Connecting Long-Term Care with the Continuum: A Panel Discussion. Thursday June 12, AM to 12PM

Transcription

1 Connecting Long-Term Care with the Continuum: A Panel Discussion Thursday June 12, AM to 12PM

2 Outline of Workshop Overview of LTPAC and ehealth/hie, Peter Schuna of Pathway Health Spectrum of exchange Definition of actual exchange Three Projects LB Homes, Harriet Wicklund Galeon Community Memorial Home, Tony VanAcker Benedictine Health System, Bill Krantz Panel discussion Audience question and answer

3 Overview Peter Schuna, President and Chief Operating Officer, Pathway Health

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7 Spectrum of Exchange Stone Age efax/scanning Fax Paper Delivery

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11 Spectrum of Exchange Modern and Future CCD/cCDA s Electronic Exchange of Data ereader Queries Push Pull

12 2012 Minnesota e-health Connectivity for Health Information Exchange Grant Program Minnesota Department of Health funding for: a) assist health and health care providers meet requirements for federal incentives for meaningful use of an EHR and/or b) expand health information exchange capability among health care providers and other trading partners to support care and/or public health, and/or c) increase the number of Minnesota pharmacies capable of accepting electronic prescriptions. Eligible applicants Community HIE Partners (two or more organizations coming together in a collaborative effort in their communities to implement health information exchange for meaningful use transactions) or pharmacies not able to accept electronic prescriptions. Grant awards $25,000 per HIE partner site or $10,000 per pharmacy.

13 LBHomes Harriet Wicklund, Health Information Management Coordinator LB Homes, located in Fergus Falls, MN is the parent company of Alcott Manor-Assisted Living, Broen Home, Broen Short Stay, Lakeland Home Care, Lakeland Hospice, Sheridan House-Independent Living, and Woodland Lodge- Enhanced Assisted Living. LB Homes serves primarily the senior population of West Central Minnesota with a spectrum of facilities and services from home health care to the last months of life. Their tagline is Caring for you, wherever you call home. LB Homes will celebrate its 100 th anniversary in 2015.

14 Goals of the Project Expand health exchange capability among healthcare partners within Fergus Falls service area Exchange client specific health information to support care and achieve public health outcomes Train employees to implement, evaluate, operate, maintain/support an interoperable electronic health record system Within the resources available, develop a sustainable and coordinated system for health information exchange between health care providers in accordance with regulations and guidance to support the development of an interoperable, private and secure national health information technology infrastructure.

15 Participating Organizations Otter Tail County Public Health Otter Tail County Human Services Lake Region Healthcare Corporation: Hospital & Clinic Lakeland Mental Health Center State Operated Services Behavioral Health Hospital New Dimensions Home Care PioneerCare SNF with Short Stay unit, Assisted Living LBHomes Broen Home (SNF with Short Stay unit,) Assisted Living, Independent housing, Lakeland Home Care, Lakeland Hospice Stratis Health project management These partners provide services throughout Otter Tail County and parts of surrounding Counties of Grant, Wilkin, Traverse, Douglas, Wadena, Todd and Becker

16 Essential Steps in Development Preparation Phase: -Demonstrations of various products by vendors ie: CHIC-HIE Bridge; ABility; Apenamed (I.O.D. Inc.); Orion; Relay Health -Stratis Health: readiness assessment -All partners participated in Privacy and Security Boot Camp -Consent management discussions -Vendor agreements were our venders able to produce a CCD and would they work to connect with HIE-Bridge -Data Exchange and Support Agreement (DESA) -Legal opinions /agreements obtained

17 Essential steps in Development Installation and Testing Phase: -Technical set up and training -Appointing our organization s Authorized Representative -Preparing HIE Bridge Enrollment Affidavits -Add users to the HIE Bridge Directory -Admin and user training for using HIE Bridge

18 Essential Steps in Development Workflow/Implementation Phase: -Coordinating efforts of IT Support & nursing staff to create the digital file to be sent -User training Go-Live Phase: -Test transactions between partners -Each partner was able to send and receive either test or actual patient/resident data

19 Key Elements of Implementation Legal Agreements - Data Exchange and Support Agreement (DESA) with HIE Bridge - Licensing agreements for HIE-BridgeDirect and HIE-BridgeConnect Information Trading Partner Agreement - agreement developed by OTC Public Health between the participating partners which was reviewed and signed Consent Management - Updating of Authorization to Release and Request Information to include an opportunity to opt out of electronic exchange - Discussions/planning for management of Opt Out process

