Health Information Exchange Use Cases and Best Practices Keely Benson, ehealth Community Manager at MeHI Dr. Larry Garber, MD, Director of Clinical Informatics at Reliant Medical Group Jay Caturia, Project Manager at Winchester Highland Management
Welcome Agenda Meaningful Use of the Mass HIway- Dr. Larry Garber Getting elinc (Private HIE) on the Mass HIway, Jay Caturia Q & A (15-20 minutes) Please hold your questions until the presentations have been completed If we don t get to your question, please leave question with contact information in the box at the registration table. 2 Massachusetts ehealth Institute
Reliant Medical Group MeHI Regional Meeting Dedham, MA November 17 th, 2015
500+ provider multi-specialty group practice 25 sites in central and metrowest Massachusetts 300,000 patients with over 1 million visits/year Not affiliated with any hospitals Not-for-profit All sites/specialties live with Epic EHR since 2007 99% Achieved MU Stage 1 90% Achieved MU Stage 2 in 2014 On track to have 99% achieve MU Stage 2 in 2015 4
Perform Medication Reconciliation Public Health Reporting Transitions of Care/Summary View/Download/Transmit 5
Patient discharged from St. Vincent Hospital or Milford Regional Medical Center C-CDA Discharge is sent via MA HIway Reliant EHR routes to PCP s EHR InBasket Meds available in EHR for F/U visit 6
At the end of each encounter, EHR checks to see if any immunizations were entered (historical) or given Automatically generates a message which is sent via MA HIway using Direct to MA Dept of Public Health s MA Immunization Information System 7
At the end of each encounter, EHR automatically generates a CCD for the encounter (includes meds, diagnoses, recent lab/rad results, procedures, etc ) Sends CCD to MAeHC s (MA ehealth Collaborative) Specialty Registry via MA HIway using Direct MAeHC generates Quality Reports DISCLOSURE: I am MAeHC s Chair 8
Provider orders a referral in EHR Provider selects destination which sends a CCD via MA HIway using Direct 2015 Epic Systems Corporation 9
90 seconds after ED registration, Reliant s CCD is automatically loaded into ED s EHR St. Vincent Hospital or Milford Reg Med Ctr ADT for Reliant Patients Reliant Medical Group s Epic EHR CCD with Hospital MRN CCD with Hospital MRN Outside Record Icon in MedHost Bedboard blinks 10
Patient desires to have a CCD Summary sent to another MA HIway provider Types.SendCCD and selects destination which is sent via MA HIway using Direct 2015 Epic Systems Corporation 11
CCD PCP Home Health CCD Hospital CCD SEE CCD KeyHIE Transform Billing Program MDS MDS Nursing Facility 12
Care Manager EMS CCD PCP CCD ASAPs and LTSS Home Health CCD Acute and 42 CFR Part 2 Hospital CCD SEE CCD Registration (ADT) CCD via MA HIway ( Direct message) Subscribed Alerts Nursing Facility 13
MA HIway helps satisfy MU of EHRs: Perform Medication Reconciliation Public Health (Immunizations and Specialty Registries) Transitions of Care/Summary View/Download/Transmit Event Notification Services will further enhance quality and safety of transitions 14
Larry Garber, MD Lawrence.Garber@ReliantMedicalGroup.org 15
Jay Caturia Project Manager Winchester Highland Management, LLC
MeHI Last Mile Implementation Grant: Winchester Home Care Project to Support Home Care Alternatives to Higher Cost Post-Surgical Services Winchester Highland Management Part I 17
elinc Health Information Exchange (HIE) Highland Management, LLC is a joint venture of Winchester Hospital, a member of Lahey Health, and the Winchester Healthcare Associates IPA. elinc is a private community Health Information Exchange (HIE) that provides services to the hospital and the IPA as its primary stakeholders. elinc : electronically Leveraging information Improving care Networking providers, and Communicating with each other 18
Winchester Community - Current Environment Community comprised of 400 Winchester Hospital and Independent Providers Roughly two dozen EHR products in use communitywide 98% overall ambulatory EMR provider adoption 65% ambulatory market penetration by eight vendors: Allscripts Professional Athena Clinicals eclinicalworks Greenway Intergy MDIntellesys NextGen NexTech McKesson Practice Partners 19
HIE Functions The elinc HIE supports two complementary, but independent functions: Secure Messaging Longitudinal Patient Clinical Data Repository Both functions are intended to support full EMR integration, but can be accessed via web-based provider portals 20
MeHI Last Mile Implementation Grant: Winchester Home Care Project to Support Home Care Alternatives to Higher Cost Post-Surgical Services The Project and Use Cases Part II 21
Home Care Alliance of MA Innovations Showcase and Star Awards Winchester Last Mile Home Care grant was selected as a Home Care Innovator by the Home Care Alliance of MA in April 2014 at the John F. Kennedy Presidential Library and Museum in Boston. 22
