HIE s and Patient Portals

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1 Page 1 HIE Markets

2 HIE s and Patient Portals Joined at the Hip but Poorly Understood Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Patient Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 2

3 Traditional HIT Systems Trap Patient Data in Silos Health System Info Technologies Health information is contained in disparate silos yet Patient care is provided in the context of a community Fragmented health information disrupts continuity of care that jeopardizes quality and increases costs Patient health information must be liberated, shared, aggregated, and analyzed to facilitate better care decisions Current reach of population health is bounded by the provider s IT systems Page 3

4 Health Information Exchange Defined Health Information Exchange (HIE) An electronic movement of health-related information among organizations utilizing nationally recognized standards and policies.* But, there are many different types of exchanges. *Source: HIMSS HIE Fact Sheet (1/19/2011) Page 4

5 HIE Markets Private Page 5 Serves Integrated Delivery Networks (IDN), health systems and/or hospitals Fastest-growing market segment of HIE Characterized by economic sustainability Not encumbered by data governance and organizational issues Regional Serving states, Regional Extension Centers Predominantly government-funded Federal Serving Federal agencies such as Veterans Affairs, the Department of Defense, and the Social Security Administration Nationwide Health Information Network (NwHIN) highway for connectivity NwHIN Exchange NwHIN Direct

6 Public vs. Private: Precarious Sustainability vs. Clear ROI Health Information Exchanges Live (P) 2013 (P) Public HIEs Private HIEs Source: Private HIEs Outpace Public Ones, special KLAS report via Health Market Science Page 6

7 Public vs. Private: Precarious Sustainability vs. Clear ROI PUBLIC PRIVATE Objective Promotes health within a geographic or political boundary Promotes health across a well-defined care community Funding Relies heavily on federal and state grants Relies on free market dynamics Sustainability Left to the whims of the political process and public funding Clear ROI The invisible hand of self-interest Governance Care communities cross political and economic boundaries making governance very difficult Care communities often overlap competition first, then cooperation Bottom Line A well-intentioned top-down approach challenged by a precarious business model Aligns the community with the HIE sponsor while enhancing care and delivery economics Page 7

8 Why HIE? Regional Perspective Patient complains of chronic back pain in Somers Point Physician prescribes OxyContin Patient complains of arthritis in Bridgeton Physician prescribes OxyContin Patient complains of chronic neck pain in Camden Physician prescribes OxyContin Patient complains of severe arthritis in Woodbury Physician prescribes OxyContin Patient complains of Reflex Sympathetic Dystrophy in Flemington Physician prescribes OxyContin The absence of an on-demand universal view of the patient s clinical record opens the door to abuse and high-dollar emergency visits. Page 8

9 Why HIE? Federal Perspective A Philadelphia resident vacations at the Jersey shore She is stung by a jellyfish at the beach The ER physician at the Jersey shore needs real-time access to list of allergies and current medications Physician launches portal with access to NwHIN gateway where Regional Medical Center has a sharing relationship with Mainland Health Federal initiatives such as NwHIN will allow for records to be requested from facilities anywhere in the U.S. Page 9

10 Private Exchanges Long Term Care Employed Practices Affiliated Practices Orders Alerts Labs Transcription Hospital Patients Partner Hospital Referrals Radiology Reports ED Summary L&D Outpatient Lab Public HIEs, State, NwHIN Home Health Data delivery via portals Clinical results Administrative data Workflow Secure, online collaboration Referrals Care transitions Program support Community outreach and provider alignment PCMH, ACO, etc. Analytics Outcomes, quality, alignment Page 10

11 Typical Private Exchange Architecture Acute Care Cloud Based Employed Physicians Hospital Intelligence Engine Primary Care Clinical Data Clinical Data HPD / Provider Repository Repository Directory Specialist (e.g., Nephrologist) Affiliated Physicians Dialysis Services Patient Patient Index Index Patient Portal Provider Index/HPD Provider Index Clinical Portal Clinic Rehab HISP* / Interop Services Affiliated Physicians Outpatient Lab Primary Care Surgery Center Home Health Hospice Patient & Family Engagement External Exchanges ehealth Exchange DIRECT / CONNECT Registry and Surveillance Reporting Reporting / Analytics Specialist Clinic / SNF Home Health Page 11 *HISP service available in version 4.3

12 Beyond the Private HIE: Exchanging with the Outside Employed Practices Hospital Patients Home Health Cross HIE On-Ramp NwHIN (Direct) IHE Profiles State Protocols Federal Agencies Other Private HIEs State Registry State HIEs Affiliated Practices Partner Hospital Outpatient Lab Regional HIEs Vendor / Service HIEs The Private HIE manages high-frequency transactions necessary for local care coordination AND links to external players via new interoperability and technology standards. Page 12

