Your Health Information Exchange

Nick Bonvino │ Chief Executive Officer │ Greater Houston Healthconnect

Leveraging the HIE for Care Coordination Across the Community

RHP3 DY8 Learning Collaborative – Thursday, December 6, 2018

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• We are a neutral entity, not-for-profit, governed by a multi-stakeholder board, here to

serve our community

• Participants sign a common agreement to share PHI in an equitable manner

• Custom interfaces with the GHH HUB are built with Participant’s many disparate EHRs

• Deep integration delivers data into the EHR workflow to better inform decisions made at the point of care

• GHH platform serves as the foundation for population health management and health services research

Our Mission: Coordinate Care Delivery

By Connecting ALL Providers

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Healthconnect Fast Facts

South East Texas Reach

24 Counties 15+ Million Patients 95% Hospitals = 20,400+ Beds 70% Physicians = 9,800+ 325+ Participation Agreements 1,025+ Venues of Care

*A representative sample of participants

*Collaborators

Houston

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Health Information Exchange

Diagnostic Imaging Exchange

Notifications for ‘At-Risk’ Patients or ACO Members

Query and retrieve patient records from across the healthcare ecosystem

Cloud-based image exchange that enables viewing and sharing of medical images

Real-time alerts when patients admitted, discharged or transferred at any Participant

Health Services Research

HIE data for outcomes research and quality improvement initiatives

Public Health

De-identified population-level data informing public health initiatives – ELR, Syndromic Surveillance

Core Services

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No Regional HIE Model

Radiology

Center

Clinic

Primary Care

Physician

Hospital

Specialist

Laboratory

Pharmacy

Each provider connects to all

Many point-to-point connections

High cost to implement & maintain

Complex to manage

Inefficient attempt to coordinate care

Result is large gaps in care

Free

Standing

ED

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Healthconnect Model

Radiology

Center

Clinic

Primary Care

Physician

Hospital

Specialist

Laboratory

Pharmacy

Healthconnect Free

Standing

ED

One connection gets all

‘Economies of Scale’

Lower costs - Improved efficiencies

Greater care coordination

The “Hub” of all data activity

HIE Value Proposition

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Radiology

Center

Clinic

Primary Care

Physician

Hospital Specialist

Laboratory

Pharmacy

Free Standing ED

Healthconnect

GHH Patient Repository – Community MPI

AD

T Fe

ed

ADT Feed ADT Feed

AD

T Feed

• Real-time ADT feeds

from all Participants

accumulated into an

index and registry

• Tools to uniquely identify

and match patients –

global identifier

assigned for the

community

• Patient’s informed

consent captured by

Participants and

managed at the HIE

• Enables unique

identification of

patients and record

locator of encounters

across the region

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Radiology

Center

Clinic

Primary Care

Physician

Hospital Specialist

Laboratory

Pharmacy

Free Standing ED

• Requestor Queries

GHH

• Matches Unique Patient

Across Community

Healthconnect

• Confirms Consent to

Share

Participant Query for outside documents

Query

• GHH Queries other

Participants

• Participants Respond to

Query

• GHH Responds to

Requestor *time from query to response is a few

secs

CCD CCD

C-CDA

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HIE Impact to Care Delivery

QUALITY SAFETY EFFICIENCY

Assessment Provides historical information Alerts to prior interventions Informs on chronic conditions

Advises current medications Advises on current allergies

Informs of existing labs/rad Narrows problem lists Reduces unnecessary testing

Diagnosis Includes diagnosis histories More complete info for new Dx

Enables diagnosis precision Avoid unnecessary treatment

Better Dx and Rx prevents downstream recurrences

Clinical Decision Support

EHR relies on community record to identify best care protocols

More data improves specificity of care = safer care

Narrows field of optimal treatments, minimizes cost

Care Planning Delivers longitudinal records Facilitates holistic care planning

More informed comprehensive care team during transitions

Seamless care transitions Improves accountabilities

E-Prescribing Renders complete drug history Enables informed prescribing

Active medication lists prevents adverse drug events (ADEs)

Reduces reliance on patient recall or pharmacy call-backs

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HIE Value Proposition to

DSRIP Participants

HIE, Diagnostic Imaging Exchange, Notifications, Health Services Research, Public Health

Valuable Clinical Data

Timely & Efficient Information

Care Coordination

Impactful HIE Tools

Broad HIE Footprint in Region 3

Meaningful Dollars

Clinical documents – CCDA, HL7 LAB, RAD, PATH, TRANS, structured/unstructured data

