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Implementation Team MeetingMedical Neighborhood Project
Coordinated by:
April 30, 20158:30 – 11:30 AM
Nationwide & Ohio Farm Bureau 4-H Center
PurposeImprove referral infrastructure across the medical neighborhood in Greater Columbus
Today’s Objectives1. Review purpose and history of the project2. Clarity on scope and approach3. Awareness on functionality of CliniSync referral tool
Important Note
Parking passes are required
Implementation Team MeetingMedical Neighborhood Project
Coordinated by:
Implementation Team MeetingMedical Neighborhood Project
Coordinated by:
April 30, 20158:30 – 11:30 AM
Nationwide & Ohio Farm Bureau 4-H Center
PurposeImprove referral infrastructure across the medical neighborhood in Greater Columbus
Today’s Objectives1. Review purpose and history of the project2. Clarity on scope and approach3. Awareness on functionality of CliniSync referral tool
8:30 – 8:35 Welcome
8:35 – 8:40 Framing
8:40 – 9:10 Review project purpose, history, clarity, and scope
9:10 – 10:20 Awareness on functionality of CliniSync referral tool
11:20 – 11:30 Closing
Today’s Agenda
Implementation Team MeetingMedical Neighborhood Project
Coordinated by:
Our Strategic Areas of Focus
www.hcgc.org
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
PATIENT-CENTERED MEDICAL NEIGHBORHOOD
COLLABORATIVE LEARNING
QUALITY TRANSPARENCY
…improve care coordination between providers & social services
…improve the use of quality data
…improve the application of learning in Greater Columbus
PATIENT ENGAGEMENT
…improve engagement between patients and providers
Patient-Centered Medical Home
Patient-Centered Medical Neighborhood
WHY?
Implementation Team MeetingMedical Neighborhood Project
www.hcgc.org
Medical Neighborhood ModelMedical Neighborhood Project
www.hcgc.org
Referral Process Between Community Organizations and Healthcare Providers
Organization A
Client Data
Client Data
Client Data
Client Data
Client Data
Referral Type
Fax
Phone
Current ViewMedical Neighborhood Project
Organization B
Organization C
Organization E Organization
D
CPC Milestone VI: Care Coordination Across the Medical Neighborhood
Demonstrate active engagement and care coordination across the medical neighborhood by creating and reporting a measurement to assess impact and guide improvement.
Medical Neighborhood Project
www.hcgc.org
Alignment with Other Initiatives
Medical Neighborhood Project
www.hcgc.org
Alignment with Other Initiatives
Medical Neighborhood Project
www.hcgc.org
Alignment with Other Initiatives
Review purpose and history of the project
Implementation Team MeetingMedical Neighborhood Project
www.hcgc.org
Why are we doing this work?
• In January 2014, UWCO and HCGC convened funded member agencies to determine the challenges organizations face when sending and receiving referrals, and identify the healthcare providers they most frequently exchange referrals with.
Challenges Identified• Lack of standardization among types of referrals• Lack of shared-infrastructure for making referrals• Lack of clarity about services provided by other
agencies
Common Healthcare Providers• Hospitals • FQHCs• Free Clinics
Implementation Team MeetingMedical Neighborhood Project
www.hcgc.org
Referral Process Between Community Organizations and Healthcare Providers
Organization A
Client Data
Client Data
Client Data
Client Data
Client Data
Referral Type
Fax
Phone
Current ViewMedical Neighborhood Project
Organization B
Organization C
Organization E Organization
D
Referral Process Between Community Organizations and Healthcare Providers
Organization A
Client Data
Client Data
Client Data
Client Data
Client Data
Future ViewMedical Neighborhood Project
Organization B
Organization C
Organization E
Organization D
Shared Referral Infrastructure
Project Design TeamMedical Neighborhood Project
• AIDS Resource Center Ohio• The Breathing Association• Central Ohio Diabetes
Association• Charitable Pharmacy of
Central Ohio• Clintonville-Beechwold
Community Resource Center• Columbus Neighborhood
Health Center• Heart of Ohio Family Health
Centers• LifeCare Alliance• Lower Lights Christian Health
Center
• Maryhaven• The Medical Group of Ohio• Mount Carmel Health System• OhioHealth• The Ohio State University
Wexner Medical Center• Physicians CareConnection• United Way of Central Ohio• US Together, Inc.
www.hcgc.org
2015 Project OverviewMedical Neighborhood Project
WHAT: Spread best practices to improve coordination of care between providers and social services in Greater Columbus.
