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Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workflows
The document discusses best practices for enabling Health Information Exchange (HIE) and integrating its capabilities into Electronic Health Record (EHR) workflows, emphasizing the necessity of HIE in delivering value-based care and enhancing patient outcomes. It outlines various use cases, benefits, and challenges of HIE, alongside the roles of organizations like the Strategic Health Information Exchange Collaborative (SHIEC) and the Patient-Centered Data Home (PCDH). It highlights the importance of interoperability, care coordination, and leveraging data analytics to manage healthcare costs and improve patient care efficiency.
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Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workflows
- 1. Best Practices forEnabling HIE and Incorporating Capabilities into EHR workflows 2018 Minnesota e-Health Summit
- 2. Agenda • Why isHIE needed? • Value Based Care • Consumerization of Healthcare • What should you expect from HIE? • HIE Capabilities • How do you do it? • Sharing Data • Leveraging Insights • SHIEC • What is SHIEC and what role does it play? • What PCDH is and how it works • Where is PCDH working and future expansion • Why is PCDH important?
- 3. Health Information Exchangeis now Table Stakes Why should you care? Payers are seeking opportunities to reduce low value care by transferring risk to Providers with System-wide, Total Cost of Care Capitated. Payers are selecting systems as strategic partners based on the value of the physician enterprise as a leading indicator of the system’s ability to maximize outcomes per dollar spent for populations. Managing inpatient efficiency is not enough to be successful in value-based arrangements. The decisions that impact inpatient activities starts much earlier, often with the patient’s first visit with a physician. Managing risk starts with a visit.
- 4. High Performing Networksand Low Value Care Why should you care? Reducing that 30% of unnecessary, low-value care will directly impact healthcare spend without an impact on outcome or quality of care delivered. Offering patients the proper direction toward high value physicians within the system will ensure that only necessary care is provided at the right cost to the plan, employer and patient. By utilizing RowdMap’s Risk-Readiness® benchmarks, your system can express to payers and employers the benefits, both financial and quality outcomes, that companies, payers and patients can receive by choosing a high value partner.
- 5. The average personsees more than 18 providers in their lifetime
- 6. And each providerhas their own EHR(s) and other clinical data sources
- 7. Patients believe thattheir physicians have access to all their health data
- 8. But we allknow the reality: Health data information is still very siloed
- 9. Community Hospital IDN Pharmacy Lab Post-Acute Specialist PCP Clinic • In thisexample alone, 28 distinct point-to-point interfaces • Organizations are forced to create contract-by-contract interoperability between local IT systems • Regional “networks” achieve only regional results Current interoperability approaches simply don’t scale
- 10. Care Coordination istoo dependent on patients and on archaic technology
- 11. Health Information ExchangeSolves a Hard Problem
- 12. To Create aPatient-Centered Network Community Hospital IDN Pharmacy Lab Post-Acute Specialist PCP Clinic Community Hospital Pharmacy Post-Acute Specialist PCP Clinic
- 13. Study by researchersat University of Notre Dame, as reported by EHR Intelligence: https://ehrintelligence.com/news/effective-hie-use-federal-incentives-may-save-medicare-billions Accessing Patient Data Through HIE Studies have shown that accessing and using data through HIE can: Reduce Medicare costs by more than $3B per year (average savings of $139 per Medicare beneficiary a year – a 1.4% decrease in spending per individual) Lead to many other financial and patient care benefits Reduce radiology exams by 26% Reduce lab tests by 25%
- 14. HIE Value Proposition:Provider Perspectives & Links to Initiatives • Enhance decision-making cycle time / effectiveness / TOC • Coordinated care, streamlined referral processes / PCMH • Quality Improvement Programs (i.e. avoid errors, ADEs) • Reduce readmissions, unnecessary procedures • Enhance patient engagement – for outcomes and loyalty • MU, PQRS, MACRA/MIPS, Immunization, RAC, Malpractice, HIMSS7 • Ops Excellence to reduce cost of supply chain, labor, overhead • Reduce unnecessary procedures and hospitalizations • Increase referrals, outreach, • New service lines or become COE • Improve rates with payers, enhance charge capture • RCM: Coding / Billing / CDI / Denials Management • Save time providers spend looking for / sending data • Productivity tools to enable PCMH • Deployment of telehealth • Risk-sharing contracts with upside and minimal revenue loss • Clinical integration network and workflow that aligns key partners • Programs to identify, stratify, engage, and manage high risk patients • Care / Disease / Case management views and tools • Enhance satisfaction of providers, staff, and patients • Mergers and Acquisitions – and Integration • Affiliation and Alliances Quality & Compliance Financial Strategic • Improve Outcomes • Compliance • Cost Reduction • Increase Revenue • CashAcceleration • Increase Effective Capacity • ACO / P4P • Population Health • Provider / Patient User Experience • Scale Overall Benefits - TCO = Value $$
