LeadingAge Minnesota 2015 Institute and Expo OBJECTIVES. What is Health Information Exchange?

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1 2015 Institute and Expo Session #212 Interoperable Medical Records 101 Wednesday, February :30-3:30 p.m. Presenters: Erin Hilligan, Campus Administrator, Ebenezer Ridges, Burnsville Candy Hanson, Program Manager, Stratis Health, Bloomington Coral Lindahl, PointClickCare Coordinator, Ebenezer, Burnsville OBJECTIVES Share the basics of health information exchange Learn basic terminology HIE, HIO, HDI, HISP, HIE Bridge, CCD, C-CDA Explore workflow changes to improve transitions of care Share best practice stories opportunities and barriers to interoperability 2 What is Health Information Exchange? Health information exchange (HIE) occurs when two or more organizations electronically exchange health-related data HIE hubs move health care information electronically across health care organizations within a region, community, or system HIE systems increase participation of multiple providers in a patient s continuity of care 3 1

2 EMR vs EHR There is a Difference Electronic medical records (EMRs) are a digital version of the paper charts in the clinician s office. Electronic health records (EHRs) are a digital version and more. Ref: HealthIT.gov 4 What is Interoperability? Ability of two or more systems or components to exchange information and to use the information that has been exchanged accurately, securely, and verifiably, when and where needed The extent to which systems and devices can exchange AND INTERPRET shared data Not just talking to each other Exchange Interpret Present data in an understandable way 5 Why are HIE and Interoperability Important? Improved health outcomes including patient safety Better communication with patients, families, caretakers, and third-parties in transitions of care Empowered patients Streamlined practice processes and reduced duplication of effort Support for the Triple Aim Meaningful Use Incentive Payments 6 2

3 Benefits of Health Information Exchange Real time access to health records across care continuums Current and accurate health information More informed decision making at point of care Decrease in duplication of services Decrease in potential for error Improved patient outcomes Data Collection Ref: Computers, Informatics, Nursing, Volume 30(9), September 2012, p Hospital Readmissions One in five elderly patients will end up back in the hospital within 30 days Estimated cost $26 billion annually Estimated $17 billion spent on readmissions that could have been avoided Ref: Journal of AHIMA. June 25, New terminology for a new era HIE: Health Information Exchange HIO: HDI: HISP: Health Information Organization Health Data Intermediary Health Information Service Provider HIE-Bridge: Minnesota s HIO provider CCD: Continuity of Care Document (Summary Document) CCD-A: Consolidated Clinical Document Architecture Use Cases: Stories that describe problems that need to be solved 9 3

4 Minnesota 2015 Interoperable EHR Mandate By January 1, 2015, all hospitals and health care providers must have in place an interoperable electronic health record system within their hospital or clinical practice setting Ref: MDH Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate 10 Who Does the Mandate Apply To? Home Care Hospice Housing with Services settings that offer health care services Nursing Homes indicated as impacted Whether listed as a covered entity or not, the EHR Mandate affects all health care providers in some way 11 Minnesota Model for Achieving Interoperable Health Records Ref:

5 HIE in Minnesota 13 Assessing Your Readiness There s a Lot to Do in Preparation 14 How Can You BEST Prepare for the EHR/HIE Environment? Commit to establishing/sustaining an EHR/HIE culture Invest in resource(s) that lead to the EHR/HIE culture in your organization Assess your current EHR/HIE environment (computer skills survey, attitude s/belief survey, LeadingAge HIE Minnesota readiness) Get involved with your trade association Invest in the LeadingAge Series 15 5

6 Best Practices for EHR Optimization Organizations should consider investing in a Super User /nurse informaticist environment Find/establish best practices that support an electronic environment Use the resources/tools that are available to you now: ehealth/index.html Collaborate within your trade association for support and resources 16 EHRs and HIE can: Help health care providers and patients manage chronic diseases Facilitate more effective communication Reduce efforts in care transitions Improve patient safety with the right information to the right person at the right time Ref: Shaline Rao, et al. Primary Care: Clinics in Office practice. Vol 39. Issue 2. Pages Prescription for Action to Addressing Common Barriers to EHR Adoption Adopt (Assess Plan Select) Addressing barriers to getting started Addressing barriers related to start-up or on-going cost Addressing barriers related to clinical and administrative needs Addressing barriers related to data standards Addressing barriers related to privacy and security Addressing barriers related to staff skills Addressing barriers related to HIT support issues Utilize (Implement and Effective Use) Addressing barriers related to implementation n Addressing barriers related to effective use Exchange (Readiness for Exchange and Interoperate) Addressing barriers related to readiness Addressing barriers related to interoperability Ref:

7 Minnesota HITPAC: Centers for Medicare & Medicaid Services' Special Innovation Project: Health Information Technology for Post- Acute Care Providers (HITPAC) Collaboration between three Fairview Hospitals and 10 skilled nursing facilities 19 Minnesota HITPAC Communities Community 1A Fairview Ridges Hospital Fairview Southdale Hospital Augustana Minneapolis BHC Innsbruck Ebenezer Ridges LeadingAge Martin Minnesota Luther St. Gertrude's The Colony of Eden Prairie Community 1B Fairview Lakes Hospital Birchwood Health Care Ecumen North Branch GoldenLiving Rush City Margaret S. Parmly 20 Two Main Focus Areas: Transitions of Care Improving Medication Management Electronic Health Record/EHR towards Health Information Exchange/HIE 21 7

8 Focus our time ensuring: The right data is being exchanged -- Proper fields to produce meaningful Patient Assessment and Discharge Summary documents An acceptable container/document is being used for the data -- The ideal being a standards-based Continuity of Care Document (CCD), exchanged system to system An acceptable means of secure transport is used -- Exchange may already be happening, system-to-system; if not, a standards-based solution (such as Direct) may have to be brought into the solution set 22 Exchange Results 42 SNF to hospital test exchanges Two hospital to SNF test exchanges Two SNF to pharmacy test exchanges Actual health information exchanged achieved with PMR pilot participants 23 Coral s story 24 8

9 Lessons Learned Nursing homes are motivated to do this work Nursing homes have fewer resources for implementation There is a wide array of EHR functionality There currently exists largely hybrid health records (paper/electronic mix) in skilled nursing facilities (SNFs) There is much optimization work to do 25 Lessons Learned (continued) View only access does not equal interoperability (although it is an HIE strategy to get there) The span of long term post acute care (LTPAC) vendors who can produce a CCD is variable Laws and rules that pre-date EHR use contribute to problematic workflows Current hybrid processes actually slow down care transitions 26 Lessons Learned (continued) The value of interoperability still needs to be realized Privacy and security practices in an EHR/HIE environment will continue to need much attention Workflow issues will need solutions quickly to advance health information exchange across the industry 27 9

10 SIM PIPP Our Future 28 Resources Guide 1: Addressing Barriers to EHR Adoption Guide 2: Recommended Standards Guide 3: e-prescribing Guide 4: Effective Use of EHRs Guide 5: Health Information Exchange 29 Discussion / Questions Erin Hilligan Campus Administrator Ebenezer Ridges ehillig1@fairview.org Candy Hanson Program Manager LeadingAge Stratis Minnesota Health chanson@stratishealth.org Coral Lindahl PointClickCare Coordinator Ebenezer codell1@fairview.org