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The Role of Health Information Exchange in Reducing Avoidable Hospital
Readmissions
Candy Hanson, Program Manager, Stratis Health&
Coral Lindahl, Point Click Care Coordinator, Ebenezer Ridges
March 28, 2014
Participants: 1-866-639-0744, no code needed
The Role of Health Information Exchange in Reducing Avoidable Hospital Readmissions
Candy Hanson, Program ManagerStratis Health
Coral Lindahl, Point Click Care CoordinatorEbenezer Ridges
March 28, 2014
Objectives
• Learn the basics of health information exchange between hospitals and other exchange partners
• Learn about the HITPAC project• Learn about the value of health information exchange
in reducing avoidable hospital readmissions• Learn about the strategies your organization can
consider as you prepare for the future of health information exchange
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Minnesota HITPAC is:Minnesota HITPAC is:
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Minnesota HITPAC CommunitiesMinnesota HITPAC Communities
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Two Main Focus Areas:
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HIE Value Opportunities (health.ahrq.gov)
• Immediate access to outside records which improves the quality and safety of patient care and saved time
• Timing of “sharability” of electronic health records especially in emergency
• Value of most recent information• Potential to minimize redundant data entry
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HIE: Information “pull” (“Connect”)
• “Connect”: a national standard that enables “pull” queries• A primary care provider recommends a procedure for their
patient, a resident at a long-term care facility– The hospital wants to pull patient record information at
admission– The provider wants to pull results of the procedure– The LTC facility wants to pull updated med list upon return
Provider Clinic
Long-Term Care
Hospital
HIE Services
DirectoryPID RLS
ConsentManager
IdMSecurity
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HIE: Information “push” (“Direct”)
• “Direct”: a national standard for “push” transactions• e-mail with a trust and security layer:
– Trust: you may only correspond with addresses with whom you’ve established mutual trust
– Security: Confidentiality, Integrity and Authenticity
• Direct is a standards-compliant, secure, directed clinical messaging standard– HIPAA-compliant– Meaningful Use-compliant– Simple– Low-cost– No added legal framework or consent management required
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Direct: “push” example
Lab to clinic: Lab receives order from clinic and responds with lab report
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Focus our time ensuring:
• The right data is being exchanged– Proper fields to produce meaningful Patient Assessment and
Discharge Summary documents
• An acceptable “container/document” is being used for the data – The ideal being a standards-based “Continuity of Care
Document” (CCD), exchanged system to system
• An acceptable means of secure transport is used– Exchange may already be happening, system-to-system; if
not, a standards-based solution (such as Direct) may have to be brought into the solution set
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What is in a Standards Based CCD?(CCD = Summary of Care Document)
• General Header Section• Allergies Section• Medications Section• Problem Section• Procedures Section• Results Section• Advance Directives Section• Encounters Section
• Family History Section• Functional Status Section• Immunizations Section• Medical Equipment Section• Payers Section• Plan of Care Section• Social History Section• Vital Signs Section
Taken from: HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, DSTU Release 1.1
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Current and Future State Process Mapping
•
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Medication Management Lessons
• Current hybrid processes have many potential opportunities for improvement
• Medication reconciliation is a different activity than medication review
• Medication reconciliation needs to be a “shared responsibility” going forward
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Prospective Medication Review (PMR) Pilot
• Implemented in our project• Workflow redesign which improve patient safety,
and will impact skilled nursing facility staff time, hospital staff time, dispensing pharmacy staff time
• Medication reconciliation done at “pre-admission” once SNF staff inform hospital that they can accept a resident
• Dispensing pharmacy will screen for 7+ items• Analytics
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Exchange Results
• 42 SNF to hospital test exchanges• 10 hospital to SNF test exchanges• 2 SNF to pharmacy test exchanges• Actual health information exchanged achieved with
PMR pilot participants
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Lessons Learned
• There is a wide array of EHR functionality• There currently exists largely hybrid health records
(paper/electronic mix) in SNFs• View only access does not equal interoperability
(although it is an HIE strategy to get there)• The span of LTPAC vendors who can produce a CCD is
variable • Laws and rules that pre-date EHR use contribute to
problematic workflows
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Lessons Learned (continued)
• The value of interoperability still needs to be realized• Privacy and security practices in an EHR/HIE
environment will continue to need much attention• There need to be hard stops across the health care
continuum for medications that are prescribed without an indication or diagnosis
• Pharmacy needs to play a bigger role in medication reconciliation
• There is much optimization work to do
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Health Information Technology: Minnesota QIO Implementation
From a Provider Perspective
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Ebenezer Ridges Care Center
• Located in Burnsville, MN • South metro location• 104 skilled nursing home with 12 TCU beds• On a campus consisting of: Assisted Living,
Independent Living, Adult Day Care and Child Day Care
• Part of the Fairview System
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Ebenezer Ridges Care Center
• We started using PointClickCare (PCC) in 2005• We started with Billing & MDS progress notes; then
moved to Care Plans, Assessments, EMAR, and Point of Care (POC)
• We scan lab results, POLST• We have a Super User – Coral Lindahl, RN-BC
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HITPAC Project
• We were asked to participate with Stratis Health and Fairview
• We received the key roles and expectations in April• We started with a readiness survey to help Stratis
Health start the workflow process
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HITPAC Project … continued
• We worked with Point Click Care to generate a CCD within our EHR
• We also shared information during our weekly calls to discuss potential medication errors related to transfer of information
• We have a press release that explained our participation in the project
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HITPAC Goals that we agreed to:
• Have a successful electronic exchange of data from the hospital to the skilled nursing facility
• Create a best practice workflow to reduce medication errors
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HITPAC
• We shared our information of how we currently receive information:
• Fax
• EPIC access
• Webinars along the way• We also discussed where there are potential areas
for errors
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HITPAC
• We have worked with our project coach – Julie Jacobs
• An audit on our utilization from the consulting group that Stratis Health uses was offered
• We chose to get our scorecard from PCC for optimization.
