How Interoperability Can Protect and Grow Referrals, Enable … · 2020. 6. 1. · Agreement (TEFCA). Contact: [email protected] Presenter BioClick to edit Master title style Kara

How Interoperability Can Protect and Grow Referrals, Enable Virtual Health,

and Improve Care Coordination5/28/2020

Copyright HPA The Catalyst 1

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Envisioning a New Normal for Physical Therapy:

How Interoperability Can Protect and Grow Referrals, Enable Virtual Health, and Improve Care Coordination

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Envisioning a New Normal for Physical Therapy:

How Interoperability Can Protect and Grow Referrals, Enable Virtual Health, and Improve Care Coordination

Click to edit Master title stylePresenters and Panelists

Therasa Bell, Co-Founder, President,

CTOKno2

Alan Swenson, VP of Interoperability

Kno2

Dr. Robert “Bob” Latz, PT, DPT, CHCIO

Trinity Rehab Services

Kara Gainer, JDAPTA

Karen Chesbrough, MPHAPTA

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Click to edit Master title stylePresenter Bio

Therasa Bell - is the cofounder, president and chief technology officer at Kno2 and is known for three things: her focus on driving interoperability in healthcare, her ability to simplify the complexities of patient document exchange and clinical workflows, and her commitment to serve that infuses her interactions with everyone around her and powers the company’s purpose to eliminate fax from healthcare by providing a solution for interoperability that can serve everyone throughout the healthcare ecosystem. Ms. Bell was recently recognized in the 2019 class of Most Powerful Women in Health IT by Health Data Management. A true inventor at heart, Ms. Bell has designed and implemented multiple technologies and systems, is the holder of multiple patents for clinical workflows, unstructured clinical documents, subnetworks and aggregating healthcare networks.

Contact: [email protected]


Alan Swenson - is the Vice President of Interoperability at Kno2, where his focus is on improving interoperability across the entire continuum of care. Alan is responsible for overseeing specific projects aimed to extend interoperability into hard to reach markets, and groups not previously part of government incentive programs to drive interoperability, such as LTPAC, behavioral health, therapies, emergency medical services, and more. He represents Kno2’s partners and customers in industry trade associations and actively participates and leads in other industry interoperability initiatives, such as Carequality, CommonWell Health Alliance and DirectTrust. In addition, Alan currently serves as a Member Board Director for NASL and is Vice-Chair of their IT Committee, leading NASL interoperability initiatives, including comments to the ONC and CMS interoperability rules and ONC's draft two of the Trusted Exchange Framework and Common Agreement (TEFCA).



Kara Gainer, JD - leads, manages, and provides strategic direction to the regulatory affairs team on key programs and initiatives in the federal regulatory space that help to move forward the priorities of the APTA for the advancement of our profession in the area of payment and public policy. She also is responsible for leading member initiatives and developing policies and programs that promote the practice of physical therapy. Prior to joining APTA, Kara was a health care consultant with Drinker Biddle & Reath, where she developed and executed comprehensive public policy strategies for her clients that integrated legislative, regulatory, and communications efforts. She also served as an Attorney Advisor for the US Department of Health and Human Services Office of Medicare Hearings and Appeals and clerked with the U.S. Senate Sergeant at Arms.



Dr. Robert “Bob” Latz, PT, DPT, CHCIO - is the Chief Information Officer at Trinity Rehabilitation Services. Dr. Latz is the President of the Technology SIG for HPA, the Catalyst. As such, he is the Technology and Innovation Director and member of the Board of Directors for HPA. Dr. Latz is active within CHIME, HIMSS, NASL and other groups in both IT and Post-Acute Care activities.


