HIE Patient Engagement Strategies Anjum Khurshid and Cameron Minich DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Learning Objectives Recognize the importance of patient engagement of HIE. Assess real world examples of a patient engagement effort. Evaluate important lessons learned when engaging patients.
Crescent City Beacon Community: Patient Engagement Strategies Anjum Khurshid, PhD, MD, MPAff
Conflict of Interest Disclosure Anjum Khurshid, PhD, MD, MPAff Louisiana Public Health Institute Director, Health Systems Has no real or apparent conflicts of interest to report. 2013 HIMSS
Beacon Communities Beacon Community of Inland Northwest Spokane, WA Western New York Beacon Community Buffalo, NY Bangor Beacon Community Brewer, ME Southeastern Minnesota Rhode Island Beacon Beacon Community Southeast Michigan Community Rochester, MN Beacon Community Providence, RI Detroit, MI Utah Beacon Community Salt Lake City, UT Colorado Beacon Community Grand Junction, CO Central Indiana Beacon Community Indianapolis, IN Keystone Beacon Community Danville, PA Greater Cincinnati Beacon Community Cincinnati, OH San Diego Beacon Community San Diego, CA Great Tulsa Health Access Network Beacon Community Tulsa, OK Hawaii County Beacon Community Hilo, HI Crescent City Beacon Community New Orleans, LA Southern Piedmont Beacon Community Concord, NC Delta BLUES Beacon Community Stoneville, MS
Beacon Community Goals Reduce the burden of chronic diseases, mainly diabetes and cardiovascular disease, by accomplishing the following goals: Improve the quality of care for chronic disease patients in patient-centered medical homes, enabled by HIT, to impact population outcomes for chronic disease; Reduce healthcare costs by decreasing preventable emergency department and inpatient visits through better coordination of care for chronic disease patients; and Engage consumers in the healthcare process by using innovative technologies
Overall Accomplishments Clinical Transformation Care Coordination Consumer Engagement Improve (Today 16 primary care practices caring for the under and uninsured) Build & Strengthen HIT (Optimizing EMR and exchanging health information supporting clinician defined best practices) Test Innovation (Deploying mobile Text4Health technology to engage individuals in diabetes care management)
PCMH and Clinical Transformation Implementation of 4 chronic care management interventions in 16 primary care practices: population-based disease registries, risk stratification, care management/care team strategies, clinical decision support Practice Coaching Learning Collaborative EMR Optimization NCQA Certification Clinical Seminar Series
Care Coordination System GNOHIE Mirth Results (CDR) Mirth Match (EMPI) Mirth Mail (Secure Mail) Mirth Care (Care Mgmt.) Mirth Analytics (EDW) ED/IP Notification Electronic Specialty Care Referral Birth Outcomes Behavioral Health Integration Analytics
GNOHIE Architecture
Transitions of Care Focus on improved care coordination across the healthcare delivery system to help ensure seamless transition of patients between primary care, specialty care and hospital-based settings. Areas of focus: Emergency Department/Inpatient Notification: Alerts and clinical information are sent to primary care providers about patient visits to emergency departments and hospital admissions. Electronic Specialty Care Referral: Referral requests and supporting documentation of the referring primary care provider are sent electronically to the specialist. Specialist s consult summaries are, in turn, provided electronically to the primary care provider. Includes telemedicine use case.
Strengths of the System The success and sustainability of Beacon efforts are based on community stakeholder involvement: Trust Engagement Ownership & Accountability
Patient Consent OPT-IN MODEL Exception = break the glass 1 consent form applies across all GNOHIE participants PATIENT ENGAGEMENT AND EDUCATION PROVIDER ENGAGEMENT PROVIDER WORKFLOW
Patient Engagement in the GNOHIE Necessary to notify PCP of ED or IP visit Two components to encourage this process: Staff training to engage patients and explain the benefits of the GNOHIE Patient-focused materials to clearly explain benefit of the GNOHIE
Staff Training for Patient Education Developed staff guidance documents and staff training protocol at LPHI Conducted trainings with FOS at participating clinics on how to collect and enter consent considering staff workflow Go-live technical assistance to ensure that FOS can appropriately describe the GNOHIE and are collecting consent properly Refresher trainings on gathering consent with FOS and continued dialogue on consent gathering barriers
Patient Education Materials Process for developing consent materials: 1. Satisfaction of legal requirements 2. Adjust reading level to 4-6 grade 3. Development of additional materials to discuss the sensitive data elements also adjusted to 4-6 reading level 4. Supportive patient materials brochures, posters, etc. to increase patient awareness of the GNOHIE and encourage enrollment 5. Translation of material in necessary languages: English, Spanish, French, Chinese, Vietnamese, Portuguese, Creole, and Arabic 6. Continued adjustment of materials in response to patient and staff feedback
Examples of Patient Materials
Iterative Engagement Process Refresher trainings with staff Discussion with staff at clinics on barriers to consent and reasons for opt-out Patient sensitivity to specific (e.g. share or partners ) Patient misconception about patient privacy and HIPAA Sensitive medical conditions/stigma Specific sub-populations opting-out (e.g. older patients vs. younger patients) Redevelopment and creation of patient supportive consent materials
Described value and benefits of GNOHIE through patient testimonials Shared videos with clinic partners for promotional purposes Patient Testimonials Promoted videos through various mediums (e.g., website, social media, community events) A resident of Greater New Orleans with a chronic illness shares her perspective on the value and benefits of the GNOHIE.
