Electronic Communication Across Provider Settings:


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  • Dan: As the lead partner, Concord Hospital…
  • Dan: Concord Hospital is part of Capital Region Healthcare…
  • Located in Central NH an hour North of Boston
  • Dan: As a leader we’ve reached out to partner organizations in our area. Our presentation will focus on the collaboration between these partner sites.
    Existing systems
    Gaps in handoffs
    Proposed plan to handle those gaps
  • Dan: Let’s start with a look at the technology of each of the partners. Here are some highlights of the systems used at Concord Hospital. Talk with Josie to get more talking points.
  • Dan: on Horizon Homecare for five years
  • Dan: Totally Integrated Electronic Record. Traditionally a disconnect between Mental Health and the PCP office. Obviously there are patient confidentiality issues to address when mental health is involved.
  • Dan: Includes Dartmouth Hitchcock and Hospital owned groups. On EMR since 1996. More recently a number of support programs on Logician as well. Increasing number of specialists are coming up on EMR.
  • Dan: This slide show Concord and surrounding areas. Needs to be a NH state image. The red numbers indicate providers at each location.
  • Dan: Culture of collaboration and penetration of existing technology positions us to be able to take the next step in sharing clinical data.
  • Dan: Culture of collaborative practice has led to develop these means to electronically communicate.
  • Dan: We’re also able to provide the “right” information where it is needed.
  • Dan: Here Dr. Angelo will discuss some specific examples of using technology manage transitions.
    Wendy: A term we call “wrap-around” EMR bridges inpatient and outpatient
  • Wendy: An ex of wraparound EMR create orders from Logician. Create order sheet. Print out order sheet.
  • Wendy: Update PAM while performing discharge. Makes more efficient use of provider time.
  • Wendy: Allows updates to meds in outpatient system
  • Wendy:
  • Wendy: Example of the medication reconciliation pilot from previous slide.
  • Wendy: These stories illustrate the there are communication difficulties to overcome.
  • Wendy:
  • Wendy:
    Dan: Experience from pilot and experience from planning grant.
  • Wendy: Leadership – slide in examples of next slide
  • Wendy: Discussion of committees. Steering, Clinical, Technology
  • Wendy: Safe environment to report ADE
    Look at grant to add more
    How will we measure culture change – number of presentations and feedback from presentations from governing bodies
    Report out staff education efforts; Feedback from surveys and focus groups.
  • Dan: Just as with any project it is important to have buy in from key stakeholders and senior management. We also know that there are some keys to our technical success. Key is automation
  • Dan:
  • Dan: This technology automates the process and removes a primary barrier, that of more steps for the provider.
  • Dan:
  • Dan:
  • Electronic Communication Across Provider Settings:

    1. 1. Electronic Communication Across Provider Settings: Connecting NH Providers June 10, 2005 Wendy Angelo, MD Dan Venecek, PMP
    2. 2. Objectives • Discuss Existing Systems • Clinical Workflow Examples • Gaps in clinical handoffs • Proposed plan to address clinical information sharing
    3. 3. Concord Hospital Lead Partner in AHRQ Grant • Second busiest acute care hospital in NH • 205 beds • Regional referral area 275,000 • 15,500 admissions in 2004
    4. 4. Capital Region HealthCare • More than 2,600 employees • 300+ physicians on medical staff • 75+ employed physicians • Serves 5 counties in central New Hampshire • Approx. 750,000 patient contacts/visits per year
    5. 5. Located in Central NH
    6. 6. Concord Area Partner Organizations • Concord Hospital • Concord Hospital Primary Care Practices • Concord Hospital Family Health Center • Dartmouth Hitchcock-Concord Clinic • Concord Regional VNA • Riverbend Mental Health Services
    7. 7. Concord Hospital Technology • Over 10 years experience with barcoded medication administration • A decade of EMR experience • PACS Medical Imaging System • Physician Portal • > 25 systems communicating via Interface Engine technology • Implementing Electronic Patient Record (Document Imaging)
    8. 8. Concord Regional Visiting Nurse Association • Horizon Homecare - McKesson • Clinicians maintain coded medication lists • Medications reconciled from patient home • Centralized database updated with clinical information entered remotely • Shared clinical information electronically (Physician Portal) • Implementing Telehealth technology
    9. 9. Riverbend Community Mental Health • TIER - Sequest technologies • Communication tool for multi-disciplinary team • Document visits • Tracking federal and state required forms
    10. 10. Over 170 providers accessing more than 125,000 electronic patient records 90% Primary Care Breast Care Center 100% Pulmonary Lipid Management 40% Surgery Diabetes Education 50% Gastroenterology Wound Healing Center 66% Dermatology Nutrition Counseling 60% OB/Gyn Sleep Center 75% Pediatrics Family Dental Center
    11. 11. 3 8 6 55 147 HillsboroHillsboro 70 LaconiaLaconia 5 3 EMR in the Concord Area
    12. 12. For a rural community we are fortunate to have a depth of EMR penetration and a culture of collaborative practice that enhances our ability to take on quality improvement at a community level.