- 15. 1. Clinical resultsdelivery (lab, radiology, etc.) 2. Medication history, summaries, alerts, etc. 3. Notification of clinical events for patients in a defined population 4. Immunizations, syndromic surveillance and public health data 5. Electronic prescribing and refill information 6. PHRs, patient-reported data 7. Claims transaction/electronic eligibility information 8. Data quality and research support 9. Connectivity to electronic health records 10. Alerts to providers 11. Enrollment or eligibility checking 12. Electronic referral processing 13. Clinical decision support 14. Disease or chronic care management 15. Quality improvement reporting for clinicians 16. Ambulatory order entry 17. Disease registries 18. CCR/CCD summary record exchange 19. Quality performance for purchasers or payers 20. Public health surveillance 21. Electronic prescribingand refill information 22. Alerts to providers 23. Query for documents 24. ADT notification 25. Claims processing 26. Population health management 27. Public health data 28. Research support 29. Syndromic surveillance 30. Eligibility checking 31. Ambulatory order entry 32. Patient-reported data 33. Connectivity to EHRs Health Information Exchange is Comprised of Many Use Cases
- 16. Once an organizationdecides to invest in HIE to support initiatives, need an approach to define the objectives & scope including stakeholders, content & use cases. The lenses through which scope can be defined include: ▪ Enhancing Transitions of Care (ToCs) ▪ Which ToCs? - What Data? - What Facilities? – Workflow? ▪ Enabling Patient Engagement & Care Management ▪ Which Problems? - Functions? - What Apps? – Workflow? ▪ Supporting Analytics for Population Health & Value-Based Payment ▪ What Contracts? - Which Population? - What Measures? – What Data? Defining the Scope of the HIE Program
- 17. • Comprehensive CareCoordination, Health Coaching and PCMH Model • Medication Management • Effective Hand-offs to Providers and Social Workers • Timely Post Discharge Follow-up • Self-Management Care Plans with Patient Education and Clear Follow-up • Identify and Provide Resources for Social Determinants of Care • High Patient Satisfaction (correlated with lower 30 day readmit rates) Sources: • Project BOOST (Better Outcomes by Optimizing Safe Transitions) – www.hospitalmedicine.org • Care Transitions Interventions (CTI) –www.caretransitions.org • CMS Community-Based Care Transitions Program (CCTP) – www.innovations.cms.gov/initiatives/CCTP/ Enhancing Transitions of Care Right Information Right Time Right Format • Guided Care Comprehensive Primary Care for Complex Patients – www.guidedcare.org • Project RED (Re-Engineered Discharge) – www.bu.edu • State Action on Avoidable Rehospitalizations (STAAR) – www.ihi.org
- 18. Enabling Patient Engagement& Care Management Patient Portal Outreach & Engagement Education Personal Health Record Remote Monitoring Medication Management
- 19. ACOs most oftenanalyze: • Claims data (96%) • Clinical data (79%) • Administrative data (52%) • Disease registry data (39%) • Patient-reported data (38%) In order to: • Identify and close gaps in care (84%) • Identify outliers in cost/utilization (80%) • Compare clinician performance (77%) • Measure/report on quality (77%) • Proactively identify risk (68%) Results are Used to: • Address specific high-cost or high-utilization patient populations (84%) • Care transitions management/care coordination programs (82%) • Disease-management programs (73%) • Post-discharge programs (68%) • Development of evidence-based clinical/care guidelines (55%) • Medication management programs (38%) Supporting Analytics for Population Health & Value-Based Payment
- 20. Determine Risk and Provide Actionable Data Real-time Intervention at the Pointof Care Coordinated Care: Complete View of Patient 1 2 3 Opportunity for a Richer Patient Portal 4 BETTER OUTCOMES COST EFFICIENCY HIGHER SATISFACTION Providing Solutions, Adding Value
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- 22. 22 • Demographics (Name, Gender,DOB, Race, Ethnicity, Language) • Allergies • Medications • Medication Allergies • Smoking Status • Immunizations • Encounters • Observations • Vital Signs (Hgt, Wgt, BP, BMI) • Pharmacy Fill Data • Lab Tests, Values / Results • Radiology Reports / Images • Other Diagnostic Results • Diagnoses • Problem Lists • Procedures • Functional / Cognitive Status • Care Plans / Team Members • Discharge Instructions / Clinical Summaries • Advanced Directives • Care Plans • eMOLST • EMS Run Sheets • Medicaid Claims Data • Social Determinants of Health Types of Data