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Karen Chesbrough, MPH - is director of the Physical Therapy Outcomes Registry at APTA. She has been with APTA for the past 11 years, previously serving as the scientific program manager for the Foundation for Physical Therapy Research. There, she directed the development of new grant funding mechanisms and oversaw the solicitation and review of grant applications and the subsequent administration of funds. Most notably, she led the development and implementation of the CoHSTAR grant (Center for Health Services Training and Research) which provides training and research opportunities for physical therapists in health services. Before that, she served as a research associate and research assistant for the Henry M. Jackson Foundation for the Advancement of Military Medicine. She managed the investigations of large population cohort studies for the Department of Defense. She received her master’s degree in public health from University of Hawai’i at Manoa and her bachelor’s degree from Virginia Tech.

Contact: [email protected] 10P a g e

The COVID-19 pandemic has amplified

the importance of interoperability and

the ease in which clinical information

needs to be securely available to us

and the entire healthcare community.

Explain what data interoperability

means in physical therapy in

everyday terms

Describe the impact of data

interoperability on care delivery

and referral relationships

Take advantage of interoperability

tools that are immediately available

during the COVID-19 crisis

Identify tangible steps your

organization can take to transition

away from fax to more interoperable

methods of exchange

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4

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Healthcare Industry Dynamics

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The amount that CMS spent on

the electronic health record

(EHR) incentive program

$35 Billion Spent $35 Billion Spent $35 Billion Spent $35 Billion Spent

Faxing in healthcare is still on the

rise. More than 10 billion fax

pages are exchanged each year

10 Billion Fax Pages10 Billion Fax Pages10 Billion Fax Pages10 Billion Fax Pages

Referring providers would switch

to a provider they were able to

accept electronic referrals

Preferred Referral PartnerPreferred Referral PartnerPreferred Referral PartnerPreferred Referral Partner

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$35B 10+B 60%

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February 17, 2009

created to motivate the implementation of electronic implementation of electronic implementation of electronic implementation of electronic

health records (EHR) health records (EHR) health records (EHR) health records (EHR) and supporting technology in

the United States

HITECH ACTHITECH ACTHITECH ACTHITECH ACT

This past decade, several legislative actions have taken place that are placing technology and interoperability

pressure on healthcare organizations across the country…post acute and longpost acute and longpost acute and longpost acute and long----term care are no longer an exception. term care are no longer an exception. term care are no longer an exception. term care are no longer an exception.

March 23, 2010

Incorporated a number of initiatives promoting more

valuevaluevaluevalue----based care based care based care based care instead of traditional fee-for-service

payment models.

AFFORDABLE CARE ACTAFFORDABLE CARE ACTAFFORDABLE CARE ACTAFFORDABLE CARE ACT

October 6, 2014

The Act mandates that postpostpostpost----acute acute acute acute settings begin begin begin begin

reportingreportingreportingreporting of quality measures starting Oct. 2016, and

standardized patient assessments data by Oct. 2018

IMPACT ACTIMPACT ACTIMPACT ACTIMPACT ACT

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January 5, 2018

Introduction to a standardized set of health data standardized set of health data standardized set of health data standardized set of health data

classes and constituent data elements for nationwide, for nationwide, for nationwide, for nationwide,

interoperable health information exchange.interoperable health information exchange.interoperable health information exchange.interoperable health information exchange.

January 5, 2018

First draft of the trusted exchange framework First draft of the trusted exchange framework First draft of the trusted exchange framework First draft of the trusted exchange framework in response to

Section 4003 in the Cures Act…an important step toward

advancingadvancingadvancingadvancing the establishment of an interoperable health systeminteroperable health systeminteroperable health systeminteroperable health system

December 13, 2016

Congress defines the importance of interoperabilityCongress defines the importance of interoperabilityCongress defines the importance of interoperabilityCongress defines the importance of interoperability and

laid out a path for the establishment of interoperable

exchange of EHI.InformationInformationInformationInformation blocking was introduced.blocking was introduced.blocking was introduced.blocking was introduced.