HOW: Implement cloud-based, shared referral infrastructure among local healthcare providers, social service agencies, and other healthcare stakeholders.
2015 Objectives• Convene interested social service agencies and healthcare providers to plan
for implementation of initial phase of project.
• At least ten social service agencies and five local healthcare providers participating in project implementing CliniSync to send and receive referrals.
• Collect project measures, document lessons learned, and share learning with public-private partners
www.hcgc.org
Project Implementation TeamMedical Neighborhood Project
• Aetna• AIDS Resource Center Ohio• American Cancer Society• The Breathing Association• Central Ohio Area Agency on Aging• Central Ohio Diabetes Association• Central Ohio Primary Care• Charitable Pharmacy of Central Ohio• Clintonville-Beechwold Community Resource
Center• Columbus Neighborhood Health Center• Columbus Public Health• Community Refugee & Immigration Services• CompDrug, Inc.• Concord Counseling Services• Ethiopian Tewahedo Social Services• Faith Mission• Gladden Community House• Godman Guild Association• HandsOn Central Ohio• Helping Hands Health and Wellness Center• Horn of Africa Voluntary Youth Committee• LifeCare Alliance
• Lower Lights Christian Health Center• The Medical Group of Ohio• Mid-Ohio Foodbank• Mount Carmel Health Partners• Mount Carmel Health System• Mount Carmel Medical Group• National Church Residences• Nationwide Children’s Hospital Primary Care
Network• Ohio Asian America Health Coalition• Ohio Association of Community Health Centers• Ohio Department of Health• Ohio Office of Human Services Innovations• The Ohio State University Wexner Medical
Center• OhioHealth Group• Physicians CareConnection• Prevent Blindness Ohio• Southeast, Inc.• Syntero• UHCAN Ohio• United Way of Central Ohio• YMCA of Central Ohio
www.hcgc.org
Implementation Team MeetingMedical Neighborhood Project
Review project scope and approach
www.hcgc.org
Project MilestonesMedical Neighborhood Project
Wave 1
Wave 2
Q2 2015 Q3 2015 Q4 2015 Q1 2016 and Beyond
• 15 – 25 Participation Commitments
• CliniSync Referral Tool Implementation and Training
• Organizations Using Referral Tool
• Begin Reporting Monthly Project Measures
• Identify Orgs to Participate in Next Wave
• Report Project Value Measures
• Participants Share Learning with Community
• Ongoing Project Participation, Reporting, and Shared Learning
Wave 3
As needed
www.hcgc.org
Referral Process Between Community Organizations and Healthcare Providers
Organization A
Client Data
Client Data
Client Data
Client Data
Client Data
Referral Type
Fax
Phone
Current ViewMedical Neighborhood Project
Organization B
Organization C
Organization E Organization
D
Project MeasuresMedical Neighborhood Project
www.hcgc.org
• Learning from other regions• Michigan• Maine, New Hampshire,
Connecticut, New York, Virginia, Georgia
• Participation, System Use, Value
• A good place to start!
Project MeasuresMedical Neighborhood Project
www.hcgc.org
• Participation Measures (Collected Monthly)• # of organizations in CliniSync network• # of services available on CliniSync network• # of patients in CliniSync network
• System Use Measures (Collected Monthly)• # of referrals sent within CliniSync• Total # of referrals made by an organization inside
and outside of CliniSync
• Value Measures (Collected Quarterly)• Value of CliniSync to the organization• Estimated time saved by CliniSync• Estimated # of new organizational relationships
from the Medical Neighborhood Project
Medical Neighborhood Project
www.hcgc.org
What questions of clarity are you sitting with regarding the Medical Neighborhood Project?
Implementation Team Meeting
Awareness on Functionality of CliniSyncReferral Tool
Implementation Team MeetingMedical Neighborhood Project
www.hcgc.org
26
CliniSync UpdateDan PaolettiCEO, Ohio Health Information Partnership
27
Module 1Project Participation
• Sign CliniSync Participation Agreement
• Attend Kick-Off (web-based)
• Participate in Training (onsite)
• Participate in Touch Point calls
Requirements for Participation
• Includes Business Associate Agreement (BAA)
• Same BAA signed by all CliniSync participants
• Pricing
•No cost to use the Community Health Record
• Patient Referrals
CliniSync Participation Agreement
• Sample Agenda
• Purpose and scope
• Consent policy & guidance
• Security
• Demonstration
• Support
• Training overview
Duration: 60 minutes (web-based)
Kick-Off for Group
• Sample Agenda
• Review workflow
• Demonstration
• Maintenance of questions and preferences
• Working sent and received referrals
• Review training materials
• Assist staff with login
• Support
Duration: 60 – 90 minutes (on-site)
Site Specific Training
• Who should be involved?