24 Counties, 15+ million patients, 95% hospitals, 70% physicians, 325+ agreements, 1,025+ venues

Real-time query-and-retrieve of patient clinical information; real-time alerts of clinical encounters

Know the five Ws of your patients Who, What, When, Where, Why

Meaningful DSRIP dollars at stake - pay-for-performance on clinical and/or quality measure outcomes

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Case Study, UTMB

Adolescent (13 years) Immunization Status (D1-271)

Controlling High BP (A2-103) PQI 08 Heart Failure Admission Rate (A2-501)

Adults (18+ years) Immunization Status (C1-272)

CVD Statin Therapy (A2-404) PQI 91 Acute Composite (Adult Dehydration, Bact. Pneumonia, UTI)(C1-502)

BMI Assessment-Children-BMI Documented(D1-211 Rate 1)

Diabetes: BP Control (A1-207) PQI 93 Diabetes Composite (A1-500)

BMI Assessment-Children-Exercise Counseling (D1-211 Rate 3)

Diabetes: Foot Exam (A1-112) Screening: Breast Cancer (C2-186)

BMI Assessment-Children-Nutrition Counseling (D1-211 Rate 2)

Diabetes: HbA1c Poor Control (A1-115) Screening: Cervical Cancer (C2-106)

BMI Follow-Up (C1-147) Diabetes: HbA1c testing (C1-113) Screening: Colorectal Cancer (C2-107)

BP Screening and Follow-Up (A2-210) ED Visits Diabetes (A1-508) Screening: Tobacco Intervention (C1-105)

Childhood Immunization Status (CIS)(D1-108) ED Visits Heart Failure (A2-509) Tobacco Use-Adolescents (D1-400)

Children With Pharyngitis (D1-212) HPV Vaccine, age 18-26 (C1-389) Vaccination: Influenza (C1-269)

Children with URI (D1-284) PDI 91 Acute Composite (Gastroenteritis, UTI) Intervention(D1-503 Intervention)

Vaccination: Pneumonia (C1-268)

Chlamydia Screening (C1-280) PDI 91 Acute Composite (Gastroenteritis, UTI)(D1-503) Well-Child in the First 15 Months (D1-237)

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Key DSRIP Measures

Adolescent (13 years) Immunization

Status (D1-271)

% of youth 13 years of age who are up-to-date with the immunizations at their most recent visit

Chlamydia Screening (C1-280)

% of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period

Diabetes: HbA1c Poor Control (A1-

115)

% of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period

Diabetes: HbA1c testing (C1-113) % of patients 18-75 years of age with diabetes who had a HbA1c test performed during the measurement period

Vaccination: Influenza(C1-269)

% patients aged 6 months and older seen for visit (Oct 1 - Mar 31) who received an influenza immunization OR who reported previous receipt of an influenza immunization

Vaccination: Pneumonia(C1-268) % of patients 65 years of age and older who have ever received a pneumococcal vaccine

HIE Lookup

Clinical documents – CCDA, ADT, HL7 LAB, RAD, PATH, TRANS Structured/unstructured data

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Diagnostic Image Exchange

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Image Exchange

Yesterday’s Image Exchange

Time Cost Patient Care

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Image Exchange

Ambra Health – Our Imaging Partner

VALUE-ADD STORAGE & ARCHIVE ACCESS & EXCHANGE VIEWING

Cloud PACS

Disaster Recovery

CD & Web Upload

Modality Send

Mobile Viewing

EMR View Link

24/7 Support

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Image Exchange

Provider Portal

View/share/download studies and reports

Access to all priors

View in Ambra UI or 3rd Party

Simplify login/onboarding process

True Cloud Access

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Image Exchange

Value Proposition

Convenient set-up, no hardware installation, easy user-interface

Improve turnaround times, deliver diagnostic information promptly

Anytime & Anywhere cloud access to diagnostic-quality imaging

Reduce time & expense of burning CDs and setting up VPN connections

Improve Client Experience

Reduce Time to Delivery

Improve Efficiencies Cut Costs

Anytime - Anywhere Access

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Image Exchange

Leading Imaging Participants

Hospitals & Health Systems

Outpatient Radiology Groups

Specialty Physician Practices

* Representative sample of GHH Imaging participants - Over 150+ Ambra participants in Texas, 1,000+ participants nation-wide

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Managing Health with Notifications