21212121STSTSTST CENTURY CURES ACTCENTURY CURES ACTCENTURY CURES ACTCENTURY CURES ACT

US CORE DATA for INTEROPERABILITY US CORE DATA for INTEROPERABILITY US CORE DATA for INTEROPERABILITY US CORE DATA for INTEROPERABILITY

TEFCA V1TEFCA V1TEFCA V1TEFCA V1

February 11, 2019

More on information blockinginformation blockinginformation blockinginformation blocking, patient access and postpostpostpost----

acute care interoperabilityacute care interoperabilityacute care interoperabilityacute care interoperability, including a proposed

timeline for compliance....

ONC/CMS PROPOSED RULINGSONC/CMS PROPOSED RULINGSONC/CMS PROPOSED RULINGSONC/CMS PROPOSED RULINGS

April 19, 2019

Draft 2 outlines a common set of principles, terms and

conditions to support the development of a Common Common Common Common

Agreement that would help enable nationwide exchange of EHI Agreement that would help enable nationwide exchange of EHI Agreement that would help enable nationwide exchange of EHI Agreement that would help enable nationwide exchange of EHI

TEFCA V2TEFCA V2TEFCA V2TEFCA V2

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March 9, 2020

Final ruling on information blockinginformation blockinginformation blockinginformation blocking, patient access and

postpostpostpost----acute care interoperabilityacute care interoperabilityacute care interoperabilityacute care interoperability, including compliance with

US Core Data for Interoperability and the use of FHIR....

September 30, 2019

A new rule empowers patients to be active participants in

discharge planning and seeks to ensure seamless exchange of seamless exchange of seamless exchange of seamless exchange of

their data between acute care and posttheir data between acute care and posttheir data between acute care and posttheir data between acute care and post----acute care settingsacute care settingsacute care settingsacute care settings.

October 1, 2019

A major overhaul to the current SNFSNFSNFSNF prospective

payment system (PPS) from feefeefeefee----forforforfor----service towards service towards service towards service towards

valuevaluevaluevalue----based care payment based care payment based care payment based care payment

CMS DISCHARGE RULECMS DISCHARGE RULECMS DISCHARGE RULECMS DISCHARGE RULE

PDPM/PDGMPDPM/PDGMPDPM/PDGMPDPM/PDGM

HHS FINAL INTEROPERABILITY RULINGSHHS FINAL INTEROPERABILITY RULINGSHHS FINAL INTEROPERABILITY RULINGSHHS FINAL INTEROPERABILITY RULINGS

COVIDCOVIDCOVIDCOVID----19 PANDEMIC19 PANDEMIC19 PANDEMIC19 PANDEMIC

April 30, 2020

CMS officially made physical therapistsphysical therapistsphysical therapistsphysical therapists, occupational therapistsoccupational therapistsoccupational therapistsoccupational therapists, and speechspeechspeechspeech-

language pathologists eligible to deliver—and receive reimbursementreimbursementreimbursementreimbursement forforforfor————

telehealthtelehealthtelehealthtelehealth services for the remainder of the public health emergency period.

CMS AUTHORIZES TELEHEALTHCMS AUTHORIZES TELEHEALTHCMS AUTHORIZES TELEHEALTHCMS AUTHORIZES TELEHEALTH

March, 2020

Emergency declaration Emergency declaration Emergency declaration Emergency declaration is announced in several states; “non-essential”

workers are ordered to stay at homeare ordered to stay at homeare ordered to stay at homeare ordered to stay at home; schools and elective surgeries are elective surgeries are elective surgeries are elective surgeries are

postponedpostponedpostponedpostponed across the nation

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• Amplifies our disconnected state

• Recognize how important it is

• Social distancing requirements magnifies

the need for virtual/telehealth services

• Clinical care changes and workflow

changes

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InteroperabilityIn healthcare, interoperability is the ability of

different information technology systems and

software applications to communicate, exchange

data, and use the information that has been

exchanged.1

17P a g e1 HIMSS Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 2nd Edition,

2010, Appendix B, p190, original source: Wikipedia

Click to edit Master title styleChance to WIN $25 gift card!