20 Key Elements of Implementation Work Flow Plan - What kind of information will be most valuable to exchange 1) what do we currently exchange 2) which of our EHR venders are able to produce a CCD - Who are the partners with which our organization will most likely exchange information - Which staff members in each organization will be working on care transitions, making use of electronic health information exchange

21 Key Elements of Implementation

22 Key Elements of Implementation

23 Key Elements of Implementation User Training - Coordination with IT staff - Identifying training needs - Which staff in each partner organization will need training - Coordination with our scheduling office to assign training Test Transaction - OTC Public Health sent a request for information on a test client to which all partners made a reply Live Transaction - Referral information prepared on discharge from an SNF was sent to the receiving Home Care Agency using HIE-BridgeDirect

24 Project Outcomes This project pushed partners to become conversant in some new technologies and standards Each of our partner organizations now have a subscription with CHIC HIE-Bridge to exchange health information using secure utilizing the DIRECT protocol All of the partners have tested sending forms, photos, or test client information between each other. Lake Region Healthcare is implementing Relay Health Some of the partners began to use the technology to replace transactions previously completed by fax, mail or zixcorp (which is not MN compliant for HIE)

25 Barriers Level of technical knowledge of members of the group Technical persons are not users of the system a team approach is needed to develop systems that are helpful Staff change for one of the partners Staff changes within the HIO Changing products available from the HIO, changing ownership of the HDI State agency breadth of impact and legal implications with behavioral health Legal questions regarding use of the CONNECT protocol Developing work flow for secure distribution to cover when persons are not on duty Determining how HIE fits in workflow outside of the EHR

26 Lessons Learned The collaborative relationship that had been developed within the healthcare provider community in Fergus Falls allowed for this project to hit the ground running. The trust needed for a successful collaboration was already in place. Initial project meetings involved discussions and demonstrations of how the HIE process would work using either the HDI or the HIO products Contracting for project management through Stratis Health to gain HIE expertise from a neutral player and their knowledge of other projects Dashboard highlighting the progress of each partner as the project progressed

27 Post-Implementation: What Next? Maintaining our community of practice with meetings to share lessons learned and continue to expand the use of HIE for transitions of care using the DIRECT protocol Continue to develop/plan workflow within each partner business and between partners Support the Relay Health application to become a Minnesota certified HIO Plan, implement and evaluate the creation of the relay Health HIE ability to add additional providers to populate the repository to create a more robust community care plan Pursue a SIM grant application in 2014 which incorporates HIE as we create a rural health model that works

28 Galeon Tony Van Acker, Director of Wellness & Prevention Services Set on a scenic campus close to the shores of Lake Osakis, Galeon offers Skilled Nursing, Short and Long- Term Assisted Living, Independent Living, Memory Care and a brand new Wellness Center.

29 Goals of the Project Stop using the old system for exchanging protected information. Introduce a new system for exchanging protected information with a greater number of key players in our area. Head toward a paperless system and simplify paperwork between organizations. Head toward EHR compliance by Increase number of people involved on our campus so that data can be shared more easily with major players in our area and between departments.

30 Participating Organizations Local Long-Term Care Organizations Knute Nelson, Glenwood Retirement Village, Coldwater Software, Barrett Care Center, Evansville Care Center, Glacial Ridge Care Center, Stevens County, Bethany, Pope County. Douglas County Public Health Cold Water Software

31 Essential Steps in Development Gather partner exchange data so the process could be laid out. Information included main contacts within the organization, and information we would like shared Find key partners within the organization that would utilize the system, as well as organizations in the area we would like to partner with. Completion of agreements for licensing, software, etc. Online meetings every month for more than a year to go over step by step instructions for completion of goals Training for administrators of the system and key players on campus.

32 Key Elements of Implementation Learn importance of protected data exchange Watching demos to complete goals Creating samples to make sure the system functions as necessary Train those using the system Establish system on campus and integrate with current setup. Maintain system. Remove those not using the system, change passwords, etc.

33 Project Outcomes We were hoping to: Exchange with all necessary Health Care organizations in the area Go Paperless Gain EHR compliance Have people utilizing on our campus We Actually: Are only using it with Public Health Have to go with an additional system to join other necessary organizations Only have 3-5 people on campus using it, and 3 of them are in an Assisted Living situation.

34 Barriers Software Company Deadlines weren t concrete so the whole group didn t move along together They did not give enough direction Couldn t explain some of the technical aspects of what we needed to do. Not enough necessary organizations for us to use it all the time Very, Very time consuming. Return on investment was minimal.

35 Lessons Learned Don t sign on unless everything is laid out from start to finish and you know it will benefit your company the way you expected. There needed to be on-site visits from the project managers to help address specific problems Make sure that all employees know what you are getting them into and keep them in the loop as the project goes along.