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Receive Real-time Notifications

on Your ‘At-Risk’ Population

Healthconnect Notifications

Radiology

Center

Clinic

Payer

Primary Care

Physician

Hospital

Specialist

Laboratory

Pharmacy

Identify patients to be monitored and send file to GHH

GHH receives ADT feeds real-time with all patient visits and activity

Upon patient and ADT match, alert pushed to Participant

ADT feed

ADT feed

AD

T fee

d

AD

T fee

d

1

2

3

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Notifications

The Mechanics of Our Program

Care coordination

Management of patients at-risk

Post-discharge care

Value-based reimbursement

DSRIP or other alternative payment models

Use Cases for

Notifications Admission

Registration

Transfer to IP / OP

Demographic updates

Visit updates

Alert Criteria Delivery

Real-time, daily, monthly

Secure email, batch files

Single / multiple recipients

Population stratification on ICD-10, high-utilizers, zip code, payer type, etc.

Encounters

Monitored

Scaled quickly

Disease agnostic

Serve large patient pop.

Powered with data

Confer immediate benefits

Aligned with your objectives

The Power of a

Notifications Program

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Notifications

Data Delivered

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Notifications

Value Proposition

Enables real-time delivery of patient encounter information

Facilitates better care coordination of patients across provider community

Supports management of high-risk patients

Reduces redundant diagnostic testing, hospital readmissions, and over-utilization of services

Enables more cost-effective delivery of services esp. when managing populations at-risk

Real-Time Delivery

Improves Patient Coordination

Lowers Cost of Care

Promotes Better Disease Mgmt.

Reduces Unnecessary Services

Aligned With New Care Models

Supports novel care and payment delivery models including ACOs, bundled-payments, at-risk value-based care

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‘HealthShare Insight’ Module

Healthcare Analytics Solution

Sample Use Cases

Data analytics platform

Captures data from HIE

Allows for actionable decision-making based on informed data analyses

Advanced reporting and querying

Quality improvement initiatives

Notifications based on specified criteria

Dashboards for populations of interest

Automatic cohort identification

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Social Determinants of Health

Community-wide initiative to capture social determinants of health:

Starting first with food insecurity

Providers collect data and add to their Continuity of Care documents

GHH shares through the normal health exchange process

Analytics and reporting on data

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Hurricane Harvey

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Hurricane Harvey

Overview

August 25-29, Hurricane Harvey hits the Gulf Coast of Texas

The storm moves east and stalls over the Houston area, with record 60” rainfall

Significant devastation and flooding along the coast and inland

Corpus Christi, Greater Houston, and Beaumont/Port Arthur most impacted

Storm eventually moved on to Louisiana

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Hurricane Harvey

Pressing Need for Medical Histories

Shelters quickly swelled with evacuees…

Many evacuees required medical attention…

An urgent need arose for access to patient medical information and practice without an EHR!

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Shelters Portal Provisioning Call-In Operations

CHI – St Luke’s request to provision additional clinicians at all locations ahead of storm

Coordinate with other HIEs - portal and support for call-ins

Coverage San Antonio, Austin, Corpus Christi, Beaumont -Port Arthur, Tyler-Texarkana, DFW

Monday organized for need

Tuesday on-site with evacuees and volunteer clinicians - Confirmed consent and queried for PHI at point-of-care 24x7 thru weekend

Embedded HIE into triage and clinical workflow. Coordination with Federal DMAT & FMS teams

Remote calls from clinicians to look-up PHI. Read results or send secure email

24x7 support for 17 days

“All hands on deck” – GHH staff and alumni worked after-hours and weekend shifts

Hurricane Harvey

Mobilization

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Hurricane Harvey

Vignettes

Steady flow 20+ patients / hr Call-in operations response time to requests, <2 mins GHH staff and alumni volunteered time

Most physicians surprised by our capabilities We were only ones with computers Patient MO: diabetics, CV, dialysis Common requests: medications, problem list, labs, notes, radiology

“I will definitely write very positive things about GHH in my post-storm report” - Ted Sikorski, MD – DMAT Commander

As hospitals became overloaded with phone calls, we became de facto source for information Similarly, with many pharmacies closed, we were the source for medication data

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Hurricane Harvey

Impact

staff hours to support shelters

937

653 70% total # of records

accessed during Harvey

Records found as % of

total requested

62% Query requests just looking

for active medications

100% patients who opted in when

asked for consent at shelters

17 # of consecutive days

with 24/7 call-in support

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Thank You!