20 Seconds to Answer…closest to answer wins

Open Question Portal

…Enter your answer there

And the question is….


When did the first fax technology arrive?

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We are using a stagecoach

to delivery critical health

information about a patient

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At a time like this… how do you want your essentials shipped?

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Roads and HighwaysRoads and HighwaysRoads and HighwaysRoads and Highways

There are approximately 4,071,000 miles

of paved and unpaved roads

RailroadRailroadRailroadRailroad

There is nearly 140,000 miles of track and

over 100,000 bridges

88% of all US residents own at least one vehicle, and every day, FAA 's Air Traffic Organization (ATO) provides

service to more than 44,000 flights and 2.7 million airline passengers across more than 29 million

AirportsAirportsAirportsAirports

As of 2016, there are 13,168 airports and

5,709 heliports, overall 19,536 facilities

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Moving ForwardThe interoperability infrastructure is in place

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Cloud FaxingCloud FaxingCloud FaxingCloud Faxing

RailroadsRailroadsRailroadsRailroads

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Start with Cloud Faxing

• Remove paper tray

• Delivery to the patient record

• Workflows

• Enable remote health

• Transition to more interoperable methods of

exchange

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Direct MessagingDirect MessagingDirect MessagingDirect Messaging

Roads & HighwaysRoads & HighwaysRoads & HighwaysRoads & Highways

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Push-based messaging

and economical

Broad availability

Acts and looks like email

Simple

Providers and organizations

National Directory

HIPAA-compliant

Secure

Requires identity verification

Trust

Patient demographics, document types

Documents & Data

And notifications

Alerts

Based upon EHR functionality

Data reconciliation

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This is enabled transactions

68+ Million 68+ Million 68+ Million 68+ Million Direct transactions between trusted endpoints

on average per month

1 Billion+ 1 Billion+ 1 Billion+ 1 Billion+ Cumulative Direct Messages since 2014

Number of Send and Receive Direct Transactions to/from Trusted Endpoints

4498

167

274

811

0

100

200

300

400

500

600

700

800

900

2015 2016 2017 2018 2019

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Of professional referrals

never result in a doctor’s visit

Of specialty practices say referral

info from providers is fair to poor

Of patients do not follow-up

with the specialist when referred

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Current Process

• Broken “hand-off”

− Patients typically left to schedule with specialist

− Referring provider often not aware appointment was made

− Follow up often doesn’t occur from specialist

− When information is shared, its typically via fax and is not easily associated (or doesn’t close out) initial referral

• Broken processes with CMS quality measures – complete referrals with the results/consultation from the rendering party

• Poor patient experience

• Risk of clinical information not being effectively shared, thus harming patient

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• Launched by ONC

• Collaborative effort by HIT vendors, HISPs, clinicians and other industry partners

• Uses existing provenprovenprovenproven industry standards only:

• C-CDA - clinical content

• Direct Standard™ - transport

• XDM - establishing context (Metadata)

• HL7 V2 messages - referral workflow

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Physician Physician Physician Physician orders &

sends PTPTPTPT referral

request via Direct

PT PT PT PT accepts referral

with patient’s

appointment time1

Standardized Standardized Standardized Standardized status

messages are exchanged

between the two offices2

PatientPatientPatientPatient completes

final visit and PTPTPTPT

completes chart

Referral Referral Referral Referral

is automatically

closed

1. A declined request will result in all data being purged by recipient’s system. The referring office will continue sending requests to other specialists.

2. Examples of status messages: no show, canceled, appointment rescheduled, etc.

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Patient QueryPatient QueryPatient QueryPatient Query

AirportsAirportsAirportsAirports

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Pull-based messaging

Get it when you need it

On Demand

For treatment and operational purposes

Record Retrieval

Providers and organizations

Directory

In place and HIPAA-compliant

Security Protocols

Know who you are getting it from

Trust

Medications, allergies, problem list, etc.

