretchgoalisreportedforallgroups,itisbasedonthemedian.

UMass GoalsInternalgoalswerecenteredonthefollowingpriorities:

• ImprovingratesofadultimmunizationsacrossUMasspatientpopulationbytheendofCY2015

• Learninghowtoadaptandtargetreportingtoimprovespecificmeasures

• DeterminingwhichopportunitiestheUMasssystemhasinplacetoinfluenceperformanceatpracticesites,specifically with regard to:

o Patientoutreach

o Patienteducation

o Providereducation

UMassreviewedcurrentprocessesandanalyzedexternalresourcestoidentifyopportunitiesforimprovementtoitsinternalsystemsalreadyinplace.UMassestablishedadditionalgoalsforitsAICollaborativestudy:

• EducatingtheprovidersandstaffontheCDCandACIPrecommendationsforadultpneumococcalandinfluenzaimmunizations,withparticularemphasisonhigh-riskpopulations

• Inselectpractices,providingadditionalresourcesforpatientoutreachandeducationusingPH/CIoutreachcoordinators

• BuildingintrainingonhowstaffcouldinputandcollectdataonimmunizationsreceivedoutsideUMass.

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OneofthegoalsabovewasthatprovidersandstaffwouldreceiveeducationregardingtheadultimmunizationrecommendationsfromtheCDCandACIP,includingthedefinitionofhigh-riskpatients.AlthoughtherewasconsiderablevariabilityamongUMassproviderswithregardtothedefinitionofhigh-riskpatients,variabilitywasallowedinupto20%ofthepatientsthuscategorized,aslongasthemajority(or80%)receivedthevaccineasindicated.

Data Documentation and StandardizationAttheinitiationoftheAICollaborative,OptumOneanalyzedthepotentialimmunizationEMRdocumentationsourcesforthegroupsinthiscollaborativeanddeterminedthatimmunizationswerecapturedin:

• RxTables

• RxPatientReports

• ImmunizationTables

• HealthMaintenanceTables

• CPT/Gcodes

• ICD-9codes

Significantvariationindocumentationpatternscanbeseenacrossgroups,resultingfromvariationsinEMRproviderandconfiguration,immunizationdocumentationprotocols,andadherencetodocumentationprotocols.ForthegroupsintheAICollaborative,pneumococcalandinfluenzavaccinationsweremostcommonlydocumentedinImmunizationTables,HealthMaintenanceTables,andCPT/Gcodes.TheleastcommonlyusedsourcesfordocumentationamongthegroupswereRxTablesandRxPatientReports.

FortheAICollaborativegroupsthatdemonstrateddocumentationbetweenmultiplesources,suchasUMass,theOptumteamprovidedthisdatasothatgroupscoulddetermineastandardizeddocumentationbestpracticeinternally.

UMasslikewiseusedOptumOnetomeasurepotentialareasofimmunizationdocumentationsources.OptumOnegenerateddatatoshowwhichdocumentationsourcesweremostcommonlyusedandthoseleastutilized.Informationwas delivered to UMass to help determine and implement standardizeddocumentationpractices.

TheUMassAICollaborativeteamleveragedtheOptumOnedatatochoosepoint-of-caremetricsthathadthebroadestpopulationsandcouldremainagnosticofpayer/project:

• Developedandimplementedapopulationhealthflowsheet for all metrics

• WorkedwithUMassITtoensureitemswerediscretedatapoints

• EnsuredmappingwithLOINC/MEDCINcodesproperlypickedupbytheclinicaldecisionsupporttool

• CreatededucationalmaterialsaspartofapopulationhealthtoolboxusedbyUMassasvalue-addtoprimarycare practices

Population IdentificationTheUMassAICollaborativestudyinvolved135primarycarelocationsand350full-andpart-timePCPsinCentralandWesternMassachusetts.(Since the Collaborative, the number of PCPs in the MCN has grown to include more than 500 employed and independent PCPs.)

Alleligiblepatientsreceivedthesamepoint-of-careremindersforneededimmunizations.TheinterventionswerenotlimitedtotargetedAICollaborativegroups.Reportedresults,however,arespecifictothetargetgroupsforpurposesoftheAICollaborative.

Thispopulationencompassedalltheprimarycareserviceswithintheentirenetwork,includingprivatePCPswithindependent practices, PCPs in health centers, and PCPs employedbyUMMHC,aswellascommunitypractices.

