How to Exchange Health Information to Improve …care they received. O’Malley A and Cunningham P....
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10/23/2014 1 How to Exchange Health Information How to Exchange Health Information to Improve Care Transitions to Improve Care Transitions Greg Cavanaugh Greg Cavanaugh y Over 25 years in health care IT y Masters in Healthcare Administration y Masters in Healthcare Administration y Adjunct Professor at Baker College y Over 25 years working with Big Brothers y Education Committee for the Michigan Association of Home Care Association of Home Care
Transcript of How to Exchange Health Information to Improve …care they received. O’Malley A and Cunningham P....
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How to Exchange Health Information How to Exchange Health Information to Improve Care Transitionsto Improve Care Transitions
Greg CavanaughGreg Cavanaugh
Over 25 years in health care ITMasters in Healthcare AdministrationMasters in Healthcare AdministrationAdjunct Professor at Baker CollegeOver 25 years working with Big BrothersEducation Committee for the Michigan Association of Home CareAssociation of Home Care
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Ben GarvinBen Garvin
CEO, Global Home Care13 years in Home Health Industry13 years in Home Health IndustryBSEE PBA
Mike DeckMike Deck
Home Health Care Management for 15 yearsState Licensed Assisted Living Facility creationConsultant to Physician group for 5 years Consultant to Physician group for 5 years Husband of 1, Father of 2.Nationally ranked 302SSH Driver
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Agenda:Agenda:
History of the push of EMR, EHR and incentivesincentivesExplanation of a Health Information ExchangeReal World Examples of useQuestions and AnswersQ
2009 Legislation2009 Legislation
SEC. 13001. SHORT TITLE; TABLE OF CONTENTS OF TITLE.
(a) SHORT TITLE.—This title (and title IV of division B) maybe cited as the ‘‘Health Information Technology for Economic and
Clinical Health Act’’ or the ‘‘HITECH Act’’‘‘SEC. 3000. DEFINITIONS
‘‘In this title‘‘(3) HEALTH CARE PROVIDER.—The term ‘health care
provider’pincludes a hospital, skilled nursing facility, nursing
facility, home health entity or other long term care facility,health care clinic, community mental health center (as defined
in section 1913(b)(1)).
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HITECH PAYMENTSHITECH PAYMENTS‘‘(o) INCENTIVES FOR ADOPTION AND MEANINGFUL USE OF CERTIFIEDEHR TECHNOLOGY.—‘‘(1) INCENTIVE PAYMENTS‘‘(1) INCENTIVE PAYMENTS.—‘‘(A) IN GENERAL.—‘‘(i) IN GENERAL.—Subject to the succeeding subparagraphs of this paragraph, with respect to covered professional services furnished by an eligible professional during a payment year (as defined in subparagraph (E)), if the eligible professional is a meaningful EHR user (as determined under paragraph (2)) for the EHR reporting period with respect to such year, in addition to the amount otherwise paid under this part, there also shall be paid to the eligible professional (or to an employer or facility in the cases described in clause (A) of section 1842(b)(6)) from the Federal Supplementaryclause (A) of section 1842(b)(6)), from the Federal Supplementary Medical Insurance Trust Fund established under section 1841 an amount equal to 75 percent of the Secretary’s estimate (based on claims submitted not later than 2 months after the end of the payment year) of the allowed charges under this part for all such covered professional services furnished by the eligible professional during such year.
Did someone say $?Did someone say $?
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Someone say money?Someone say money?
How about Home HealthHow about Home Health‘‘(A) The term ‘certified EHR technology’ means a qualified electronic health record (as defined in 3000(13) of the Public(as defined in 3000(13) of the Public Health Service Act) that is certified pursuant to section 3001(c)(5) of such Act as meeting standards adopted under section 3004 of such Act that are applicable to the type of record involved (as determined by the Secretary, such as an ambulatory electronic health record foran ambulatory electronic health record for office-based physicians or an inpatient hospital electronic health record for hospitals).
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How about Home HealthHow about Home Health‘(B) The term ‘eligible professional’ means a—‘‘(i) physician;(i) physician;‘‘(ii) dentist;‘‘(iii) certified nurse mid-wife;‘‘(iv) nurse practitioner; and‘‘(v) physician assistant insofar as the assistant is practicingin a rural health clinic that is led by ain a rural health clinic that is led by a physicianassistant or is practicing in a Federally qualified health
center that is so led.
What’s Meaningful Use?What’s Meaningful Use?
CMS recently released meaningful use Stage 2 which intends to increase health Stage 2 which intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.
Meaningful Use Stage 3 is still on the drawing board
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Interoperability is keyInteroperability is key
Current legislation◦ Improving Medicare Post Acute Care ◦ Improving Medicare Post Acute Care
Transformation Act of 2014 (IMPACT)Calls for standardized assessment across all post acute care providers. “Requirements…..(B) require data described in subparagraph(a) to be standardized and interoperable so as to allow for the exchange of data among such post acute care providers and other providers and the use of such providers of such data that has been exchanged”
Proposed Conditions of Proposed Conditions of Participation revampParticipation revamp
Concept of Care Team across providersUse of HL7 CCDA standard (summary Use of HL7 CCDA standard (summary document)“electronically exchange health information with health care providers in other health care settings”
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So how are we going to talk?So how are we going to talk?
121+ hospital facilities representing over 80% of Michigan’s acute care bedsbeds
3,000 other connected participants & providers of many types
95+% of the transaction volume flowing to the state through MIHIN
Combined 5+ million people in community health record MPIs
Unique HIE in U.S. relative to qparticipation, financing, geography, and real solution breadth/activity
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VisionTo significantly improve health outcomes and healthcare value for patients, providers, organizations and communities we serve.
