January 7, 2015

Tenet: Transition of Summary Program

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Agenda• Tenet Healthcare Overview

• Overview Meaningful Use Stage 2– Summary of Care Measure Challenges

• 2013 Old State

• 2014 Current State– Direct Enrollment Program

• Current Outcomes, Lessons Learned, Challenges

Tenet Healthcare TodayA diversified provider of healthcare services

Alabama

1 Hospitals

5 Outpatient Ctrs

New Mexico

2 Outpatient Ctrs

Texas

19 Hospitals

62 Outpatient Ctrs

Arizona

6 Hospitals

4 Outpatient Ctrs

Florida

10 Hospitals

28 Outpatient Ctrs

Georgia

5 Hospitals

15 Outpatient Ctrs

S. Carolina

4 Hospitals

10 Outpatient Ctrs

N. Carolina

2 Hospitals

4 Outpatient Ctrs

Connecticut (LOI)

4 Hospitals

Pennsylvania

2 Hospitals

3 Outpatient Ctrs

Massachusetts

3 Hospitals

4 Outpatient Ctrs

Missouri

2 Hospitals

3 Outpatient Ctrs

Illinois

4 Hospitals

4 Outpatient Ctrs

Michigan

8 Hospitals

9 Outpatient Ctrs

Tennessee

2 Hospitals

6 Outpatient Ctrs

80 Hospitals (a) (b)

193 Outpatient Centers

California

12 Hospitals

33 Outpatient Ctrs

Mississippi

1 Outpatient Ctr

Updated 7/15/2014

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Tenet Clinical Systems• Hospital Clinical System Services

portfolio attesting for Stage 2– Cerner – McKesson – Meditech – Epic

• Case Management Systems– Esend– Allscripts– Midas

Objective: Deploy a standard TOC/SOC workflow across Tenet that is EHR agnostic.

January 7, 2015

2013 Current State Analysis

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Summary of Care Workflow 2013

• Case managers usually engaged• Hospice and Home Health• LTAC, SNF, Assisted Living, Rehab

• Nursing usually engaged• Another Care Facility• Home with Specialty Follow-up

Summary of Care for Stage 1

1.Nursing checks a box that a Summary of Care was provided in the Nursing Discharge Instructions as part of the discharge process.

2. Case Managers or Health Information Management department personnel prepare and print the documents which are specific to the type of facility the patient is going to or home health, etc.

Adoption for STAGE 1 near 100% with easy button

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2013 analysis current stateIdentify Senders

• Ability to print from EMR– HIM– Nursing Supervisor– Unit Clerks– OB RNs

• Ability to send email from EMR– HIM– Nursing Supervisor

Nursing survey: Who prepares the medical record for transfers in your facility ?

2013 analysis current stateIdentify Receivers

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2013 analysis of future stateIdentify Receivers

Analyze discharge dispositions and opportunity to adopt

Post Acute Care facilities: LTAC, hospice, rehab, home health

– 21 – 25% of discharges

– Case Management systems were not direct HISP enabled

Follow up specialty services includes ambulatory office

– Too many ambulatory clinics still have paper health records or

– If EMR in ambulatory, then did not have direct in production

– Timeline to support Direct email exchanges did not align

Hospital to Hospital transfer

– Incidence 2% - 7%, too low to be only pathway

– HIE – not enough mature models across all Tenet markets

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MU Stage 2 planning 2013Post Acute Care facilities: LTAC, hospice, rehab, home health

– LTPAC providers are not eligible for incentive payments under the HITECH Act

– LTPAC providers have no knowledge of “Direct” or program intent

• Secret shopping results: “Just email it to me*@gmail.com”

Solution: Provide Direct Email to Post Acute Care FacilitiesPost acute facilities + hospital transfers = ~ 30%

January 7, 2015

2014 Current State

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Direct Email Program Tasks

Consult Legal

1. Design Terms of Use Agreement2. Design Welcome Letter3. Approve round 1 external facilities approach

a. Analyze ‘discharge placements’ with a look back of 6 months and calculate % of total placements during that period.

b. Identify which post acute facilities would add up to 30%c. Design a workbook creating a list of highest frequency

placements firstd. Track % opportunity as external agencies are enrolled

into Direct program

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Direct Enrollment Program Director of Case Management Responsibility

1. Identify high volume placement facilities – final placement report from case management system

2. Provide Welcome Letter

3. Obtain Terms of Use Agreement

4. Obtain two users info for each facility: name, email, phone per facility

Org Name (Vault)(Facility - if different from Org

Name)User

NameUser

PhoneUser Email Referral % Comments

Manteca Care and Rehabilitation Center

Manteca Care and Rehabilitation Center       22% 

                          Healthy Living at Home Sacramento       17%                           St Jude Care Center St Jude Care Center       10%                         

48%

Magic number is 30%

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Direct Enrollment Workflow

January 7, 2015

2014 Current State

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Current OutcomesRelevant patient information such as health summaries, physical therapy reports, lab results, diagnostic reports can be shared to provide optimal continuum of care services by simply attaching documents in an email.

•Direct Email replaces paper, printing, scanning, refaxing, and provides the most secure and efficient method to exchange personal health information •By the end of 2014

– Tenet hospitals connect to 324 post acute care agencies – Tenet Sponsored Direct Inbox count 543

• National Post Acute Care organizations that have implemented their own Direct Email program over the course of 2014

– Kindred– Manor Care– Gentiva– AlaCare

“ Hospitals want to enroll all of their referring agencies in the Direct program because this is so much faster, better and easier than what we used to do”

- Katrina Cravens, Sr. Specialist Case Management

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Transition of Care Lessons LearnedSuccess Failure

• IT and clinical operations joined at the hip

• Greater than 30% of transitions are eligible for Measure B

• Case Manager ownership• Off-shift workflows solid• Twice daily report monitoring

discharge orders depicting ToC met or not met with a look back of 3 days.

• Trending MU reports for 7 days compliance identifies if there is lack of weekend adoption

• “This is an IT project and we need to minimize clinical workflow changes”

• Less than 30% of transitions are eligible for measure B

• No weekend or after 5 workflows

• Harder and more expensive: unreliable placement data in the case management system

• Manage Risks• A hospital that has not been documenting placements per standard will

struggle with adoption of a new workflow• A hospital that turns their workbook in late or can’t get terms of use

agreements back, two users etc. will struggle with adoption• Escalate to sponsors and execs early if deadlines are missed

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Current Challenges• Constraint: Vendor certified on only one method for reporting

Summary of Care transmissions– Excludes automation techniques for generating and sending a

ToC that count for MU Stage 2 such as HIE. Tenet sends more than we can count .

– Direct is only direct. 1 sender to 1 intended receiver• Physicians: “I have too many Direct email addresses”. EMR

systems supports only one in their system address book• Lack national directory for Direct email addresses. Resolution in

process but what upgrades and training will it take to use it?Note: Tenet will not disclose direct email addresses to non-Tenet hospitals

that we have provisioned . We have no process to maintain such communication of end user changes to other hospitals. External agencies may share with other hospitals and share personnel changes as they arise.

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Health Data Sharing Models• Direct Exchange * Payor Portals• HIE * Physician Portals• Cloud Services * ACOs*HL7

• Population Health Management (big data)• BMDI * Medical Home

• Lifetime Personal Health Record

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