InterventionThefirstUMassinterventionthatimpactedtheworkoftheAICollaborativebeganin2012,theyearUMassasanentitydecideditwastimetoworkonhealthcarereform,improvequality,andthinkaboutissuesfromapopulationhealthperspective.

Beforethat,UMasswasspecialtyfocused,concentratingonhigh-tech specialized care.

WhatUMassneededwasacrediblemeanstohelpitsprimarycarebaseunderstandthepremisebehindhowpopulationhealthworksandyetmaintainsapatient-centricflavor.

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Considering the size of their healthcare system and the inertia involved,thereweredifficultiesinherentinchangingdirection.ItwasliketurningtheTitanic.

Overtimetheybuiltateamfocusedonpopulationhealth,withdeliverablestoPCPstohelpthemunderstandthenewwayoflookingatpopulationhealthandqualitymetrics,aswellasawaytovisualizeperformancereportingthatwasactionable.Thequestionswere:WhatcouldUMassprovidetothedoctorsthattheywoulduse,notdismantle,andtakeactiontoimprovepatientcare?Whatwouldbeacredible,quality-driveninitiativethatwouldhelpthemcareforpatients?Physicianengagementisthemostimportantpieceinanypopulationhealthinitiative.

UMassbuiltreportingplatformsandaphysicianengagementnetworkandinfrastructure,sotheywouldnothavetostartfromscratchforeveryideaorproject.IthadtobedesignedwiththeideathatPCPswouldbetheendusers.Thepopulationhealthguruscouldstrategize,datacrunch,anduseanalyticandlogic,buttotheenduser—thePCP—ithadtobepatient-centricandpresentdataasclean,actionable,up-to-date,andasclosetorealtimeaspossible.

UMassparticipationintheAICollaborativewasanaturalprogressionofthisworkthatwasunderway.

SeveralinterventionsweredesignedtoimproveratesofadultimmunizationsacrossUMass’patientpopulationbytheendofCY2015.TheteamsoughttodetermineopportunitieswiththeinfrastructureUMasshadbeenbuildingtoinfluenceperformance at practice sites, specifically with regard to patientoutreach,patienteducation,andprovidereducation.

Highlightsincluded:

• AsanACO(effectiveJanuary2015),UMasswasusingtheNQFmeasurestandardassociatedwiththatprogramforentireadultpopulation.

• DataonimmunizationswascollectedduringprimarycareofficevisitsandenteredintotheEHR,claims,stateregistries, etc.

• Adultimmunizationinterventionswereincorporatedintotheexistingpopulationhealthmanagementandqualityimprovementinfrastructure,including:

o PatientCareRegistriesidentifyingevidence-basedgaps in care for the entire primary care panel (patient- and practice-centered)

o Outreachcoordinatorstoschedulepatientsforserviceswhenpracticeresourcesareinsufficient

o PracticeImprovementFacilitators(PIFs)whoworkwithphysiciansandpracticestaffonworkflowredesignandeducation

o Transparentperformancereportingandcustomizedpopulationhealthanalytics,integratingclaimsandclinical data

o Physicianleadershipstructureincludingmedicaldirector and primary care “pods,” each with a physician leader

TheinterventionsfortheAICollaborativeinvolvedaddingtoorimprovingcommunicationswithintheexistingPopulationHealth/ClinicalIntegrationinfrastructurethatUMasshadbeendevelopingforthreeyearspriortotheAICollaborative.

CommunicationwiththepopulationofPCPsinvolvedpoint-of-careremindersbuiltforthephysiciansandembeddedintheelectronichealthrecord(EHR).Thephysiciansandstaffhadpreviouslyreceivedtrainingonhowtousethedashboard,todeterminewhichgapsshouldbemetduringpatientvisits.However,informationonimmunizationshadnotpreviouslybeenincludedonthedashboard.

Specificallyforfluandpneumoniavaccines,aspartoftheAICollaborativeinterventions,thegapswereprovidedonthedashboardforallagesandpopulations,notjustforadultsandhigh-riskpatients.Reporting,however,forpurposesoftheAICollaborativewasfocusedonthetargetedgroupsandageranges.

ThePH/CIteamtrainedstafftoentervaccinesintotheEHRsystem—includinginformationreceivedfromotherphysicianoffices,hospitals,orpharmacies—toconverttheinformationintodiscretedataintheflowsheet.

