NHIN 304 - HIT Success Stories from the Patient Perspective

HIT Success Stories from thePatient PerspectiveNHIN 304FACULTY:FACULTY- Jeffrey Halbstein-Harris, BS, LRCP, RPFT, RCVT- Carol Lolley-Harris, BS June 20, 2011- Heidi Sitcov, RN, M.EdMODERATOR: Kate Berry – National eHealth Collaborative Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

NHIN University is nowNeHC University! y Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

Advisory Council y• Holt Anderson – North Carolina Health Information and Communications Alliance, Inc. (NCHICA)• David Baker, MD – Northwestern University• William Bernstein, JD – Manatt• Pam Cipriano, RN, PhD – Institute of Medicine• Adam Clark, PhD – FasterCures• Gwenn Darlinger – BlueCross BlueShield Association• Arthur Davidson, MD – Denver Health• Mary Jo Deering, PhD – Office of the National Coordinator for Health IT• Mark Frisse, MD – Vanderbilt University• Lillee Gelinas, RN – VHA, Inc.• Regina Holliday – consumer HIT activist• Linda Kloss – Kloss Strategic Advisors• Dianne Lee – St. Louis Community College/Region C Community College Consortia to Educate Health Information Technology Professionals• Patricia MacTaggart – George Washington University• Chuck Parker – Continua Health Alliance• Andrea Sodano, PhD – Boston University• Timothy A. Swope – Personalized Medicine Coalition• Steven Waldren, MD, MS – American Academy of Family Physicians• Chantal Worzala, PhD – American Hospital Association Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

NeHC University provides unique opportunities for N HC U i it id i t iti finterested stakeholders to learn about multiple health IT initiatives, programs, and trends all in one place initiatives programs Spotlight Learning Series p g g Industry Leader Briefings y g HIT Trends HIT Orientation Guest Lectures NHIN University Health IT Policy and Standards Committees Quarterly Update Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

Consumer Consortium on eHealth Overview Milestones and Timeframe • Convene diverse stakeholders to share best practices and develop coordinated program for Goals: consumer engagement in eHealth • Engage and empower consumers on applications, tools and benefits of eHealth PHASE 1 PHASE 2 PHASE 3 Develop Project Develop Implement Engagement Plan Engagement Plan FEBRUARY – APRIL MAY – SEPTEMBER OCTOBER – 2012 • Conceptualize project • Gather additional feedback • Finalize plans • Assess interest and gather feedback • Launch work groups • Publicize availability of resources gathered • Recruit Steering Committee • Encourage volunteer participation in through inventory • Develop and iterate on draft project work groups • Develop online community for ongoing description • Develop work group project plans discussion and collaboration • Plan launch of Consortium • Convene work groups to develop • Launch coordinated outreach to consumers • Identify potential work groups and chairs detailed plans and providers • Identify resource needs and sources • Refine approaches as needed • Pursue grant and sponsorship funds • Measure impact over time Steering Every 3-4 weeks Every 2-3 months Every 2-3 weeksCommittee MeetingsWork Group Meetings Every 2-3 weeks (June – Sept)Consortium Meetings April 26th 2-3 2 3 additional meetings in 2011 www.nationalehealth.org/consumers

Presentation slides are available now! http://www.nationalehealth.org/NHIN304.aspxRecorded webinar will be available in 24 to 48 hoursFull tF ll transcript will b available i approximately 7 t 10 d i t ill be il bl in i t l to days Want more? Check out the supplemental materials available on the NeHC website! Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

Please enter your questions orcomments in the Q&A window at the bottom right of your screen You can also send us an email at info@nationalehealth.org, tweet a question using hashtag #NeHC or comment on our Facebook page at #NeHC, www.facebook.com/nationalehealth Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

Carol Lolley‐Harris Carol is currently a Patient Access Registrar at a local community hospital. She has 10 years experience in diverse areas of patient care including roles as Certified Nursing Assistant, Patient Care Coordinator using web‐based Emergency Care follow‐up for North Carolina Medicaid, Associate Professional working with at‐risk youth and personal experience with the challenges of dealing with Home Health Hospice and primary care coordination. She received her BS degree from the University System of New Hampshire in the field of Environmental Studies and has completed graduate classes in Social Work at NC State. As a Patient, Carol utilizes the Duke Medicine Health‐View Portal in partnership with care providers to monitor and manage her personal healthcare an d wellness.

