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Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workflows

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Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workflows

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Health Information Exchange (HIE) allows health care providers to access and share a patient’s medical information securely and electronically, providing a unified view of patient data across health care organizations. HIE enhances clinicians’ workflow and their ability to connect, coordinate, and collaborate on patient care quickly and easily. However, health care organizations frequently struggle with last-mile connectivity from their clinical system of record to the receiving system and incorporating HIE capabilities into EHR workflows. This session will provide a framework for successful HIE onboarding including data access, conformance testing & validation, as well as share strategies for implementing HIE capabilities at the point of care. This session will also introduce the concept of Patient Centered Data Home and illustrate how the exchange of information utilizing the PCDH model is a cost-effective, scalable solution to assuring real-time clinical data is available whenever and wherever care occurs to improve the quality of care.

Health Information Exchange (HIE) allows health care providers to access and share a patient’s medical information securely and electronically, providing a unified view of patient data across health care organizations. HIE enhances clinicians’ workflow and their ability to connect, coordinate, and collaborate on patient care quickly and easily. However, health care organizations frequently struggle with last-mile connectivity from their clinical system of record to the receiving system and incorporating HIE capabilities into EHR workflows. This session will provide a framework for successful HIE onboarding including data access, conformance testing & validation, as well as share strategies for implementing HIE capabilities at the point of care. This session will also introduce the concept of Patient Centered Data Home and illustrate how the exchange of information utilizing the PCDH model is a cost-effective, scalable solution to assuring real-time clinical data is available whenever and wherever care occurs to improve the quality of care.

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Best Practices for Enabling HIE and Incorporating Capabilities into EHR Workflows

  1. 1. Best Practices for Enabling HIE and Incorporating Capabilities into EHR workflows 2018 Minnesota e-Health Summit
  2. 2. Agenda • Why is HIE 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. 3. Health Information Exchange is 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. 4. High Performing Networks and 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. 5. The average person sees more than 18 providers in their lifetime
  6. 6. And each provider has their own EHR(s) and other clinical data sources
  7. 7. Patients believe that their physicians have access to all their health data
  8. 8. But we all know the reality: Health data information is still very siloed
  9. 9. Community Hospital IDN Pharmacy Lab Post-Acute Specialist PCP Clinic • In this example 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. 10. Care Coordination is too dependent on patients and on archaic technology
  11. 11. Health Information Exchange Solves a Hard Problem
  12. 12. To Create a Patient-Centered Network Community Hospital IDN Pharmacy Lab Post-Acute Specialist PCP Clinic Community Hospital Pharmacy Post-Acute Specialist PCP Clinic
  13. 13. Study by researchers at 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. 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. 15. 1. Clinical results delivery (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. 16. Once an organization decides 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. 17. • Comprehensive Care Coordination, 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. 18. Enabling Patient Engagement & Care Management Patient Portal Outreach & Engagement Education Personal Health Record Remote Monitoring Medication Management
  19. 19. ACOs most often analyze: • 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. 20. Determine Risk and Provide Actionable Data Real-time Intervention at the Point of 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
  21. 21. Sources of Data
  22. 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. 23. Core HIE Services Patient Record 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. 24 Patient History Patient Risk 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
  25. 25. 25 Quality Reporting
  26. 26. ReportingCapacity Activity & Usage Reporting 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. 27. Source Organization Specific Source System Type of Clinical Data Date first 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. 28. Prepare Data Feeds – Conformance Testing
  29. 29. • Many EMRs have 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. 30. • Method of Subscription • 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
  31. 31. Contextual Single Sign-On
  32. 32. FLAG Green Yellow Red 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
  33. 33. Clinical Event Notifications
  34. 34. Continuity of Care Document Reconciliation
  35. 35. 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 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
  36. 36. Patient Centered Data Home
  37. 37. Patient Centered Data Home
  38. 38. Relevant History National association of 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
  39. 39. 44
  40. 40. MUCH MORE THAN I.T. GALENHEALTHCARE.COM

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