ThePH/CIteamalsousedgapreportsonamonthlybasis–todooutreachtolistsofpatientswhohadnotbeenseenatall—andthosegapreportsincludedallpreventivecaretheyshouldreceive,ataminimum,includingimmunizations.

Also,UMassdeployedwhattheyconsidertheir“bootsontheground”inthepractices:PracticeImprovementFacilitators(PIFs).PIFswereutilizedtoteachprovidershowtodeliverthemessagesandtoprovidetrainingandtools,includingthedownloadingandregularuseoftools(e.g.,CQS,aclinicaldecision tool).

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FortheAICollaborative,thePH/CIoutreachcoordinators,inselectpractices,scheduledappointmentsviaphone.Theoutreachcoordinatorsatthepracticelevelareoftenusedasaresourceforpatientoutreach,andtheywereusedselectivelyintheAICollaborativestudytodrivetargetedimmunizations.

AspartoftheAICollaborative,therewereinitiativesdevelopedbyhealthcenterswherethestaffvoluntarilyorganized“wellnessclinics”(e.g.,aSaturdaywherepeoplecouldwalkinunannouncedandgetimmunizations,aswellasbloodpressurechecks,mammograms,etc.).

UMMHC hospitals already had initiatives in place and were offeringfluandpneumoniavaccinestoallpatientsadmitted.

Outcomes and Results • Leveragedcurrentphysicianengagementinfrastructureforeducationandreporting

• Alignedallpopulationhealthworktobeagnosticofpayersand programs

• Implementedclinicaldecisionsupportatpointofcare

• ResultsfromOptumOnemeasurements:

o Pneumococcalimmunizationratesforpatients65yearsandolderincreasedfrom60.6%atpre-interventionperiodto80.2%

o Pneumococcalimmunizationratesforhigh-riskpatients19-65yearsincreasedfrom26%atpre-interventionperiodto31.6%

o Influenzaimmunizationratesforentiretestgroupincreasedfrom40.5%fromJuly2014toApril2015to43.4%fromJuly2015toApril2016,exceedingtheCollaborativeaverageinterventionperiodvaccinationrateforthe2015-2016fluseason(37.3%)

OptumOnemeasurementsallowedUMasstoexpandpracticesfromtheAICollaborativefocusedonadultimmunizationstootherinitiatives.

Lessons Learned and Ongoing ActivitiesMostoftheAICollaborativeinterventionsusedbyUMassinthisstudyinvolved“piggy-backing”ontotheexistinginfrastructureatUMass.Thatexistinginfrastructureforphysicianengagementhasenabledthemedicalgrouptobeagilestrategically,developleadershiprolesthroughoutthenetwork,andprovidecommongroundforawidespreadnetworkofemployed,academic,andindependentproviderstoworktowardasystemoftrulywell-coordinatedcare.

Leveraginganinfrastructurethatwasbuiltinanagnosticwaytoachieveallpopulationhealthgoals—andusingthatinfrastructuresuccessfullytoachievetheAICollaborativegoals—onlyconfirmedtheimportanceofbuildingtheinfrastructureinthefirstplace.

ThekeytosuccessisastrongcorestructureofPCPsengagedincarepathwaysbi-directionally.Pivotalchangescanbeaccomplishedoncethatcoreisinplace,butfirstanorganizationmustbuilditsinfrastructure.ThePCPsneedasupportteam.Smallgroupsneedthesupportofalargerorganization.

Thisismoreaboutbuildingacultureandadatasystemforthepurposeofdeliveringhigh-qualityservices

Thelinksbetweenpatientexperience,patient-reportedoutcomes,andpatientengagementareavitalpiecetothepopulationhealthpuzzle.Inordertoprovideactionableaccuratedatatoprovidersandhealthcaresystems,thealignmentofqualitymetricsisessentialtoreducethecomplexityofworkatthepointofcare.Furthermore,theadoptionofunifiedmetricsatthepayerlevelacrossthenationshouldbetheprimaryfocusofthenewhealthcareenvironment,inclusiveofpatientexperience,patientengagement,andpatientreportedoutcomes.

ThePH/CIgroupatUMassandthedata-driven,physician-led,patient-centeredinfrastructureithasbuilthelpedguidethisworktomaintainthepatientatthecenterofcarewithoutlosingthe physician voice.