HIway Implementation Grant: Round One Winchester Hospital Joint Program grant awarded in 2014 Goal: increase use of Home Care services for post-surgical procedures over days in a Skilled Nursing Facility. Strategy: employ Secure Messaging to Increase patient engagement through enrollment in post-surgical treatment seminars featuring choices for home care services Patient education was done through Joint Program classes Improve timely exchanges of Transition of Care documents to increase patient exposure to home-based care options for post-surgical rehabilitation following join replacement procedures. Pilot Sites: Excel Orthopedics - orthopedic specialty practice Winchester Hospital Home Care Winchester Hospital Pre-Admission Testing 23
The primary tool was DIRECT Messaging Use Case: Pre-Admission Testing Excel Orthopedics and the Pre-Admission Testing Department electronically exchanged Demographic and Insurance Information, Surgical Order packets, scanned, signed Orders and relevant Surgical Booking forms. DIRECT Messaging was substituted for the traditional methods of mail and fax. Delays in communication that normally result when documents are lost in route, unfiled or unacknowledged were significantly reduced. Participants reported improved care coordination through more timely exchanges in Transition of Care documents. The incidence of surgical re-scheduling due to incomplete Surgical Packets were markedly reduced. 24
The primary tool was DIRECT Messaging Use Case: Home Care Services Prior to surgery, Excel and the Home Care Department electronically exchanged demographic information of patients who elected to attend a Winchester Hospital Joint Class. Timely, electronic notifications allowed the Home Care team to increase participation in the Winchester Hospital Joint Class. Increasing the number of patients who are discharged directly from the inpatient unit to Hospital Home Care services decreased the number and length of SNF for post-acute days. Following Hospital discharge, the Home Care Department electronically transmitted nursing notes back to Excel. Nursing notes assist Excel surgeons in tracking patient progress to support follow-up visits, on-going treatment orders, PCP communication and interceptions of possible hospital re-admissions 25
MeHI Last Mile Implementation Grant: Winchester Home Care Project to Support Home Care Alternatives to Higher Cost Post-Surgical Services The Mechanics of the Grant Part III 26
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The Project Stakeholders End Users: PCPs and Surgical Specialists Hospital Surgical Services, Home Care, and ACO Departments MeHI Executive Office of Health and Human Services (EOHHS) MA HIway On-Boarding Team EHR Vendors and various HISP partners Various Legal Teams 28
Stakeholder Requirements: End Users Supportive of Office of the National Coordinator ( ONC ) Meaningful Use & Evolving Industry Reporting Requirements for Transition of Care Lowest possible impact on the workflow and workload of the support staff and physicians Control of excessive administrative burdens and costs Fewest steps or clicks possible Integration of all message traffic in or out of practice EMR Full integration of DIRECT Messaging functions into a Longitudinal Clinical Repository to support physicians with non-interfacing EMRs. 29
Stakeholder Requirements: MeHI, EOHHS and MA HIway On-Boarding Teams Beginning with the on-boarding process: HIway End User Participation Agreements HIway Vendor Participation Agreements allowing for HISP HISP transactions Exchanging and Testing of Root Certificates and Trust Anchors Exchange of HISP Provider Directories Patient Consent Form and Signature Collection Process 30
Responses to Stakeholder Requirements: HIway - End User Participation Agreements MA HIway proposed to require each physician to sign HIway - End User Participation Agreement. Winchester community participants in the Highland Management (HM) elinc network are required to sign an elinc Participation Agreement in order to access, use and disclose PHI through elinc. Working closely with the Legal Council for EOHHS, HM has authority to transfer the PHI of elinc participants across the HIway pursuant to the HIway-eLINC Participation Agreement. Individual providers are not required to sign an additional MA HIway Participation Agreement. 31
Responses to Stakeholder Requirements: HIway - Vendor Participation Agreements MA HIway originally proposed to require each HISP vendor to accept the HIway Root Certificate, Trust Anchors and DIRECT addresses. In support of the elinc Multi-Entity HIE proposal, the HIway made accommodations for HISP HISP transactions: Secure Exchange Solutions was allowed to sign a Vendor HIway Participation Agreement prior to the exchange of security credentials. A method of Provider Directory exchange was adapted for use between the HIway and third-party HISP vendors. 32
Responses to Stakeholder Requirements: Patient Consent Form and Signature Collection Process Section nine (9) of Massachusetts Chapter 224 act of 2012 requires the capturing of patient consent to opt-in to HIway sharing. Working closely with the Legal Council for EOHHS, HM has developed one universal Patient Consent form and collection process acceptable for use with both the MA HIway and the elinc HIE Repository. Patient consent is collected once per patient within the network and will be available in a central registry. 33