Initial Stages of PatientEngagement Using Web Portal Technology At Duke Health Carol Lolley Harris and Jeffrey Harris Lolley-Harris Untangled Healthcare June 2011 J

Finding a Doctor g

Hear she is great, where is she? g ,

Wonderful they have lab on site and are close to home!

I hope she is in p , better check. p plan,

Yep, no problem. She even has e-prescribing and is taking new patients!

Think I will set up an appointment to check her out as my primary care physician

Guess I sign in here, looks like I can do a lot of stuff with my account too!

WowTake health surveys, make appointments, refill my medications, add family y, pp , y , y members, check my lab data and physician notes and billing!

The survey is useful!They actually are collecting information about my preferences!Th t ll ll ti i f ti b t f !

Making my first appointment

I like Dr. Seo and after a few appointments I can start reviewing my health status and interacting with my doctor through her notes Click on test and review results

Looks like I need to work on my LDL! Trend data and Dr. Note

I can review my blood pressure trends here as well as other important health information

My doc can also communicate with other notes and drawings

All of my doctors in my health care system can see my medication list! ANDI can click on a simple link to learn about each medication, even OTCs! medication

Patient medicine education

I store all my demographics here Hidden cross ref Medical rec numbers Since no Master Patient Index

I can even set up notifications and reminders

And of course check out my payment status!

I cant wait to see what comes next!

Jeffrey Harris Untangled Healthcare LLC Raleigh, NC Mr. Harris has 30 years of experience as a dedicated leader in Health Informatics, clinical services administration, disease management and team‐leadership in software development organizations. He has worked in hospital, private practice and payer environments in private and public sectors. Motivated to drive excellence in patient‐centered outcomes and economic sustainability for the business enterprise, Jeff has been instrumental in the deployment of numerous team‐based ‘technically facilitated’ clinical initiatives throughout the industry. As a clinical‐data expert, Jeff is frequently recruited to assist information technology teams with the clarification of cross‐organizational needs, leading to the deployment of innovative information systems that employ decision support to enhance interdisciplinary communication, patient safety, treatment timeliness and adherence to evidence‐based guidelines.

E-Healthcare Making sense of it all Jeffrey Harris Untangled HealthcareFrom Confusion To Fusion (we hope?)• Patient recall (interview) • Digital shared continuous history• Paper records • Magical transfer of data across vast• Manual processes with forms p distances including pictures, treatments,• X-ray film and Fluoroscopy diagnosis, test results• Microscopes and Cell Counts • Computers converting data to information shared with the service providers who• Postal Service include patient and family as active• Telephones component of treatment team• Fax Machines • Shared accountability for well-being• Human Computers Who are you We are I am more people? better healthy, What are you informed knowledgeable, doing? d i ? motivated and I can’t remember accountable all of my doctors and why my parents passed away?

“The Future is here: But not evenly distributed.” Dean Sperry, Hartford, CTA case manager perspective on “the state of the State” Paraprofessionals lens: Professional 1980-1988 Acute Care Respiratory Therapist to Division Director 1989-1997 Program Director | Cross-Venue Physical Medicine and Rehabilitation (chronic heart failure, moderate to end stage COPD) 1998-2001 clinical knowledge expert to start-up software company developing web- native n-tiered community case management system 2002 2006 2002-2006 Director of clinical informatics NC Community Care (Medicaid PCCM program) 2007-2011 Consultant: Population management, Clinical integration Personal Diabetic dx 1968 Spinal Stenosis dx 1999 Insulin pump user since 1984 (Joslyn Center Patient Education Program) Self advocate since the onset of prospective reimbursement and managed care