13 Today s Agenda Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Patient Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 13

14 MU 2014 Edition Stage 1 and Stage 2 MU Objective: Ability to view online, download, and transmit information about a hospital admission MU Stage Health Outcome s Policy Priority Set Objectives - Eligible Hospitals and CAHs (EH/CAH) MU Stage 2 Engage patients and families in their health care Core Provide patients the ability to view online, download, and transmit information about a hospital admission MU Stage 1 Final Rule 7/23/2010 (Display version) Page # EHR Incentive Program Stage 2 Final Rule 8/23/12 (Display Version) Commentary Page #s Requirement EHR Incentive Page Program #s Stage 2 Final Rule Commentary Pages: Requirement Page: 639 Applications Used for Stage 1 Certification** & Applications Used for 2014 Edition Certification** Soarian Clinicals R3.4 SP2 (Common Clinicals, Clinical Team, Physician) Advanced Interoperability Service (AIS) Mobile MD 4.3 Patient Portal Applicable Function Comments and Implementation Considerations Clinical Letter MobileMD Patient Portal with AIS to view, download and transmit functions as well as two (2) automated measure reports. Transport Options - Customers must use the Direct SMTP Protocol: requires MobileMD HIE or other certified exchange infrastructure with AIS Siemens Recommended Best Practices Implementation of the exchange infrastructure as well as the plan to meet the thresholds should be in place in 2013 so 2014 is reserved for final implementation of secure messaging, the C- CDA generation and receipt workflow, and the exchange testing. Page 14

15 MU 2014 Edition Stage 2 MU Objective: Transition of Care or Referral MU Stage Health Outcomes Policy Priority Set Objectives - Eligible Hospitals and CAHs (EH/CAH) MU Stage 1 Final Rule 7/23/2010 (Display version) Page # EHR Incentive Program Stage 2 Final Rule 8/23/12 (Display Version) Commentary Page #s Requirement Page #s Applications Used for Applicable Function Stage 1 Certification** & Applications Used for 2014 Edition Certification** Comments and Implementation Considerations Siemens Recommended Best Practices MU Stage 2 Improve care coordination Core The eligible hospital or CAH EHR Incentive Program who transitions their patient to Stage 2 Final Rule another setting of care or Commentary Pages: 176- provider of care or refers their 204 patient to another provider of Requirement Pages: 640- care provides a summary care 641 record for each transition of care or referral Soarian Clinicals Clinical Letter R3.4 SP2 (Common AIS Clinicals, Clinical MobileMD HIE Team, Physician) Advanced Interoperability Service (AIS) Mobile MD 4.3 HIE Transport Options - Customers must use the Direct SMTP Protocol: requires MobileMD HIE or other certified exchange infrastructure with AIS Referrals require addressing to intended recipient(s) and require implementation of the new secure messaging functionality. Receipt of referral summary of care records will be routed to intended recipients in Soarian Clinicals. Implementation of the exchange infrastructure as well as the plan to meet the thresholds should be in place in 2013 so 2014 is reserved for final implementation of secure messaging, the C- CDA generation and receipt workflow, and the exchange testing. Page 15

16 Today s Agenda Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Patient Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 16

17 Patient Engagement Stage 2 Objectives Stage 2 Measures Provide patients the ability to view online, download More than 50% of all (EP unique) patients provided and transmit information about a hospital admission information; EP within 4 business days of EP having (EH) or their health information (EP). Replaces the information; EH within 36 hours of discharge. Stage 1 objective in 2014 to provide patients More than 5% of unique patients do view. Electronic copy of discharge instructions (EH) and Timely electronic access to health info (EP) Use Certified EHR technology to identify patient specific education resources and provide to patient More than 10% of all unique patients admitted to IP/ED (EH) or with 2+ office visits in 24 months (EP) Generate and send reminders (EP) More than 10% of all unique patients provided Provide clinical summaries for each office visit (EP) More than 50% of office visits within 1 business day Use secure electronic messaging to communicate More than 5% of all unique patients with patients (EP) Soarian Features Consolidated CDA Document will be produced in the required format natively in Soarian MobileMD Patient Portal including Automated Measure Report Patient education via HL7 Info button for discharge medications, problems, lab results Services MU Security and Privacy Assessment MU Clinical Process Optimization MobileMD / AIS Implementation Services C-CDA Implementation Services Page 17

18 Industry Background (source: Advisory Board) Page 18

19 Strategic View: Person Engagement Person engagement provides consumers with access to tools and information to actively participate and manage their health and wellness, care, benefits, and financial situation. The difference between patient engagement and person engagement is that person engagement has additional focus on wellness, managing care, and being a patient less. Wellness Community Patients and Advocates Page 19