36 Post-Implementation: What Next? Possible implementation of additional system so we can interact with local hospitals and clinics Looking to increase the documents that can be uploaded into the system from our health records software so that we do not have to take extra steps like scanning, saving in different formats, etc.

37 Benedictine Health System Bill Krantz, Director of Information Technology As one of the largest Catholic senior care organizations in the United States, with approximately 40 elder care communities in six Midwestern states, we believe our Benedictine Core Values of Hospitality, Stewardship, Respect and Justice are not just posters on the wall; those values guide the work we do every day. The Benedictine Health System participating organizations can be found in Minnesota, North Dakota, Missouri, Wisconsin, South Dakota and Illinois. We are a mission-based, non-profit health system headquartered in Duluth, Minnesota, sponsored by the Benedictine sisters of St. Scholastica Monastery in Duluth. BHS provides complete long-term care services for aging adults, including independent housing, assisted living, skilled nursing and rehabilitation services.

38 Essential Steps in Development Long Term Care is not included in Health Care Reform or Meaningful Use efforts. HIE and national efforts just beginning LTC would benefit from interoperability efficiencies Including LTC seems inevitable what can we do to participate today?

39 INTEROPERABILITY Data Exchange Partners Software Capability Connection Method

40 DATA EXCHANGE PARTNERS Who do we want to exchange data with? What do we want to exchange? What are their capabilities for exchange?

41 CONNECTION METHOD Health Information Organization Health Data Intermediary NwHIN - Healtheway DIRECT secure messaging Peer to peer exchange

42 SOFTWARE CAPABILITY What is our EHR capable of exchanging? Health Care Reform provided a roadmap for hospital software through CCHIT certification and meaningful use incentives.

43 CONCLUSIONS Software capability should be developed LTC would need to be included in interoperability at some point Can t go wrong with CCD/CCDA Peer to peer connection only reliable connection method at that time Development follows national standards

44 PROJECT GOAL Develop the capability to send and receive an XML CCD file electronically between our LTC software and a hospital system s software following national standards and protocols. Useful for exchanging information in transitions of care.

45 MILESTONES Complete and verify CCD Coding Standards and MatrixCare data mapping Create an XML CCD from MatrixCare Create a manual process for users to generate a CCD in MatrixCare Create a process for capturing patient consent in MatrixCare

46 MILESTONES Create a process to send a CCD Create a process to receive a CCD Import a CCD into MatrixCare and display in a human-readable format Consume CCD information into MatrixCare resident records

47 PARTICIPATING ORGANIZATIONS Benedictine Health System MDI Achieve Allina Health Epic BHS - St. Gertrude s Health & Rehab Center Allina - St Francis Regional Medical Center

48 Key Elements of Implementation Experienced development personnel from our LTC software partner MDI Achieve Engaged, cooperative hospital partner Allina Health Funding - MN Dept. of Health Facilities willing to be our lab St. Gertrude s, St. Francis

49 PROJECT OUTCOMES CCDs are being exchanged electronically between St. Gertrude s St. Francis Capability for other locations using MatrixCare and Epic to exchange Readable CCD files are attached to resident records

50 PROJECT OUTCOMES CCDs can be generated for internal use care planning, visiting MDs/NPs, printed and sent with discharged residents, attachments for DIRECT Messaging Over 10,000 CCDs generated by BHS facilities in the first 6 months

51 PROJECT OUTCOMES Consuming the CCD only milestone not achieved Technically can be done but needs input from clinicians and legal Risks of auto-populating data Legal liability of using third party data Differentiating between our data and third party data

52 BARRIERS Funding LTC not eligible in HCR Learning curve standards, software development, user education Workflow changes for us and hospital partner

53 LESSONS LEARNED Workflow challenges may be more difficult than technical challenges Further development of standards needed for various LTPAC sectors incomplete solution today Encouragement given but limited funding and support for LTPAC

54 Post-Implementation: What Next? Find additional funding to develop further vendor development pace limited by provider s ability to pay Standards are lagging incomplete solution Create face sheet from CCD import With MA and MC cuts, LTC must create efficiencies

55 Post-Implementation: What Next? Extend functionality to other BHS locations with other Allina locations Expand connections to other LTC partners hospital systems, county services, etc. using mutually agreed upon methods Determine how other CCD information can be consumed in the EHR

56 INTEROPERABILITY Data Exchange Partners Software Capability Connection Method

57 QUESTIONS??

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61 I have a dream World's Oldest Paperboy Will Retire This Weekend After 70 years, over half a million deliveries, and a hip surgery, the world's oldest paperboy is finally ready to deliver his last paper this weekend.

62 Panel Discussion and Questions