Physiciansatthepointofcaremustbeprovidedwithdatathatispatient-centeredandactionable.Datahastobeaccurateandreal-time.Resultsofinterventionsmustbetransparent.

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Focusandconcentrationonanygiventopicorinitiativewillwaxandwane.Thebattleistoconsistentlyremindthefront-linehealthcareproviderstorefocustheirenergiesontopicsaspriorities develop or change.

ProviderengagementfortheAICollaborativewasconsistent;itdidnotincreaseordiminishatanypointduringthestudy.Withphysiciansbeingbombardedwithsomanyregulations,demands,newinformation,etc.,regularcommunicationandreinforcement is essential.

Communicationavenuesmustbecomeregularandexpected.Forexample,takepatientcareregistriesforgapsincarethatthestaffuseforpre-visitplanning(includingimmunizations).ThePH/CIteamhasmadeitanintegralpartofthepoint-of-caredeliverysystem,somuchsothatiftheregistryisnotdeliveredregularlyonFridaysat12,staffwillnowtaketheinitiativetorequestit—whichdemonstratesthatstaffhasdeveloped a dependency on the registry.

TrueofallCollaborativesisthatbenchmarkingagainstpeersisthemaindriverofparticipationandoffersthemostmeaning.Organizationsarepromptedtoaskthemselves:“Comparedtosimilar systems, how are we doing in comparison? How can welearnfromthosewhoaredoingthingsdifferently,orevenoutperformingusincertainareas?Howaretheydoingit?Likewise,whatcantheylearnfromus?”

InthecourseoftheAICollaborative,itbecameapparenttotheUMassAITeamthatprovidersandadministratorscanusedifferentapproachesandbeequallysuccessful.So,inasense,thereareno“best”practices.Differentapproachesworkfordifferentcommunitiesanddifferentproviders.Thelessonisnottoconcentrateononeparticularway,butrathertoviewproviderinput,engagement,andacknowledgingworkflowaskey.

WhatmightUMasshavedonedifferently?PerhapstheAITeamcouldhaveconsidered:

• Initiatingeducationandoutreachpriortodevelopingperformancereportingandclinicaldecisionsupporttools

• Developingideasforeffectiveproviderengagementpriortoroll-outsimplybecausemovinglargeinitiativesontoprovidergroupsdoeshavemoreinertiathanexpected

• Trackingrelativeincreasesinimmunizationratesforpracticesthathadadditionalresources(likePIFsassisting

withpatientoutreach)orpracticesthatincorporatedspecialevents(likewellnessclinics),askingthequestion:“Dotargetpracticesgivenmoreresourcesoutpacetheperformanceoftheentirenetwork?”

Ongoing ActivitiesUMassiscurrentlyseekingtomorecloselyalignitshealthcaresystemwiththecommunity—toincludeleveragingcommunityresourcestohelpwithmarketingandawarenessaroundhealthcareissues.UMasscouldthussolidifyitsrelationshipsandconnectionsandbringoutsideresourcesinordertosupportinternalorcommunity-wideinitiativesthatwouldultimatelybenefitpatients.

InAugust2016,UMMHCsponsoredacommunityresourcesummitinvitingover60guestsrepresentingissuesthatimpactpatients—issuessuchasfood,money,andhousing.AnimportantlessonlearnedfrompeersintheAICollaborativewas that UMass had to leverage the care it was providing topatientsinthecommunityinamuchmoreextendedcontinuumofcare.UMasshadtogooutsidethewallsoftheclinical system and develop relationships with grassroots communityservicegroupsliketheAsianCoalition,thefoodbank,etc.

Also,inthePH/CIinfrastructure,therearenowmorethan73distinctmeasuresthatare“infocus,”includingoutcomemeasures(diabetes,cardiovasculardisease),prevention(cancerscreening),andpatientexperience(PROMs,engagement,etc.).Allperformancereporting/registriesaregroupedtogether―andareessentially“seamless.”Keepinmindthat,totheenduser,eachoftheseinitiativesisnotaninitiative.Insteaditshouldbeexperiencedasongoingandsimplyapartofthefocus,asawhole,onimprovingpopulationhealth.

Fortheproviders,inparticular,itshouldbeseenasonemoreway to improve patient care, one patient at a time.

