impact: planning for go-live s&i framework longitudinal coordination of care pilots workgroup...
TRANSCRIPT
IMPACT: Planning for Go-Live
S&I Framework Longitudinal Coordination of Care
Pilots Workgroup Meeting
March 10th, 2014
Larry Garber, MD
IMPACT Grant
February 2011 – HHS/ONC awarded $1.7M HIE Challenge Grant to state of Massachusetts (MTC/MeHI):
Improving Massachusetts Post-Acute
Care Transfers (IMPACT)
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IMPACT Objectives & Strategies• Facilitate developing a national standard of
data elements for transitions across the continuum of care
• Develop software tools to acquire/view/edit/send these data elements (LAND & SEE)
• Develop consumer-oriented translator• Integrate and validate tools into Worcester
County using Learning Collaborative methodology
• Measure outcomes3
Pilot Sites to Test the Datasets• Selection Criteria:
– High volume of patient transfers with other pilot sites– Experience with Transitions of Care tools/initiatives
• 16 Winning Pilot Sites:– St Vincent Hospital and UMass Memorial Healthcare– Reliant Medical Group (formerly known as Fallon
Clinic) and Family Health Center of Worcester (FQHC)
– 2 Home Health agencies (VNA Care Network & Overlook VNA)
– 1 Inpatient Rehab Facility (Fairlawn)– 1 Payer (Fallon Community Health Plan)– 8 Skilled Nursing and Extended Care Facilities
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Legal Issues
• Data Use Reciprocal Service Agreement (DURSA) between pilot sites and State HIE/HISP (MA HIway)
• Contract between SEE vendor (Lantana) and HIway for testing/support
• Accessibility waiver
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Accessibility waiver• Poor vision
– Should be able to increase font size
– We’re encouraging 24” – 27” monitors
• Color blind– Color shouldn’t be only distinguishing attribute
– Added “*” next to red required fields
• Blind– Navigable 100% using keyboard
– All fields have meaningful tags/names that can be read by text-to-speech software6
Software testing• Iterative development
– End user feedback– Prioritized punch list (pre-, peri-, post-GoLive)
• Unit testing – each piece• Integrated testing – end-to-end• Security testing• Create support mailbox to send/receive• Confirm correct version of web browser
– Type, version, corporate polices, certificates• Alpha test – 1 site with fake ZZZpatients• Beta test – all sites with fake patients
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SNF Receiving Hospital Summary• Text-message notification of new webmail message
24x7 (Administrator, Clinical Liaison, DON, DO Admission, DO Social Service?) Do you need to purchase a dedicated phone? Remember that at 3AM when there’s new mail, everyone on the list will get the text message, even those sleeping at home…
• Who prints the incoming CDA summary document for the paper chart? Same as the person who gets the text message?
• Where is it printed? Are there printers in convenient locations? Are the PCs configured to use the printer by default?
• What is done with the printed summary? Are multiple copies needed? Does a copy need to be faxed to a physician or nurse practitioner?
• Should new CDA with admit date be started? 8
Sending Summary to ED/PCP/HH• Which prior documents will you copy from? • Which sections do you want to copy from
prior? • Where will other pieces of information come
from? What can be cut & pasted? Pharmacy ordering system?
• What information should be entered for the SBAR vs. a Transfer Summary?
• Who sends document, how do they know it’s ready and where to send?
• Do you need to print extra copies (e.g. paper record, PCP, specialists, patient/family, EMS)?
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KeyHIE Transform?
• Converts MDS (or OASIS) into CDA document mailed back to site’s mailbox
• How often are MDS’s done? Is there one when you need it? How long is an MDS reliable for?
• Can SNF MDS’s be distinguished from Long-Term Care patients?
• Will the incoming document easily show who the patient is?
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Site Configuration
• Users, UserIDs, Passwords. Who will manage hires/fires (Access Administrator)?
• What Direct Addresses are in Provider Directory? Which is preferred?
• Set up Gmail rules to send text
• Distribute blank CDA document11
Training
• PowerPoint
• Video recording of training session
• Cheat sheet (How to… Where to find…)
• Pilot site preferred Direct addresses
• Post-training competency test
• Train-the-trainer (2 hours)– Scalable
– Can still customize workflow for each site
– Provides on-site support12
Training
1. What’s the problem we’re solving?
2. How will each user see benefit?
3. Big picture of HIE
4. Big picture of software
5. GUI overview
6. Logical use cases to train details
7. Big picture again
8. Competency test13
Scenarios
• View received CDA and print it
• Find and Edit previously received CDA
• Find previously edited CDA and Send it
• Start new CDA from scratch
• Create a CDA from documents received from Hospital and MDS
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Go-Live Support
• Roll-out pairs of trading partners– Hospitals and SNFs/IRFs/LTACHs
– PCPs and ERs
– Home Health with Hospitals/SNF/IRF/LTACH
• On-site support
• Since low volume, can do dress rehearsal on go-live day with fake patients
• Identify best practices and software bugs
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Post-GoLive
• Debrief/Share Best Practices
• Celebrate
• Market successes with a press release
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