    13. 13. Current Electronic Communications • Communication between hospital services and the practices – HL7 interfaces between lab, radiology, hospital transcription, and the outpatient EMR – Secure messaging of rehab progress notes to PCP • Primary care to specialty care – electronic outbound referrals from ambulatory EMR – Secure messaging between providers • Specialty care consult notes to primary care – interfaced directly into ambulatory EMR
    14. 14. Current Electronic Communications • Providing the “right” information at the “right” time – ED granted access to EMR – Physician Portal brings together hospital experience (EKG’s, images) – Clinical data gathered by VNA can be viewed via Physician Portal
    15. 15. Communication Between Inpatient and Outpatient • “Wrap-around” EMR • Using tools that directly pull information from the outpatient to the inpatient environment • Discharge processes that facilitate the maintenance of the outpatient record • Tools and processes used by hospitalists to smooth transition points
    16. 16. Clinical Handoff Scenario Hospital Admission Orders • Hospital admission template in EMR • Order sheet auto- populates with problems, allergies, and medications • Decreases transcription errors • Creating hospital admit orders within EMR
    17. 17. Clinical Handoff Scenario Hospital Discharge Dictation Placeholder for Hospital Course
    18. 18. Clinical Handoff Scenario Hospital Discharge Easy to read patient discharge instructions
    19. 19. Even with our current technologies and collaborative environment there are many examples of difficult transitions
    20. 20. The Biggest Risk at Any Transition Point is Medication Error
    21. 21. Our Current Pilot Pre-op Medication Reconciliation • Pt is pre-op for lung surgery • Surgery about to be canceled because of elevated liver functions of unknown etiology • Going through pre-op process • Clearance nurse realized that he was on two meds that PCP did not know about • Letter faxed to PCP • PCP had him discontinue meds • Liver functions improved
    22. 22. Barriers to Medication Reconciliation • Varying Accuracy of Medication Lists • Often does not represent what the patient is actually taking – OTC, herbs, vitamins, meds stopped or started by patient • Difficult, if not impossible, to share discrete data electronically • Information not shared between episodes of care in different settings • Provider push back on any workflow that increases their workload
    23. 23. How do we overcome these barriers…
    24. 24. It’s NOT about the technology It is about getting the right people at the table
    25. 25. Leadership • Recognized Challenges – A sense of urgency that this issue needs to be addressed – Financial Match Commitment and Fair Distribution of Shared Costs – Support for needed changes at each organization – Liability concerns among partners – Governance Structure
    26. 26. Collaboration of the Clinical Community • Clinical and Frontline Staff from each partner to address – How to keep the project patient centered – Patient Privacy & Confidentiality Concerns (HIPAA Standards) – Sensitivity to provider workload and Clinical Workflow Changes
    27. 27. Our Vision of Success • Organizational Success Defined by: – A cultural change has occurred – Actively seeking collaboration between partners – Workflows re- engineered to be more Patient- centric
    28. 28. Our Vision of Success • Technological Success Defined by: – All partner EMRs store medications in a discrete format – Able to share the same medication list across provider settings – Use Automated Technology to Broadcast Updates/Changes to all of a patient’s providers – Measure number of updates/changes broadcast and number accepted
    29. 29. Our Proposed Technological solution The creation of a community wide grid
    30. 30. Technology Solution Novo Innovations, Inc • Information captured in local EMR • Continuity of Care (CCR) record updated • Changes securely broadcast to all nodes on the grid • Provider notified of change and allowed to update EMR EHR 2 CCRCCR CCRCCRCCRCCR CCRCCR EHR 3 EHR 1 EHR 4
    31. 31. Development Considerations • Events – when is the information acquired and distributed? • Extraction – how is the data acquired from the local EMR? • Patient matching – who is the patient, who has interest in the patient? • Intervention – how do providers receive and accept data? • Insertion – how is data input into the local EMR?
    32. 32. Why we will succeed • Collaborative environment established • Record of successfully implementing clinical info systems • Focused on quality and patient safety • Partner clinicians and IT • Patient safety demands that we succeed