Responses to Stakeholder Requirements: Supporting Transition of Care Redirecting SNF stays with Home Care Services Excel Orthopedics successfully exchanged Surgical Scheduling Requests & Booking Packages with the Winchester Pre-Admissions Testing Dept for patients requiring joint replacement surgery. Excel Orthopedics successfully exchanged referrals to a Patient Education Programs with the Winchester Home Care for patients interested in Home Care alternatives to a SNF placement. Winchester Home Care successfully transmitted Home Nursing Notes to the Excel Orthopedics to support patient follow-up care and interceptions of possible hospital re-admissions. 34
MeHI Last Mile Implementation Grant: Winchester Home Care Project to Support Home Care Alternatives to Higher Cost Post-Surgical Services Concurrent and Post-Grant Expansion Part IV 35
Concurrent and Post-Grant Expansion Efforts Responses to Ongoing Stakeholder Concerns & Requirements End User: Transitions of Care As an add-on to the grant, an interface was developed to add nursing notes to the workflow of the pilot sites, thereby assisting Excel Orthopedic surgeons in tracking patient progress, to support follow-up visits, on-going treatment orders, PCP communication and interceptions of possible hospital re-admissions. Winchester PCPs are increasing the use of DIRECT Messaging to transmit Consult and Referral requests and relevant documents to Specialists. Likewise, Specialists are beginning to use DIRECT to close-the-loop with timely Consult and Referral notes. Notifications of Patient Admissions and Discharges with accompanying Discharge Summaries were sent from the Winchester Hospital and Emergency Departments electronically via DIRECT Message to PCPs and ACO Care Managers 36
Concurrent and Post-Grant Expansion Efforts Responses to Ongoing Stakeholder Concerns & Requirements End User: Transitions of Care Winchester Hospital s Home Care grant provided proof of concept to support the reduction of post-surgical costs through the substitution of Rehab or SNF care with Home Care services. Highland Management has been in discussions to extend the use of DIRECT messaging for Home Care Services beyond the grant to other practices and community-based, LTC service providers. Highland Management has been in discussions with other hospital surgical service departments to expand the use of DIRECT Messaging beyond the grant to other independent surgical practices. Winchester PCPs are interested in Notifications of Admissions and Discharges of patients from surrounding community Hospitals. 37
Concurrent and Post-Grant Expansion Efforts Responses to Ongoing Stakeholder Concerns & Requirements HIE Partner eclinicalworks and Contributing EMR Vendors Longitudinal Patient Clinical Data Repository High variability in functional requirements exist across vendors in supporting CCDA/CCD interoperability with a Central Clinical Data Repository HM is working with the interoperability teams of each of the Community-wide EMRs and eclinicalworks. Advancements have been made toward standardizing functional requirement to support CCDA/CCD direct interfaces with our Central Clinical Data Repository. Some EHR vendors continue to lag behind in supporting full interoperability with the a Central Clinical Data Repository. eclinicalworks is working on a Product Enhancement Requested to offer full integration of DIRECT Message functions into a Longitudinal Clinical Repository to support exchanges of comprehensive, consolidated medical records with non-interfacing EMRs. 38
Concurrent and Post-Grant Expansion Efforts: Responses to Ongoing Stakeholder Concerns & Requirements: EMR Vendors and various HISP partners Ongoing work is required of EHR vendors to improving their capacity to support basic DIRECT Message functions such as: Directory and Message Exchanges with MA HIway account users Capacity to generate and consume messages exchanged among practices using DIRECT through any HISP: Limitations exist in Message Payload Types and Sizes Differences in functional requirement exist for CCDA/CCD interoperability among community EMR vendors using DIRECT Gap still exist in the transmission of required MIIS Immunization and Registry data via the MA HIway 39
Concurrent and Post-Grant Expansion Efforts Responses to Ongoing Stakeholder Concerns & Requirements EMR Vendors and various HISP partners HM has been working with the MA HIway Operations team to improve the interoperability of community, ambulatory-based EMRs and their HISP partners to increase the types of payloads that can be exchanged as well as the capacity of EMR vendors to generate and/or consume transportable documents via DIRECT Messaging. In support of DIRECT message and DPH Immunization & Registry MA HIway transmission requirements, HM has been working with the MA HIway Operations and DPH MIIS teams to facilitate data exchange with each of the various EHR vendors in our Community. 40
Thank you 41
Contact Us Keely Benson, ehealth Community Manager Email: benson@masstech.org Phone: 617-371-3999 x241 42 Massachusetts ehealth Institute