• Think about who manages referrals today
• Referral coordinators
• Intake staff
• Think about who trains staff today
• Train-the-trainer approach
Site Specific Training, continued
• Discuss experiences
• Communicate workflow strategies
• Share lessons learned
Duration: 15 - 30 minutes weekly
Touch Point Calls for Group
34
Q & A
35
Module 2Organization’s Profile
Community Health Record
36
Community Health Record
Continuity of Care Record
Clinical Results Inbox
Patient Referrals
Web Direct
Results Delivery
Integrated EHRDelivery of results and reports
Locally Hosted PDF Delivery
ProviderDIRECTory
Use yours or our Direct-enabled secure email to exchange with other providers
Join our statewide list of >13,000 providers
Notify
Automated delivery of event notifications as they happen throughout the network
HIE DataPublishing
Registration Data
Discrete Notes
CCDAs
Public Health
Consulting
CliniSyncPLUS
Practice Transformation
• Community Health Record
• Expressed consent role
• Patient referrals module
• Ability to search for and add patients
•Continuity of care record (addition to provider-
based practices)
Provisioned Access/Roles
• Inbound Preferences
• Questionnaire Management
• Options
Your Organization Customized
39
Preview
40
Q & A
• Referral Documents and Instructions
Inbound Preferences
Example: Map or
New Patient Packet
• Duplicating paper form and mandating answers
Questionnaire Management
• Favorites, staff permissions and email notifications
Options
44
Module 3Sending a Referral
• Search for patient
• Select patient
• Click create referral
• Choose referring provider
• Choose referral destination
• Enter reason
• Answer questions
• Attach record/result if necessary
• Review
• Click refer
Sending A Referral
• Search for patient
• No patient found
• Click add patient (consent gathered)
• Enter patient demographics
• Submit
• Patient has been added to the Community Health Record patient index
• Create referral as normal from added patient
Adding A Patient
• Click Referrals at top right of screen
• Sent Referrals tab opens
• View list of referrals
• Click on referral from Sent list to see detail
• Communicate with referring practice within sent referral
Monitoring Sent Referrals
48
Preview
49
Q & A
53
Module 4Received Referrals
• Click Referrals at top right of screen
• Click Received Referrals tab
• Use filters as needed
• Click on referral to see detail
• Adjust status as needed
• Sending practice/facility will see status change and any scheduling detail entered
• Check for new messages
• Acknowledge and reply to sending practice/facility about the referral
Working Received Referrals
55
Preview
56
Q & A
59
Closing
60
CliniSyncCommunity Health RecordServices
What is the Community
Health Record?
61
Community Health Record
Continuity of Care Record
Clinical Results Inbox
Patient Referrals
Web Direct
Results Delivery
Integrated EHRDelivery of results and reports
Locally Hosted PDF Delivery
ProviderDIRECTory
Use yours or our Direct-enabled secure email to exchange with other providers
Join our statewide list of >13,000 providers
Notify
Automated delivery of event notifications as they happen throughout the network
HIE DataPublishing
Registration Data
Discrete Notes
CCDAs
Public Health
Consulting
CliniSyncPLUS
Practice Transformation
62
What can I do in the
Community Health Record?
CONTINUITY OF CARE
•Access a patient’s treatment history, hospital encounters, problem list, allergies, lab results, radiology and other transcribed reports exchanged through CliniSync.
•Check patient demographic and insurance information captured by other providers.
•View, print or download encounter-specific or full continuity of care summaries for your records.
•Coming soon: Query Ohio’s Automated Rx Reporting System (OARRS) as required by law.
RESULTS INBOX
•Receive and manage your patients’ results and reports via your own inbox.
PATIENT REFERRALS
•Initiate and coordinate patients’ referrals with other CliniSync providers using customizable templates.
WEB DIRECT
•Send and receive secure emails with attachments to more than 13,000 providers in our statewide DIRECTory.
Next StepsMedical Neighborhood Project
www.hcgc.org
• Reflections and learning will be included in meeting record
• Individual organizations invited to participate over the next few weeks• Starting with healthcare providers
• Medical Neighborhood Learning Group
Thank you for your participation!