E-HEALTH / HEALTH INFORMATION EXCHANGE

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Nov 15, 2013 (3 years and 9 months ago)

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Health Information
Consulting, LLC

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E
-
HEALTH / HEALTH INFORMATION EXCHANGE

USE CASE IMPACT

ON

PROVIDER WORKFLOW




Health Information
Consulting, LLC

Bio


35 year career in healthcare


20 years in Consulting with an emphasis on clinical systems and focus on
physician adoption of I/T


Clients range from small physician groups to large multi
-
hospital organizations


Conducted over 200 vendor selections for both hospitals and physicians with
over 100 EMR engagements ranging from small practices to complete hospital /
physician integrated delivery systems


Worked with major HIEs including Chicago, Minneapolis, Wisconsin, Washington
DC, New York City and many enterprise HIE projects


Spent 15 years in the vendor community and is former VP of Sales for the
physician systems division at Baxter


Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare
Informatics Graduate program teaching Healthcare I/T Procurement


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Health Information
Consulting, LLC

Topics

A.
Evolution of Intra Provider Messaging

B.
Today’s Challenges

C.
HIE Use Case Impact on Provider / Patient Workflows


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Health Information
Consulting, LLC

EVOLUTION OF PROVIDER
MESSAGING

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Health Information
Consulting, LLC


Not so Distant Past Provider Messaging

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Health Information
Consulting, LLC

Information Access Evolution

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Health Information
Consulting, LLC

Changing Provider I/T Environment

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2006

5%

Physician EMR use to
20%

2011

20%
Physician EMR use to
50%

2015

50%

Physician EMR use to
75%

2011

1.
Value based purchasing (ACO)

2.
Comparative effectiveness / Quality Measures

3.
Care coordination / CCD exchange

4.
Consumer access to their records

5.
Data standards


ICD
-
IO


SNOMED CT


Rx Norm


LOINC


Others




2011

2015

2019

2019

Health Information
Consulting, LLC

WORKFLOW CHALLENGES

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Health Information
Consulting, LLC

Workflows


When You’ve Seen One…You’ve Seen
One


Physician adoption / Provider variance


who has an EMR and who doesn't?


If I need to send a record summary to the next provider, how do I know what
preference they have to receive it?


If they have an EMR are they ready to use the CCD as a means of conveying
patient records?


Staff adoption and data/document hand off


when will it become efficient?


Patient variability


do they want an electronic copy and how do I get it to them?


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HIPAA Compliance

Security

Consent

Health Information
Consulting, LLC

Changing of the Guard

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Old

New

Insurance

Card verification / phone call

On line eligibility checking

Patient Medical History

Interview

HIE History Access

and Patient Interview Validation

Receipt of patient discharge summaries,

lab results
via fax, triage and clip to the chart

Electronic receipt of messages, results and other data

from the network to the EMR inbound application

Patient care documented with pen,

paper and
Dictaphone

EMR

clinical documentation, voice to data, direct data
entry via templates all mapped to SNOMED CT,
RxNorm, LOINC etc.

Paper

prescription handed to the patient, medication
recorded via written note in the chart

eRx on a handheld

with
review

of online formulary
and comparison to current medication history via
SureScripts and other sources

Manual checklist of problems,

diagnosis, CPT codes
and health maintenance reminders, referral letters,
fax of patient records

Electronic

care plan, CCD export to the next provider,
consumer, provider and payer access to care plans,
consumer patient record portals, PHRs

Manual

calculation of patient activity

Electronic

quality measure reporting, public lab data,
disease surveillance

Health Information
Consulting, LLC

Provider System Fragmentation

Email Web
Browser

Clinic EMR

Clinic
Portal

Hospital
Portal

Diagnostic
Systems

Hospital(s)

A, B, C…
Home
Screens

Hospital(s)

A, B, C...X
EMR
Screens

Regional

HIE

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Log
-
in


Passwords


Patient search


Navigation


Flows

Health Information
Consulting, LLC

HIE IMPACT ON PROVIDER
WORKFLOWS

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Health Information
Consulting, LLC

Typical HIE Use Cases / Services

Core Services


Provider Data Exchange Engine


Patient Identity Management


Record Locator Service (RLS)


Consent Tracking


Provider Directory (Direct)


Secure Messaging


Audit/Security Management


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Common Use Case Examples


Patient Visit Registry View


RLS
Viewer


Clinical Summary View


Results Delivery / Documents


Lab Orders / Results (Discrete)


CCD Exchange


CCD Publishing to the HIE


Registries


Disease, Public Health
etc.