20 Engaging the Patient Hospital Patient Portal Engaging patients in their healthcare is a critical aspect of care delivery today Care planning Wellness and awareness programs Post-discharge compliance and preventable readmits Affiliated Practices Patients and Advocates Outpatient Lab Enabling community-wide views and dialog between patients and their providers is a competitive necessity View patient records via the infrastructure, regardless of organizations, settings, or EMR systems Employed Practices Send messages between patients and any participating provider on the network Control access to information flowing across the infrastructure Page 20

21 Multiple Patient Access Points Confusing for Patients Acute Care Clinical EMR Lab Financial / Billing Login / Password Login / Password Login / Password Login / Password? Patients and Advocates Login / Password Typical design of Multiple EMR/EHR PP deployed across the community. Requires provisioning into multiple systems with many logons, different UI s and Bill Pay Systems. Physician EMR 1 Physician EMR 2 Outpatient Lab Urgent Care EMR Page 21

22 Community (HIE) based Patient Portals Provide Patients with a Single Access Point Login / Password Acute Care Clinical EMR Lab Financial / Billing CCD / C-CDA Lab Rpts Secure Messaging Secure Messaging Secure Access / Provisioning Portal Data Repository Interoperability Gateways Patients and Advocates Patient portals aggregate clinical data from disparate EMRs across the care community. Physician EMR 1 Physician EMR 2 Outpatient Lab Urgent Care EMR Page 22

23 Today s Agenda Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Patient Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 23

24 Technology Maturity Care Management/Population Health The End Game Example Applications Maturity Stage ACO Population Health Management Disease Management - Advanced Population Analytics - Contract & Risk Management - Financial Business Intelligence - Care Management - Disease Specific EBM - Clinical Business Intelligence - Telemonitoring Transformation Community Care Coordination - Referral Management - Patient Registries - Transitions of Care - Cross Venue Outcomes Reporting Provider HIE & epatient Engagement - HIE & Pt. Portals, Social Media and mobile solutions - Community MPI - Secure Communication Tools Clinical Integration Ambulatory EMRs & Ancillaries - Ambulatory EHR - Performance Analytics - emeasures & erx - Practice Management Page 24 Acute Care EMRs & Ancillaries - Acute EMR - emeasures - Mobile Devices Consolidation Source: AHA Center for Healthcare Governance

25 The Solution for Care Management Person-centered data repository across disparate IT systems Population analytics to identify at-risk patients, monitor care outcomes, and help minimize financial risk Workflow technology to help automate evidence-based care processes, coordinate expanded care team activities, and trigger timely, actionable interventions that engage the patient Care Management leverages cloud computing to connect and inform every provider in the care community regardless of their EHR. 20XX-XX- XX

26 Today s Agenda Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Patient Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 26

27 Customer Success Dignity Health, San Francisco CA 1,651 Practices CONNECTED 6,275 Clinicians CONNECTED 5,239,951 Patients CONNECTED Page 27

28 Sacramento HIE Hospital Affiliated Physicians Dialysis Services Rehab Acute Care 4 Hospitals 2.7 million HL7 messages exchanged per month 414 Practices with Clinician Portal access 59 EMR Connections with Practices MobileMD Intelligence Engine Clinical Data Repository Intelligence Engine HPD / Provider Directory Patient Provider Index Index Provider Patient Patient Index Clinician Index Portal Portal Clinician Portal HISP / Interop Services 8,800 Skilled Nursing Facility Referal secure messages exchanged Employed Physicians Primary Care Specialist (e.g., Nephrologist) Clinic Affiliated Physicians Outpatient Lab 1.1 Million Patients 700 Referral/Consult Request secure messages exchanged Primary Care Surgery Center Home Health Hospice Patient & Family Engagement External Exchanges ehealth Exchange DIRECT / CONNECT Registry and Surveillance Reporting Reporting / Analytics Specialist Clinic / SNF Home Health Note: All reported statistics are for reporting period of 1/1/2013-8/28/2013 Page 28

29 HIE Statistics HIE Active Physicians Distinct Patients Arizona 1, ,524 Bakersfield ,775 Bay Area ,025 Central Coast ,790 Henderson ,445 Merced ,307 North State ,286 Sacramento 1,228 1,170,244 San Bernardino ,199 Sequoia ,793 Southern California ,410 St. John's ,831 Stockton 432 1,127,748 Enterprise Totals 7,145 5,453,377 Page 29

30 Today s Agenda Introductions Health Information Exchanges MU Drivers for Adoption Person Engagement/Portals Care Management/Population Health Use Cases / Customer Snapshot Questions Page 30

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