Frequently Asked Questions

Transcription

1 Frequently Asked Questions About PreManage The Oregon Health Leadership Council has formed a unique coalition of major stakeholders, including hospitals, health plans, Emergency Department (ED) physicians and the Oregon Health Authority (OHA), who are committed to addressing the issue of overutilization of ED services through the voluntary implementation of a technology solution called the Emergency Department Information Exchange, EDIE. The EDIE Plus Utility builds the foundation by collecting hospital event data and providing real-time notifications to emergency departments and limited, identified caregivers. PreManage is the natural evolution to more comprehensive care management across populations of patients and leverages the data and IT infrastructure in place with EDIE Plus. PreManage provides the mechanism to share hospital event information in real time directly with those responsible for care management and care coordination to improve care for complex patients and achieve the triple aim of better health, better care and lower costs. What is PreManage? PreManage provides real-time notifications of hospital events (including ED, inpatient and discharge utilization data) to those responsible for care management and care coordination of those patients. PreManage expands the services in EDIE to users beyond EDs and hospitals, by sending notification of hospital and ED utilization, care guidelines and discharge summaries to pre-defined health plans, Coordinated Care Organizations (CCOs), medical groups or physicians with the goal of dramatically improving communication of inpatient and emergency patient activity among all partners and clinicians involved in the care and care management of those patients. What Does PreManage Do? PreManage leverages the data collected via the statewide EDIE Plus Utility and shares that data in real time with the entities/providers responsible for managing and coordinating the care of the patient, based on pre-established criteria. The goal of PreManage is to provide concise, actionable utilization and care guidelines information in real time to those responsible for the care, care coordination and care management of those patients. Notifications are based on pre-defined criteria established by entity and delivered in the workflow of the care giver or case manager. How Does PreManage Work? All acute care hospitals in the state are currently on track to implement EDIE in 2014, and the OHLC collaborative will work with hospitals to add the Plus elements to which will add all inpatient admitting, discharge and transfer data to the ED encounter data collected under EDIE. Those parties responsible for the care management of a specific population of patients, such as CCOs, health plans, local health information exchanges (HIEs), medical groups or physician practices could contract with the vendor (Collective Medical Technologies (CMT)) to provide real-time notification and care guidelines for their panel or membership base. EDIE Plus/PreManage Business Plan DRAFT FOR REVIEW 7/02/14 1

2 We have identified three use packages where PreManage might be helpful, including: HIE Connect which would push all hospital encounter data to an HIE, who would then be responsible to notify their stakeholders; Provider Direct where providers contract directly with CMT to push notifications of all hospital activity on their specific panel of patients; and Health Plan/CCO Direct where a plan/cco contracts with CMT for notifications on hospital activity on their defined membership base. In each scenario, patient membership data is uploaded to CMT by the user (HIE, provider, plan, CCO). CMT performs a patient match using their proprietary matching software against the data collected via the EDIE Plus utility and returns notification data based on pre-defined criteria. What is the process to implement PreManage? To implement PreManage, health plans, CCOs, HIEs, or medical groups/physician practices must contract directly with CMT to subscribe to the service. The contracting organization is responsible to upload their patient panel or membership to CMT and establish notification and data sharing criteria. CMT is responsible for performing a patient match. Financing of the service is between CMT and the contracting organization. Data usage agreements are part of the contracting process and must conform to HIPAA regulations and Oregon standards developed and approved by the OHLC in partnership with the OHA and the Oregon Association of Hospitals and Health Systems. How will PreManage be implemented across Oregon? OHLC and its partners will facilitate implementation efforts including hospital participation to ensure the technology is in place to operationalize EDIE and EDIE Plus to collect all hospital event activity across the state (all ED data should be operational in EDIE by November 2014). Interested organizations will contract directly with CMT to subscribe to the PreManage service, adhering to all data usage agreements. When would PreManage be available in Oregon? PreManage will be available once a community is live on EDIE, but will be of greatest benefit when the common EDIE Plus Utility is universally implemented and operational across all 59 acute care hospitals. EDIE is intended to be fully implemented in Oregon by November 2014 for all ED data and adding the inpatient/discharge data has a goal of being fully implemented in all hospitals by the end of How will PreManage be funded? Each organization and community will determine if PreManage has value for them. Participating organizations will develop a contractual and financing arrangement for a PreManage subscription directly with CMT. There is nothing that restricts parties from sharing financing arrangements to achieve economies of scales for a common population of patients or notice requirements.