UMassnowhasmorethan500PCPsintheMCN—full-timeandpart-time,employedandindependent—andisgrowingrapidly.UMassis“movingthemasses,”indeed,buttheindividualproviderisstillpatient-centricandpatient-driven.ThePCPsarebeginningtounderstandthatinconcentratingoneachofthesegoals—patientbypatientbypatient—itiscumulativeandmattersintheoverallscopeaswellasintheindividualpatient’scase.

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References1.WilliamsWW,Lu,PJ,O’Halloran,A,Bridges,CB,Pilishvili,T,Hales,CM,&Markowitz,LE.(2014)CentersforDiseaseControl and Prevention (CDC). MMWR MorbMortal Wkly Rep.2014;63(5):95-102http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6305a4.htm.

2.Williams,WW,Lu,PJ,O’Halloran,A,Kim,DK,Grohskopf,LA,Pilishvili,T,Skoff,TH,Nelson,NP,Harpaz,R,Markowitz,LE,Rodriguez-Lainz,A,&Bridges,CB.(2016)SurveillanceofVaccinationCoverageAmongAdultPopulations—UnitedStates,2014;SurveillanceSummaries/February5,2016/65(1):1–36http://www.cdc.gov/mmwr/volumes/65/ss/ss6501a1.htm.

3.OfficeofDiseasePreventionandHealthPromotion(ODPHP).HealthyPeople2020.https://www.healthypeople.gov/.

Acronym Legend_________________________

ACIP: AdvisoryCommitteeonImmunizationPracticesACO: AccountableCareOrganizationAI Collaborative: AMGA’sAdultImmunizationBestPracticesCollaborative

AI Team: UMassAdultImmunizationBestPracticesCollaborativeTeam(drawnfromPH/CIteam)

APP: Advanced Practice ProviderCDC: Centers for Disease Control and PreventionCMS: CentersforMedicare&MedicaidServicesCQS: ContinuousQualitySysteminAllscriptsEHR:ElectronicHealthRecordGPRO: GroupPracticeReportingOption(GPRO)WebInterfaceforACOreportingtoCMS

HEDIS: HealthcareEffectivenessDataandInformationSetfrom NCQA

HP2020: Healthy People 2020LOINC: LogicalObservationsIdentifiers,Names,CodesMEDCIN: A system of standardized medical terminologyNCQA: NationalCommitteeforQualityAssuranceNHIS:NationalHealthInterviewSurveyPCPs: Primary Care ProvidersPH/CI Team: PopulationHealth/ClinicalIntegrationTeamat

UMassPIFs: PracticeImprovementFacilitatorsemployedaspartofUMassPH/CITeam

PROMs: Patient-reportedOutcomesMeasuresUMass: UMassMemorialMedicalGroupUMMHC: UMassMemorialHealthCare(umbrella

organization)

Ideally,systemscanbedesignedsothatproviderscanbegiven small goals related to their patients. That is the concept thatislacedthroughoutwhatUMassdoes.Theproviderisapracticing physician, and that is the priority for most of them. Aboveall,theydonotwanttolosethatconnectionwiththeirpatients—providingcaretothepeoplewhorelyuponthem.

Future StepsUMassisintheprocessofbuilding/implementingEpicasitsEHR.OneofthegoalswithEpic’simplementationistotakewhatwaslearnedintheAICollaborativeandbuildchangesintotheworkflowsofthenewsystemwithpoint-of-careremindersandbestpracticealerts.UMasshopestodiscoverandtakeadvantageofprebuiltdesigncomponentsfromotherEpicusers.Epicroll-outisanticipatedforOctober2017.

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Appendix

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Appendix

Figure 1: UMass AI Collaborative Results: Pneumococcal Vaccines

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Appendix

Figure 2: UMass AI Collaborative Results: Influenza Vaccines

Project TeamThomas Scornavacca, DO

Senior Medical Director, UMass Memorial PopulationHealth,OfficeofClinical

Integration

Francis Wanjau Manager,PracticeImprovement

Pat Ramos Supervisor,Outreach&Coding

Tracey Wilkie Director,PopulationHealthReporting&

Analytics

OnePrinceStreetAlexandria,VA22314-3318

amga.org/foundation

ThisprojectwassponsoredbyPfizerInc. Pfizer was not involved in the development

ofcontentforthispublication.