E-Health / Health Information Exchange Use Case Impact on Provider Workflow

Health Information Consulting, LLC 1

E-HEALTH / HEALTH INFORMATION EXCHANGE

USE CASE IMPACT

ON

PROVIDER WORKFLOW


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


Topics

A. Evolution of Intra Provider Messaging

B. Today’s Challenges

C. HIE Use Case Impact on Provider / Patient Workflows


EVOLUTION OF PROVIDER MESSAGING


Not so Distant Past Provider Messaging


Information Access Evolution


Changing Provider I/T Environment

2006

5% Physician EMR use to 20%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


WORKFLOW CHALLENGES


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


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


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


HIE IMPACT ON PROVIDER WORKFLOWS


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


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.


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


Typical Hospital View of Their Service Community

Hospital SystemsEmployed PhysiciansAffiliated PhysiciansOther Providers


ONC View of The Service Community

PatientPhysiciansAncillary ProvidersHospitals


Goal: Data and Information Exchange

Point of Care

Clinical Information / Data Analytics

Care Continuum


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


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


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


MANAGING THE FUTURE


Physicians Want “One Stop Shopping”

Patient Security (Sign-on) Privacy Policies Consent Policies Data Integrity (Trust) Error Correction (Trust)Auditing (Risk) Change Management (Standards)


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?


Patient Centric Approach to I/T


Thanks !

Health Information Consulting, LLC

Mike Mytych

[email protected]

262-253-9110

mailto:[email protected]