Use Case: Care Coordination, Management and Advocacy Long standing friend in need of help fell through Florida’s Safety Net Patient Classification: Demographic: 50 y/o Caucasian female Bio - Complex comorbidity (degenerative spinal disease disease, acute trauma with questionable TBI, constellation of auto immune diseases) Psycho - History of episodic substance abuse ETOH and prescription narcotics, depression, PTSD Social - Indigent, Income= $1300/MO; homeless; divorce in process, domestic violence victim, Medicare dually eligible SSDI Post graduate degree in behavioral SSDI, health Functional - Mental: Cognitive defects memory and executive function Physical: Chronic i limitations t l Ph i l Ch i pain li it ti to locomotion and ti d IADL Summary: Can t Can’t work, can t drive, can t think = NO HOPE can’t can’t

Question: Given patient status, how would the clinical world find all of this information during assessment? P ti t i t i Patient interview Patient found on SS Dept. attempt to locate data street in Repeated testing to R/O dx North Hospital Critical Path Carolina Discharge to community g y Patient ER New Medical History Variant Visit Patient Acute Admission Subjected to DC Planning Process DC next Classic Scenario lower level care

Helping a friendIn two years, she:1. Was a victim of domestic violence2. Transitioned from military to public health systems3. Was treated by 12 physicians and surgeons and b h i l d d behavioral health specialists4. Was placed on twenty two different medications, some of which were within the same class and directly contraindicated5. Lost her ability to think clearly6. Lost her family7. Lost everything…save her best friends of over twenty years8. So here we are. • Our friend with her treatment records and medicine when she arrived at our home

Helping a friend• Provide food and shelter• Collect data• Assemble on-line health record• Draft clinical and social summary• Research best institutions for identified problems• Make appointments• Provide transportation

Data collection• Objective: • Methods:• Gather as much as possible and p filter for sentinel information Claims extract – Diagnosis – Procedures – Providers Good for preventive svcs, providers Hospitalizations and visits. – Medications Dx missing on claim records not helpful – Hospitalization Episodes Required many hours of patient interview to reconcile ‘truth’• Store Data in secure online Microsoft HealthVault repository with proven Note for Microsoft: Blue Button download to MS Health Vault connectors to EMRs, PHRs faulty (TXT ONLY), file incompatibility need xml and Vendor Hubs, e.g. Quest, or CCR. If third party to provide connector don’t advertise Health Vault Connectivity CVS Walgreens RxHub connect did not work CVS did work. If these are user issues then tell us what to do please.

Assemble on-line health recordAttempt to connect health- Blue button record effortvault to Blue Button Health Test Failed aborted Record Established Mayo Clinic PHR Attempt to connect health- Test Successful and completed data entry for vault to Mayo Clinic PHR patient CVS used Mayo PHR as Summary Pharmacy of Record choice

Final OutcomeCombined Mayo Transported Patient to UNC HealthCare withPHR with Manual Summary Documents and FilmsClinical Summary Patient T P ti t Team Today T d Mayo Primary Care MD PHR Psychiatrist Physiatrist Ph i t i t Behavioral Health Program Health Patient UNC Vault Medications Start St t = >20 Today = 8 CVS Functional Status Independent all IADL Self transportation Self perceived health status improved

What we need (IMHO) ( )• First and foremost: A straw-man model of what industry is building and utility to consumer A five consumer. minute elevator speech that a person at the local ice cream stand will understand• Public Education Program (Uniform and Nation Wide)• Vendor collaboration on interoperability• Monitoring of meaningful use from the patients perspective• Thanks for listening!!!!

Heidi SitcovMs. Sitcov, RN, M.Ed, has extensive nursing experience in a variety of clinicalsettings, and many years of electronic health record (EHR) implementationexpertise. She is well versed in meaningful use and physician engagementstrategies when deploying EHRs. Since joining the Health IT Consulting firmClinovations, Ms. Sitcov has worked on redesigning EHR training materials forBon Secours Health System, assessed the EHR training needs for the health centersaligned with the District of Columbia Primary Care Association, and assists withbuilding physician order sets for the Adventist Hospital System and MedstarHealth System in preparation for their Computerized Physician Order Entry(CPOE) implementations.Prior to joining Clinovations, Ms. Sitcov worked at Kaiser Permanente HealthSystem as a subject matter expert on the implementation of their ambulatory EHR.She was also on staff at the Nursing Informatics Department at Inova HealthSystem, training physicians on the use of electronic order entry, and assisting withCPOE implementation policies and procedures. She has a Bachelors degree insocial psychology from Northwestern University, received her RN from theNewton Wellesley Hospital School of Nursing, and has a Master of Educationdegree from Suffolk University.