3 What is the State s role in EDIE, EDIE Plus and PreManage? OHA is a partner, supporting the OHLC effort to implement EDIE, EDIE Plus and PreManage. OHA provided seed funding in 2013 (funded from Oregon s Centers for Medicare & Medicaid Innovation, State Innovation Model grant), covering approximately half of the first year s cost for implementing EDIE, contingent on the agreement of the vast majority of Oregon hospitals to participate. OHA has identified real-time, statewide hospital notifications (such as those offered through PreManage) to be a top priority, high value service, necessary to support and optimize the CCOs efforts and the coordinated care model in Oregon. OHA staff advise and participate in planning efforts for EDIE, EDIE Plus, and PreManage, coordinate recommendations to Oregon s CCOs on their participation, and will be exploring in 2014/2015 leveraging federal and state funds to support the CCO/Medicaid share of costs. How does PreManage differ from the Transition of Care requirement included in the Meaningful Use Stage 2 Core? The Meaningful Use Stage 2 Transition of Care Core Measure requires eligible hospitals (EHs) and eligible providers (EPs) who transition their patients to another care setting or refers to another provider of care to provide a summary of care for each transition or referral. EHs and EPs must send a summary of care document on at least 50% of transitions or referrals (electronically or via paper/fax); at least 10% of the summary of care notices must be exchanged electronically between electronic health record (EHR) users regardless of the systems used; and at least one summary of care document must be sent electronically from one EHR system to a different EHR system (e.g., Epic to Cerner).The intent is to improve the coordination of care and to update a provider s EHR with the summary of care electronically, within their standard workflow. The intent of PreManage is also to improve the coordination of care and care management of individual patients as well as populations of patients. PreManage will send notices of ALL actual hospital activity (inpatient, admitting, discharge, and transfer events) vs. an order for a transition or referral. PreManage data is not necessarily intended to automatically update EHRs, but instead to notify directly those parties responsible for case management and care coordination with concise and actionable data. There are similar goals between the Meaningful Use Transition of Care requirement to exchange summary of care documents upon care transition or referral, but the data exchanged, the format of the data and who/how the data is received may be very different. Specifically, Meaningful Use requires that the summary of care document be created by a Certified EHR Technology (CEHRT ) solution in a certain format (CCDA) and then transmitted by that CEHRT solution using one of the transport mechanisms that are part of certification (e.g., Direct) or via the ehealth Exchange (formerly known as the NwHIN Exchange). However, at this time, PreManage is not a CEHRT solution, does not produce/send CCDAs, and is not part of the ehealth Exchange, so any exchange of information using PreManage cannot be counted by EPs or EHs toward their Meaningful Use Stage 2 Transitions of Care measures. Is PreManage duplicative of Care Everywhere? Care Everywhere, an Epic Systems corporation product, allows care providers to securely exchange patient medical information with other Epic systems, as well as with different EHRs that comply with certain industry standards. Normally, a provider working in a patient chart would query for outside

4 records at the time of care and pull other records information into their chart so they have a complete medical history and relevant data to best treat their patient. An outside records query can also be scheduled to occur automatically for scheduled patients with trusted partners. Other HIEs may serve the same function of sharing critical patient medical records information for the purposes of improved patient care and reducing unnecessary tests and procedures. PreManage is not considered an HIE, but is instead considered to be a notification system. PreManage provides care managers and providers the tools to know, in real time, which patients are in the ED, admitted and being discharged to allow for better coordinated care across a community of providers. PreManage pushes notices out based on pre-defined criteria rather than pulling in all clinical data to a patient s record. The primary users of Care Everywhere or other HIEs are typically clinicians to improve care. The primary users of PreManage are normally care managers or those responsible for care coordination. There may be some overlap in data stored and shared between Care Everywhere/HIEs and PreManage, such as care guidelines, diagnosis and discharge summaries, but the systems can be viewed as synergistic as opposed to duplicative. Is PreManage duplicative of Health Information Exchanges? Depending on the functionality that an HIE may have, PreManage could be duplicative and not required. If an HIE has robust care management functionality with automated notification to members already in place and adopted, PreManage may not provide much additional value. An HIE would normally have data from their member hospitals while PreManage will have data from all acute care hospitals in Oregon and Washington which may provide enough additional value to warrant adding PreManage data to the HIE. Each HIE and community will need to determine if there is a value proposition for PreManage. How will PreManage notices be delivered? Notification of all hospital activity impacting a member can be delivered multiple ways depending on the workflow of the individual being notified. CMT can support a variety of notification options, including Direct secure messaging, secure fax, printed reports, or direct interface into a CCO or Health Plan Case Management tool, a Health Information Exchange or an individual provider EHR. Who benefits from the PreManage service? Ultimately, we anticipate all Oregon patients will benefit from a reduction in fragmented care and more comprehensive and timely care management via real-time notification of ALL hospital activity to their care teams and case managers. We anticipate groups and entities that are at risk for costs and outcomes to benefit. PreManage will allow for the use of a common notification service that leverages data already collected. In real time, interested parties will receive notification of all ED and inpatient/transfer and discharge activity of their patients/members based on pre-defined criteria, resulting in improved care transitions, better coordinated care and lower costs. How does PreManage protect the privacy and security of patients? CMT has taken all necessary steps to be compliant with state and federal security and privacy regulations concerning personal health information. In particular, CMT has policies and processes

5 established with each user of PreManage to verify the relationship between the user and patients is covered under HIPAA for treatment, payment or operations. Whom should I contact if I want more information or want to participate? Contact [email protected]. The Oregon Health Leadership Council will be providing regular communication as EDIE is implemented in hospital EDs across Oregon and PreManage becomes available to Oregon stakeholders. If you would like to be added to the distribution list for these updates, or have suggestions for future communications, please [email protected].