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HITPAC
• A gap analysis was compiled and presented to us from Julie at Stratis Health
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HITPAC Gap Analysis and Recommendations
Project Overview
• The long term post acute care (LTPAC) setting is highly impacted by numerous transfers of care; over 40% of hospital discharges are to post-acute settings and are among the heaviest users of medications. Nearly 12 million medically complex Americans need long-term and post acute care services in nursing homes, home health, or other settings. CMS estimates that over 18% of Medicare patients are re-hospitalized within 30 days of discharge and that 13% of all admissions costing $12 billion dollars are potentially avoidable.
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HITPAC Gap Analysis and Recommendations… continued
• Health information technology (HIT) and electronic records have the potential to improve the efficiency in the LTPAC settings by reducing medical errors, improving communication, and the overall quality of patient care. The goals of this project are to assist post acute providers to advance the use of HIT systems, continue to encourage the overall adoption of electronic health records (EHR)s in long term care settings, and to standardize health information exchange (HIE) between hospitals and LTPAC.
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HITPAC Gap Analysis and Recommendations… continued
To this end, and to understand the opportunities that might be present in reaching these goals, we collected information for this report from two LTPAC communities, consisting of 3 hospitals and 10 post-acute care facilities in Minnesota. The following data gathering tools were used:•HITPAC Education and Technical Assistance Readiness Interviews•Weekly project calls with recruited communities•Workflow Process mapping•Gap Analysis
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HITPAC Gap Analysis and Recommendations… continued
Findings:
• Limited LTPAC EHR functionality
• Interoperability
• CCD
• Medication Reconciliation and e-Prescribing
LTPAC and Acute Care Facilities:
• Gaps in medication reconciliation procedures
• Diagnosis Codes - underutilized
• Gaps in privacy and security practices in transitions of care
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Early Recommendations• All EHRs generate and consume a Continuity of Care
Document (CCD)• 225 Data points mapped to date• Current state-MDS, OASIS, Interact, other proprietary
formats
EHR Configuration and training related to Medication Management, Clinical Decision Support and e-Prescribing tools
HITPAC Gap Analysis and Recommendations… continued
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• Medication Libraries • Predictive text• Electronically generated reports• Order Sets, Diagnosis code – driven
Best practice around Medication Reconciliation• Pharmacy consults• EHR Clinical Decision Support tools
HITPAC Gap Analysis and Recommendations… continued
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How are we different?
1. Readiness to work with a CCD
2. Experience with PCC and where we are next
3. There was value for us in using the CCD – 90% of our admissions come from a Fairview hospital
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How Can Other LTPAC providers prepare?
• Look at what you are able to do with your current EHR
• Be willing to sit down and look at your current exchange of information – are there areas of improvement?
• Set a plan
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Barriers
• Having someone understand the language of the technology
• Redesigning the workflow process• Your EHR vendor ready for the CCD• Having partners ready to exchange
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Best Practices for EHR culture
• Have a technology interest• Have a curiosity around quality – how do you collect
data, what do you do with the data, what are you trying to improve?
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Key Lessons
• We are farther ahead than we thought• There is a lot of work to do• It can be done
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HITPAC Web Page
http://www.stratishealth.org/providers/HITPAC.html
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Our Key Collaborators…
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How can care settings prepare themselves for the EHR/HIE environment?
• Commit to a establishing/sustaining an EHR/HIE culture (don’t be intimidated by the new language)
• Invest in resource(s) that lead in EHR/HIE culture in your organization
• Assess your current EHR environment (computer skills, attitudes, and beliefs about an EHR environment)
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Best Practices Ideas for EHR optimization:
• Organizations should consider investing in a
“Super User”/nurse informaticist environment• Find/establish best practices that support an
electronic environment• Use the resources/tools that are available to you
now• Collaborate within your trade association for support
and resources
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Questions?Candy HansonProgram ManagerHealth Information Technology for Post Acute Care (HITPAC)Stratis Health952-853-8524
www.stratishealth.org
Coral Lindahl
Point Click Care Coordinator
Ebenezer Ridges
952-898-8465
www.fairviewebenezer.org
This material was prepared by Stratis Health, the Minnesota Medicare Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 10SOW-MN-SIP-HIT-14-04 032514
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Upcoming RARE Events….
Stay tuned for the next RARE Webinar in April 2014.
RARE Action Learning Day – June 17, 2014,Crown Plaza Hotel, Plymouth, MN
Stay tuned for more details!
Future webinars…
To suggest future topics for this series, Reducing Avoidable Readmissions Effectively “RARE” Networking Webinars, contact Kathy Cummings, [email protected]
