e-health / health information exchange use case impact on provider workflow
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Health Information Consulting, LLC 1
E-HEALTH / HEALTH INFORMATION EXCHANGE
USE CASE IMPACT
ON
PROVIDER WORKFLOW
Health Information Consulting, LLC 2
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
Health Information Consulting, LLC 3
Topics
A. Evolution of Intra Provider Messaging
B. Today’s Challenges
C. HIE Use Case Impact on Provider / Patient Workflows
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EVOLUTION OF PROVIDER MESSAGING
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Not so Distant Past Provider Messaging
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Information Access Evolution
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Changing Provider I/T Environment
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
Measures3. Care coordination / CCD exchange 4. Consumer access to their records5. Data standards
ICD-IO SNOMED CT Rx Norm LOINC Others
2011 2015 2019 2019
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WORKFLOW CHALLENGES
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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?
HIPAA Compliance
Security
Consent
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Changing of the Guard
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
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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
RegionalHIE
•Log-in•Passwords•Patient search•Navigation•Flows
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HIE IMPACT ON PROVIDER WORKFLOWS
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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
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
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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
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.
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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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Typical Hospital View of Their Service Community
Hospital SystemsEmployed PhysiciansAffiliated PhysiciansOther Providers
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ONC View of The Service Community
PatientPhysiciansAncillary ProvidersHospitals
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Goal: Data and Information Exchange
Point of Care
Clinical Information / Data Analytics
Care Continuum
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Traditional Workflow Example
1. Patient calls for doctor appointment2. Patient is sent forms to fill out and bring into
office3. Patient arrives at clinic with forms4. Forms are reviewed by staff and entered tin
to the system5. Patient is “roomed” and vitals written in chart6. Patient previous test results arrived via fax
and clipped to chart for clinician review7. Physician conducts exam and annotates
findings in chart8. Provides written Rx to the patient9. 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
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
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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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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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MANAGING THE FUTURE
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Physicians Want “One Stop Shopping”
Patient Security (Sign-on) Privacy Policies Consent Policies Data Integrity (Trust) Error Correction (Trust)Auditing (Risk) Change Management (Standards)
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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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Patient Centric Approach to I/T
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Thanks !
Health Information Consulting, LLC
Mike Mytych
mmytych@hicllc.com
262-253-9110
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