MissionTo create and operate a digital information system to promote the secure access to health information for the advancement of the patient care delivery coordination and value of healthcare across the patient care delivery, coordination, and value of healthcare across the communities we serve.
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Health Information ExchangesHealth Information Exchanges
Most are Non-profit, 501(c)3Community CollaborativeyPriorities/Goals◦ Patient health and safety◦ Quality improvement◦ Administrative efficiency◦ Cost ReductionCost Reduction
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What is HIE?What is HIE?
Method to electronically move personal health information securely among health care information securely among health care providers, hospitals, long-term care facilities, urgent care centers, public health departments, community mental health, etc.
What is HIE?What is HIE?
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Why care about HIE?Why care about HIE?Patients seek care from many providers, in many different locations.We are terrible health historiansWe are terrible health historians.New reimbursement methodologies require knowledge of care provided outside our institutions/networks.Cheaper, more secure, and more reliable way to share information with other providersshare information with other providers.
Why care about HIE?Why care about HIE?Information from the Indiana Public Health Emergency Surveillance System indicated that of g y ythe 7.4 million ED visits by 2.8 million patients, 40% of the visits were for patients with data at multiple institutions. They also found that nearly all EDs shared patients with more than 80 other EDs.
AMIA Annual Symposium Proc. 2011; 2011: 409-416. Epub 2011 Oct 22.
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Why care about HIE?Why care about HIE?
Survey of 3,436 adults with a PCP and at least i it t i li t ithi th l t one visit to a specialist within the last year
reported that only 46% of respondents found their PCP always seemed informed about specialist care they received. ◦ O’Malley A and Cunningham P. Patient Experiences with Coordination of Care: The Benefit of Continuity
and Primary Care Physician as Referral Source. J Gen Intern Med. 2009 February; 24(2): 170–177.
Current HIE Use Case ResultsCurrent HIE Use Case Results
Administrative Efficiencies2-person specialty practice saved 1.5 hours of staff time per week by using an HIE to receive laboratory results.
eHealth Initiative. eHealth Initiative releases results from 2008 survey on health information exchange. Survey links health IT to lower cost and improved outcomes. Available at http://www.ehealthinitiative.org/ehealth-initiative-releases-results-2008-survey-healthinformation-exchange.html-0. Accessed 24 July 2010.
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HIE Case StudiesHIE Case StudiesA significant portion of patients already known to be colonized or infected with MRSA are not d f d h d hb identified as such at admission to neighboring hospitals. The 286 unique patients with 587 admissions and 4,335 inpatient days accounted for an additional 10% of MRSA admissions over one year with over 3,600 inpatient days without contact isolationcontact isolation.◦ J Am Med Inform Assoc. 2008 Mar-Apr; 15(2):212-6. Epub 2007 Dec 20.
How can HIE help?How can HIE help?Supports efforts to reduce hospital readmissionsCan help reduce duplicative testing imaging Can help reduce duplicative testing – imaging and labsAdministrative efficienciesImprove communication between all providers in the health care teamS t M i f l U P i C M di l Support Meaningful Use, Primary Care Medical Homes, ACOs, etc.
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Data Push ModelData Push ModelHow does HIE Work?
Data Pull ModelData Pull Model
How does HIE Work?
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Current HIE Use CasesCurrent HIE Use Cases• Connect physicians and other health care providers
electronically to facilitate clinical messaging and sharing encounter reportsencounter reports
• Results Delivery (Lab as discrete data, Radiology, Clinical Documentation such as discharge summaries and consultations, Cardiology Reports)
• Immunization Submission to MCIR – CDC standards compliant
• Notifications of inpatient admissions and discharges – real-time notifications are pushed into providers’ EMRs
Query patient’s community-wide longitudinal health record - Print or forward (with an interface) pertinent clinical docs to EMRS b ib i ( h ll il bl li i l d
Current HIE Use Cases (cont’d)Current HIE Use Cases (cont’d)
Subscribe to a patient (push all available clinical data to practice EMR)Push practice EMR data to patient’s longitudinal health record and distribute to patient’s identified care teamClinical Messaging – both through interfaces, clinical inbox and Direct; No more gmail, yahoo mail, texting… Also useful for referral routing and consultative report Also useful for referral routing and consultative report routing.
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Current HIE Current HIE Use Case ResultsUse Case Results
HIE used for 21.8% of ED patient visits for headache found a decreased odds of for headache found a decreased odds of diagnostic neuroimaging and increased adherence with evidence-based guidelines.◦ Bailey J, Wan J, et.al. Does Health Information Exchange Reduce Unnecessary Neuroimaging and Improve Quality of Headache
Care in the Emergency Department. J Gen Intern Med. May 31, 2012.
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…or maybe here…or maybe here
ChangesChanges
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ChangesChanges
Information in the Opening P kPacket
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ChangesChanges
Information in the Opening P kPacketChanges in Privacy Policy
ChangesChanges
Information in the Opening P kPacketChanges in Privacy PolicyStaff training
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Importance for Home CareImportance for Home Care
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Importance for Home CareImportance for Home Care
We have the Best Patient Info
Importance for Home CareImportance for Home Care
We have the Best Patient InfoHelps us prove our worth
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Importance for Home CareImportance for Home Care
We have the Best Patient InfoHelps us prove our worthSnowball Effect
Importance for Home CareImportance for Home Care
We have the Best Patient InfoHelps us prove our worthSnowball Effect
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BenefitsBenefits
BenefitsBenefits
More Patient Information
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BenefitsBenefits
More Patient InformationCoordination with PCP
BenefitsBenefits
More Patient InformationCoordination with PCPHospital Admission Alerts
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Some additional thoughts as a groupSome additional thoughts as a group