- 23. Core HIE Services PatientRecord Search: Access to a more comprehensive patient profile Statewide Delivery of Clinical Summaries: Ability to push clinical summaries (CCD, C-CDA) and lab results Clinical Event Notifications (CENs): 24/7 Custom alerts provide real-time updates for patients in care Direct Messaging: Secure HIPAA-compliant messaging Predictive Analytics: Assessing risk and managing patients to optimize care
- 24. 24 Patient History PatientRisk of Event or Outcome Risk Model Development Population Risk Models 1000s of Patient Features • Age • Gender • Geography • Income • Education • Race • Diagnoses • Procedures • Chronic conditions • Visit and admission history • Outpatient medications • Vital signs • Lab orders and results • Radiology orders • Social characteristics • Behavioral characteristics Multivariate Statistical Modeling – Decision Tree Analysis Machine Learning (predicts future 12 months) • Predicted future cost • Risk of inpatient admission • Risk of emergency department (ED) visit • Risk of acute myocardial infarction (AMI) • Risk of asthma • Risk of cerebrovascular accident (CVA) • Risk of congestive heart failure (CHF) • Risk of COPD • Risk of diabetes • Risk of hypertension • Risk of mortality Event Based Risk Models (predicts future 30 days) • Risk of 30 day readmission • Risk of 30 day ED re-visit Predictive Risk Scores
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- 26. ReportingCapacity Activity & UsageReporting Data Audit Reporting Analytics for proactive care management HIE Capability Exchange Hospital & Clinic Data EMR Connections CCD, Lab Results, Exchange Event Notification & Patient Portal Care Plan Coordination Health Information Exchange Enablement Data Exchange Information Exchange
- 27. Source Organization Specific Source System Type of Clinical Data Datefirst live in production Volume Estimates (e.g., # of unique patients) Clinical Data Format (include terminology used, if any) Location or region XYZ Health System (hospital) ADT (GE) Admissions data, discharge summaries Since Jan 2009 2,000,000 HL7 v2.5.1 Tallahassee ABC Hospital Lab (Cerner) Lab results Since Feb 2010 1,000,000 HL7 v2.5.1, LOINC coded Jacksonville St. Sam’s Hospital Transcripti on (XYZ vendor) Transcribed reports: surgical notes, radiology reports Since June 2010 1,000,000 HL7 v2.6 Lakeland Participant On-Boarding Readiness
- 28. Prepare Data Feeds– Conformance Testing
- 29. • Many EMRshave extensibility frameworks to expose information from the HIE • Tasking & Alerting can be leveraged • Contextual Single-Sign-On from EMR to HIE • CCD Export/Import • Standard HL7 Integration Integrating HIE Capabilities to the Point-of-Care
- 30. • Method ofSubscription • Subscription file • All patients • Rule-based • Trigger • IP admission/discharge • ED admission/discharge • SNF admission/discharge • Patient expiration (death) • Frequent ED notifications at time of encounter • Detect receipt of clinical notes and notify PCP • Detect duplicate CT scans real-time • Detect when prescription is filled or not • Method of Notification • Clinical Message Center (Portal) • HL7 v2 MDM interface Integrating HIE Capabilities to the Point-of-Care: Clinical Event Notification
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- 32. FLAG Green YellowRed Consent YES NOT GIVEN N/A Data YES YES NO New Data YES N/A N/A Consent Status: Yes External Data: Yes New Data: : Yes Message on Mouse Over Integrating HIE Capabilities to the Point-of-Care: EHR Flags
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- 34. Continuity of CareDocument Reconciliation
- 35. What is theStrategic HIE Collaborative (SHIEC)? www.strategicHIE.com … The National Trade Association for Health Information Exchange Organizations And SHIEC has a nation-wide HIE interoperability initiative called … Patient-Centered Data HomeTM What is the Strategic HIE Collaborative (SHIEC)? www.strategicHIE.com … The National Trade Association for Health Information Exchange Organizations And SHIEC has a nation-wide HIE interoperability initiative called … Patient-Centered Data HomeTM Strategic HIE Collaborative
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- 38. Relevant History National associationof more than 40 statewide, regional, and community HIEs How this IA aims to connect the whole country? Patch together a “quilt” of HIEs to cover the whole country Who’s in Charge SHIEC. SHIEC’s board is elected from among HIE members. Legal Document Evolving approaches (could be DURSA) Geographic Span Nationwide, but limited by who’s a member and who’s not Most Common Transaction ADT notification from one HIE to another and clinical data at point of care in response Less Common Transaction Clinical data back to the HIE in the patient’s home state Other Information Current focus is on sharing clinical data (a) at point of care, (b) to maintain longitudinal record in patient’s home state Patient-Centered Data Home
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- 45. MUCH MORE THANI.T. GALENHEALTHCARE.COM