Public Health ELR


PHR Service


EKG Viewer


Health Information
Consulting, LLC

Health Information Exchange

Premise of why ONC / HHS is promoting regional / State HIEs


Fundamentally changing how we deliver patient care and manage patients over time


Patient care and management should not be encumbered by provincial provider attitudes
that they are in control of their patient’s records


Patients are to be empowered to take an active role in their care, management and
outcomes


Data for quality measurement knows no boundaries of IDN, Physician Group or any other
provider type…but rather centers around the totality of patient data and consistency of
information analytics across the industry and the life of the patient

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ONC


HIT Strategic Plan Draft March 2011

…the Medicare and Medicaid EHR Incentive Programs reward eligible providers who digitize health care
information and share it electronically across provider settings. These requirements will grow stronger in
future stages. Second, ongoing payment reforms initiated by the Affordable Care Act


including accountable
care organizations, medical home models, and bundled payments


are an even more important potential
driver of provider motivation to exchange information.

Health Information
Consulting, LLC


Meaningful use of EHRs


across the continuum


Implementation of Health Information Exchange (HIE) to support continuity of
care


Care
Coordiation through access to patient centric community care plans


Agile
and
thin
I/T
applications that can be modified over time without major
system disruption


Semantic interoperability
of systems and reducing the cost of fragmentation


Analytics supporting fundamental health care delivery change



Tactical Delivery of Long Range ONC I/T Vision

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Health Information
Consulting, LLC

Typical Hospital View of Their Service Community

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Hospital
Systems

Employed
Physicians

Affiliated
Physicians

Other
Providers

Health Information
Consulting, LLC

ONC View of The Service Community

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Patient

Physicians

Ancillary
Providers

Hospitals

Health Information
Consulting, LLC

Goal: Data and Information Exchange

Point of Care

Clinical
Information /
Data Analytics

Care Continuum



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Health Information
Consulting, LLC

Traditional Workflow Example

1.
Patient calls for doctor appointment

2.
Patient is sent forms to fill out and bring
into office

3.
Patient arrives at clinic with forms

4.
Forms are reviewed by staff and entered tin
to the system

5.
Patient is “roomed” and vitals written in
chart

6.
Patient previous test results arrived via fax
and clipped to chart for clinician review

7.
Physician conducts exam and annotates
findings in chart

8.
Provides written Rx to the patient

9.
Physician indicates treatment plan to nurse
who in turn orders tests and instructs
patient further

10.
Printed and hand written instructions
provided to the patient


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Tomorrow’s Workflow



Patient registers via the web and fills out HRA and
other documents


Patient arrives and checks in via kiosk


Hospital distributed results from prior days testing
via HIE to the clinic EMR messaging inbox


Patient is roomed with digital feeds of vitals to EMR


Medical Assistant confirms all new information from
HIE that shows last weeks ED visit that was not
known by this clinic


Physician conducts exam, documents in EMR and
uses eRX tool that shows a previous script from the
ED that he was not aware of and confirms with the
patient that they are taking the medication


Physician enters electronic order for testing to be
done at the hospital


Patient asks for electronic copy of the visit record
and also asks that the record not be disclosed to
Provider “x” as her ex
-
husband is a physician at that
location


Assistant logs onto the HIE and indicates how
Consent has been modified

Health Information
Consulting, LLC

Provider Workflow Challenge


Multiple logins


Variable workflows for common functions


Record completeness


Data differences among systems
-

e.g. allergies, current meds


Venue differences
-

ED, walk in clinics office, specialist, inpatient


Error correction


Common format for clinical documentation


Patient consent


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Health Information
Consulting, LLC

HIE Patient Consent Issues


Opt in
-

Opt out changes


Emergency care


Behavior health


“Peyton Place” issues


Clinical documentation inconsistencies
-

patient corrections


Patient self
-
consent/assignment


Break the glass provisions


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Health Information
Consulting, LLC

MANAGING THE FUTURE

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Health Information
Consulting, LLC

Physicians Want “One Stop Shopping”

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Patient

Office
EMR

Hospital
EMR

Patient
Messaging

HIE



Security (Sign
-
on)



Privacy Policies



Consent Policies



Data Integrity (Trust)



Error Correction (Trust)


Auditing (Risk)



Change Management (Standards)

Health Information
Consulting, LLC

Wrap Up


Challenge your organization to assess the impact of your decisions on the
“patient centric” process


Understand the workflow implications for your providers with special emphasis
on affiliated physicians


Patient movement among providers is not going to disappear so understand that
you are a part of the patient’s provider community


Accountable care, care coordination and disease management will require much
greater consistency of information exchange among providers…are you part of
the solution or a part of the problem?

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Health Information
Consulting, LLC

Patient Centric Approach to I/T

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Health Information
Consulting, LLC

Thanks !

Health Information Consulting, LLC


Mike Mytych


mmytych@hicllc.com


262
-
253
-
9110

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