More Than OK Innovation in Care Transistions
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More Than OK Innovation in Care Transistions

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Presented at InnoTech Oklahoma 2013. All rights reserved.

Presented at InnoTech Oklahoma 2013. All rights reserved.

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  • Start in Primary Care venue(CCD generated and contributed post visit) Patient had visit in Hospital venue (CCD captured and contributed)Patient has records from other providers across the state (CCD’s contributed)SMRTNET aggregates and creates 1 longitudinal view of patient across the State/Network)Aggregated Patient record is sent to OU CDS systemAlgorithm is ran on Patient record and generates a prescriptive Preventive Services RecommendationsPreventive Recommendations are distributed to Primary Care provider to pro-actively engage his/her populationPortal viewNative to EMR system via SSO or Web Service
  • Change to PCP’s Pool(Anna)Change user to PCP’s RC (Anna)Add patient to the list(Anna)Make the status Completed(Anna)Change to the sent folder(Anna

More Than OK Innovation in Care Transistions More Than OK Innovation in Care Transistions Presentation Transcript

  • More Than OK Innovation In Care Transitions Norman Regional Health System Yeaman and Associaties Brian Yeaman, MD & CMIO
  • Taking action in Oklahoma
  • The Tug-of-Data-War © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • The “Global Medical Record” Largest member of the oldest and most established privately sustained HIE in the nation Disparate connections to all major EHR platforms State wide HIE / “Global Medical Record” • >150 million data elements • > 4 million patient encounters • 2.7 million lives (36 interfaces) © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Oklahoma Health Information Exchange © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • You Don’t Know What You Don’t Know 70% crossover data between major health systems for all patients © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • You Don’t Know What You Don’t Know What is your use case? ED Visit/New Admission Discharge Coordination Specialist Referral Medication Reconciliation New or Return Patient to Clinic © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Oklahoma: HIE 2.0 Aggregates data in the Global Medical Record Manages care transitions Integrates with all major EHR platforms Single click from EHR to the Global Medical Record Supports innovative environment beyond HIE © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Redefining the Delivery and Business Case for HIE © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Why Information Exchange?
  • Why Information Exchange?
  • Improving Care Transitions
  • Aging Population
  • Population Health & Healthcare Reform 80% of healthcare costs are related to highly manageable chronic conditions, yet the US spends less than 2% on prevention management © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Oklahoma Challenge Grant Long Term Care Challenge Grant Add on to the State HIE Cooperatives Care Transition Focus Acute Care to Long Term Care Patient Transitions One of Four in the Nation OK, MA, MD, and CO Final Year of Funding Year 2 of 2 © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • ADL Documentation
  • Relevant Data Exchanged Regarding the Transition or Visit Initiate Close Accept Financia l/Eligibilit y Complet e Patient Seen Schedul e
  • Challenge Grant Outcomes 98% compliance with Daily Assessments in EHR by Nursing Aides 30% reduction of 30-day readmissions overall in all five facilities 40% reduction in 30-day return to ED post-acute care discharge 97% patient satisfaction 50% reductions in readmissions in one year (Cedar Creek Living Center) © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • Prescription Drug Monitoring Program OBNDD
  • Prescription drug abuse death is one of the fastest growing public health epidemics, outpacing deaths from traffic fatalities – and outnumbering deaths from heroine and cocaine combined. Center for Disease Control (CDC)
  • Meditech EHR eCW Cerner
  • Technology and Healthcare Reform Culture change: the five “E’s” Evidence-Based Medicine Electronic Conversion of Health Records End of Episodic Care Exchange of Records Across the Care Continuum Enterprising Care Delivery © 2013 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
  • “If you don’t like change, you’re going to like irrelevance even less.” Eric Shineski U.S. Army General