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Critical Conversations in Transitions of Care – Part 1
Transferring Patient Data from the Hospital to LTPAC
Wednesday, March 2, 2016
Gregory L. Alexander, PhD, RN, FAAN Professor
Sinclair School of Nursing, University of Missouri
John F. Derr, RPh.
CEO
JD & Associates Enterprises, Inc.
Conflict of Interest Gregory L. Alexander, PhD, RN, FAAN, Professor, Sinclair School of Nursing, University of Missouri
and John F. Derr, RPh, CEO, JD & Associates Enterprises, Inc.
Have no real or apparent conflicts of interest to report.
• Data exchange MOTIVATIONS
• Data exchange CHALLENGES
• Data exchange APPROACHES and QUESTIONS
Agenda
Learning Objectives Objective 1: • Summarize the motivations driving the data exchange needs of acute
providers
Objective 2: • Summarize the challenges facing the data exchange efforts of acute
providers
Objective 3: • Describe at least one approach an acute care provider has leveraged in
sending patient data to an LTPAC provider organization
Objective 4: • Compose at least one data exchange question acute care providers
should ask LTPAC providers
http://www.himss.org/ValueSuite
STEPS: Electronic Secure Data
• Data exchange MOTIVATIONS
• Data exchange CHALLENGES
• Data exchange APPROACHES and QUESTIONS
Agenda
Situation Motivation
MARKET FORCES Meet Requirements Of The HITECH Act and Meaningful
Use
Reduce
Re-hospitalizations
Provide Electronic Transition of Care to LTPAC Providers
Quality LTPAC Partners in Pay Model Bundling
Ensure Continuity Quality of Care Management
Why Does Acute Care Require Electronic Interoperability with LTPAC ?
Situation Motivation
DISCHARGE CHALLENGES
Discharge and Transitioned to Another Provider Site or
to Person’s Home
Complete Electronic Health Record for Next Provider
Continuity of Care Within the Spectrum of Care
Quality Metrics Harmonized
Trusted Partnerships
Why Does Acute Care Require Electronic Interoperability with LTPAC ?
Situation Motivation
PATIENT CARE Integration Into the LTPAC Electronic Medical Record
Incorporation of the Hospital Care Plan Into the
Chronic Care Diagnosis and Longitudinal Care Plan
Assurance of Continuity of Care
Accurate Data for Risk Payment Systems
Re-hospitalization Data Integration Into the ER EMR
Why Does Acute Care Require Electronic Interoperability with LTPAC ?
• Data exchange MOTIVATIONS
• Data exchange CHALLENGES
• Data exchange APPROACHES and QUESTIONS
Agenda
Nearly all hospitals have the infrastructure to enable exchange.
Exchange with outside ambulatory care providers and outside hospitals is increasing.
Data Exchange CHALLENGES Three basic types of barriers to data exchange • Operational Barriers • Financial Barriers • Technical Barriers
Data Exchange CHALLENGES
Financial Barriers
Operational Barriers
Data Exchange CHALLENGES
Technical Barriers
• Data exchange MOTIVATIONS
• Data exchange CHALLENGES
• Data exchange APPROACHES and QUESTIONS
Agenda
• Electronic health information exchange created between providers
• Meets Meaningful Use documentation standards
• Documentation completed prior to discharge for electronic submissions
• Information completed for follow-up care
• Discharge documentation completed in EMR Discharge Navigator:
– Selecting providers/locations – Entering data and searching for CORRECT entry – Choose entry that begins with TOC only
Data Exchange APPROACHES
Data Exchange APPROACHES Case Study: Scheduling appointments
• Determine which interdepartmental communication forms are
required
• Establish communication workflows that incorporate communication forms
• Identify all stakeholders who require information about appointments
• Determine IT readiness for stakeholders
• Educate and conduct pilot test of exchange
Data Exchange APPROACHES Case Study 1: Scheduling appointments
0
Discharge Paperwork Used for Post Acute Report
1. Face sheet (EMS needs) 2. Med rec 3. Rounding report (HC) 4. 3 days MD notes 5. Patient summary report (HC) 6. Advance directives/living will, if applicable 7. H&P (only for long distance transfers over 25 miles) 8. DA-124C (mandated for new patients) 9. DA-124A/B, if applicable 10. Patient transfer form (MD orders/nursing pt functional assessment) 11. Physician certification statement (for ambulance transfer only) (EMS needs) 12. Transfer and authorization form (for hospital-based NH or ED transfer to
another hospital
Data Exchange QUESTIONS
Questions
Gregory L. Alexander, PhD, RN, FAAN Professor Sinclair School of Nursing, University of Missouri E-mail: [email protected] LinkedIn: https://www.linkedin.com/pub/gregory-l-alexander/20/a2a/9b2
John F. Derr, RPh. CEO JD & Associates Enterprises, Inc.
E-mail: [email protected] LinkedIn: https://www.linkedin.com/pub/john-derr-r-ph/8/4b7/245