My dad’s story: Coordination of carevia EHR resulted in an extended lifeexpectancy Heidi Sitcov, RN M.Ed June 20, 2011

About Us ME MY DAD• 18 years at Kaiser Permanente • 10 years /Ob/Gyn nursing • Passed away in July 2010 at y y • 3 years /pediatric case management age of 89, four years after • 2 years /utilization management diagnosis of GIST • 3 years /nursing informatics (gastrointestinal stromal tumor) • A ti Active and h lth until hi d healthy til his• Recent: diagnosis in 2006 • Inova: EHR trainer • Hospitalized only twice in his • Current: EHR Implementation Consultant lifetime for minor surgeries • Lived in Buffalo, NY with his wife• Living in DC area for 30+ years of 60 plus years

One Year of Abdominal Discomfort & Fatigue = One Year of Different Doctors, Treatments, & DiagnosesReasons given for symptoms:• Low iron level• It’s normal to be tired at age 85• Constipation due to inadequate fiber No consistency in care y No care coordinationTreatments provided: Paper medical records• Iron pills• Stool softeners• B12 injections• Pain pills

Admitted to Hospital in June 2006Symptoms:• Swollen ankles• Extreme fatigue• Abdominal painWithin 3 days of admission: diagnosis/prognosis:• Malignant mass in intestines• Thought to be cancerous• Life expectancy - 3 months

Bonding with the GI Doc over an EHR1. No ambulatory visit information available in the hospital to th t the GI specialist i li t2. Extensive history had to be retaken with patient and family3. GI’s practice started using an EHR the prior year – practice included internal medicine, family practice, cardiologists, oncologists. Th i EHR resulted i di l i l i Their l d in: Outstanding continuity of care Patient-provider messaging was “over the top” p g g p4. Dad discharged to home with referral to Hospice5. Dad switched to the medical group using EHR6. 3 month prognosis turned into 4 more years of living

Our family shares in the knowledge• My mom and I were health care proxies• Had access to emailing my dad’s doctor and viewing up to date test results, problem list and med list• Med list allowed for accurate adherence to lengthy medication regimen/including oral chemo• Decision support available that triggered reminders regarding tests and care needed• Decreased billing problems due to concise accurate coding• As my dad’s final weeks of life occurred, hospice had clearly documented records that provided a complete summary of my dad’s medical problems

During his last days, my dad expressed his readiness to die due to his increasingly poor quality of lifeHe said “I got the best care ever” and felt everyone at thepractices knew his history and 4 year struggle with cancer It “took a village” of EHR dedicated p g providers to help in p keeping my dad alive 3.5 years longer than expected

Mom and Dad in 2008

TheWalkingGalleryJacket: “Saved” Saved Artist: Regina Holliday

Before you log out out… Please take a moment to fill out the Pl t k tt t thsurvey on the right side of your screen The responses from this survey help us to improve our future programs and your experience Questions or Suggestions? Send us an email at Q ti S ti ?S d il t university@nationalehealth.org Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

Thank you for your participation! National eHealth Collaborative N ti l H lth C ll b ti 818 Connecticut Avenue NW, Suite 500 Washington, DC 20006 (877) 835-6506 info@nationalehealth.org www.NationaleH lth N ti l Health.org Register for NeHC University:www.NationaleHealth.org/NeHCUniversity Register for NeHC University: www.NationaleHealth.org/NeHCUniversity

NHIN 304 - HIT Success Stories from the Patient Perspective

by National eHealth Collaborative on Sep 22, 2011

Accessibility

Categories

Upload Details

Usage Rights

Statistics

NHIN 304 - HIT Success Stories from the Patient Perspective Presentation Transcript