Demonstration of Patient Experience Described value and benefits of GNOHIE through demonstration of patient experience Shared videos with clinic partners for promotional purposes Promoted videos through various mediums (e.g., website, social media, community events) A transition of care demonstration with a resident of Greater New Orleans.
Patient Success Story Described value and benefits of GNOHIE through success stories Abigail s Interview Shared videos with clinic partners for promotional purposes Promoted videos through various mediums (e.g., website, social media, community events) Abigail, a RN from Daughters of Charity, shares a ED/IP notification success story.
Clinics, Hospitals and Healthcare Entities Common Ground Health Clinic Daughters of Charity Services of New Orleans EXCELth, Inc. Healthcare for the Homeless (City of Health New Orleans Health Department) Jefferson Community Health Care Centers Mary Queen of Vietnam/New Orleans East Louisiana Community Health Center NO/AIDS Task Force Odyssey House Louisiana St. Charles Community Health Center St. Thomas Community Health Center Tulane Community Health Centers 504 HealthNet Children s Hospital New Orleans Interim LSU Public Hospital Ochsner Health System West Jefferson Medical Center Tulane Medical Center Our Partners Vendors, Associations, Non Profits, and Governmental Entities Blue Cross Blue Shield of Louisiana Voxiva, Inc. Success EHS Primary Care Development Corporation Louisiana Department of Health and Hospitals City of New Orleans Health Department Louisiana Health Care Quality Forum (LaHIE) Louisiana Hospital Association Mirth Louisiana DHH Office of Public Health Walmart Metropolitan Hospital Council of New Orleans Novo Nordisk Community Organizations American Diabetes Association Communities of Color Network Louisiana Language Access Coalition McFarland Institute Neighborhood Partnership Network Southeast Louisiana Association of Diabetes Educators Vietnamese American Young Leaders Association of New Orleans
HIE Consumer Engagement Immunization Information System Cameron Minich
Conflict of Interest Disclosure Cameron Minich, Indiana State Department of Health Immunization Information System Manager Has no real or apparent conflicts of interest to report. 2013 HIMSS
HIE Consumer Engagement with Immunization Registries Identify the intersection of public and private HIEs with HIX, Medicaid and other healthcare reform initiatives Recognize the lessons that have been learned in the HIE space in the last 2 years Identify the elements of a successful HIE Distinguish the value that HIE brings to the patient
Where did we begin? Indiana State Department of Health Immunization Information System CHIRP Began in 2002 5,000+ Indiana Medical Providers 9,200+ Weekly users 42,000 daily HL7 messages 5 State of Indiana HIEs connected
Indiana HIEs Indiana Health Information Exchange IHIE Michiana Health Information Network MHIN Medical Informatics engineering MIE HealthBridge HealthLinc
Why the HIE to IIS Connection? Immunizations are the gateway Most medical facilities provide some kind of vaccine Flu vaccines HebB for birthing Hospitals Tetanus provided in ER Immunization is data needed for HEDIS and other quality assessment programs Stage 1 Meaningful Use Attestments - 65% Immunizations
Connecting the HIE to CHIRP Connecting to the registry and use of the HIEs is not mandatory Registry use is optional Connecting via the HIE is optional CHIRP is opt out Indiana HIEs are opt in
Successful HIE Established providers including both hospitals network and private medical facilities Bidirectional data flow Collecting specific information to produce accurate medical records Data sharing Consumer out reach, and HIE promotion
The HIE Timeline Testing began with 2 HIEs in November 2009 First successful production message January 27 th 2011 First bidirectional message April 18 th 2011 All 5 state of Indiana HIEs connected live May 2012 Surescripts and other HIEs
What makes a successful HIE Accurate Immunization Data Availability to Accurate Immunization Data Understand Accurate Immunization Data
How to engage the consumer? Do you need your vaccine history? Kids need a copy for school entry Individuals need for college and continuing education Employees need for proof of vaccination Flu vaccine requirements in Hospitals
How we did it Indiana HITEC Support Meaningful Use initiave
MyVaxIndiana Developed by ISDH as consumer portal that will allow individuals access to Immunization history Partnership with HIEs allows their providers to grant access to MyVaxIndiana through existing HL7 connections HIE
Consumer path through HIE
Information provided by MyVaxIndiana Print Official Record Download as a PDF file Download as an HL7 or XML for PHR upload NoMoreClipboard Microsoft Vault Mail to patient Fax to patient, or to someone on their behalf Includes ACIP recommended vaccine forecast
HIE Consumer Success June 2011 measles outbreak HIE participation in registry helped to control outbreak in two large exposures; workplace and school trip Having accessible online database of immunization records decreased the time necessary to assess consumer immunization status January 2013 Indiana birth dose HepB rates HIE connections through birthing hospitals allows accurate and timely reporting of birth doses
So what do the HIEs bring? Providers offices and hospital networks Immunization history Accurate data that consumer need Simplified point of contact and point of connection for medical providers
Thank You! Cameron Minich Application Systems Analyst Program Supervisor CHIRP Immunization Information System Manager cminich@isdh.in.gov Indiana State Department of Health 2 North Meridian Street, 3rd Floor Indianapolis, IN 46204 (317) 233-7073 Anjum Khurshid, PhD, MD Director, Health Systems akhurshid@lphi.org Louisiana Public Health Institute 1515 Poydras St, Ste. 1200 New Orleans, LA 70112 (504) 301-9800 www.lphi.org www.crescentcitybeacon.org