Data

Millions of records exchanged each month

Widely Adopted

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Coming SoonComing SoonComing SoonComing Soon

Ambra

Central PA Connect

eHealth Exchange

ELLKAY

eMedicalPractice

epiSource

Health Catalyst

HealthLX

InterSystems

iPatientCare

JCMR

Life Book

Life Image

Manifest MedEx

MiHIN

Nuance

Patagonia Health

Philips

Paractice Velocity

Safety Net Connect

SwellBox

Womba

600k Care

Providers

90M+ DOCUMENTS

EXCHANGED

MONTHLY

2000+

Hospitals

50K

Clinics

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Hospital Hospital Hospital Hospital sends referral for

physical therapy (PT)

PT PT PT PT

receives

Query Query Query Query for

additional patient

information1

Additional Additional Additional Additional patient

information received

via ResponseResponseResponseResponse

Patient accepted at PT Clinic Patient accepted at PT Clinic Patient accepted at PT Clinic Patient accepted at PT Clinic

complete information

yields efficiency gain

1. Hospital can also query PT Clinic for progress notes and care plans 38P a g e

• Fast Healthcare Interoperability Resources (FHIR) is a standard describing data formats and elements (Resources) and APIs for exchanging electronic health records

• Created by the HL7

• Supplements query and Direct to get specific pieces of information instead of full documents

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• Focus from government on patient/proxy access

• Patient has access to their data from a FHIR-based mobile application of their choosing

• Mobile apps may get tied into TEFCA for governance

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• Direct Messaging has not solved for this

challenge

• Fax remains a dependency

− Difficult to track

− Difficult to reconcile

− Time consuming for your customers

A Gap Still A Gap Still A Gap Still A Gap Still

RemainsRemainsRemainsRemains

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InteroperableInteroperableInteroperableInteroperable

eeee----Signing is HereSigning is HereSigning is HereSigning is Here• Most importantly, seamless workflows

between you and the signing provider− Universal and agnostic signing solution

− Easy reconciliation to the patient and the care plan

− Compatible with both EHRs (yours and the signing

provider)

• Together we’re bringing interoperable e-

signing to the healthcare industry

PT Outcomes Registry Foundation

PT Outcomes Registry: Establishing a Common Language CDR Format

Patient

Demographics

Section

With information

from10 patients

Pt 2 :

Subsequent

Visits

PT 1:

Initial

Visit

CCDA Format

• 10 patients

• 16 files are shared

• Data has to be matched across files

• Not based on current data standards

Social History

Observation

Section

With information

from10 patients

Result

Observation

SectionWith information

from10 patientsProcedures

Section

With information

from10 patients

Medications

Section

With information

from10 patients

Problems

Section

With information

from10 patients

Vital Signs

Section

With information

from10 patientsMedications

Section

With information

from10 patients

Payers

Section

With information

from10 patientsAllergies

Section

With information

from10 patients

Encounters

Section

With information

from10 patientsPlan of Care

Section

With information

from10 patients

Advance

Directive

Section

With information

from10 patients

Family History

Section

With information

from10 patients

Patient Notes

Section

With information

from10 patientsPatient Lab

Order Section

With information

from10 patients

• 10 patients

• 10 files are shared

• Data on each file is specific to single pt

• Based on current data standards

Pt 2:

Conclusion

of

Care

PT 1:

Subsequent

Visits

Pt 2 :

Subsequent

Visits

PT 1:

Initial

Visit

Pt 7:

Conclusion

of

Care

PT 1:

Subsequent

Visits

Pt 9 :

Subsequent

Visits

PT 10:

Subsequent

Visits

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Why LOINC, FHIR, and CCDA Matter

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A goodwill effort to assist all of healthcare during the COVID-19 pandemic at no charge.

To learn more, visit https://kno2.com/covid19_recordretrieval/

Everything you need know…

OnOnOnOn----Demand Record Demand Record Demand Record Demand Record

Retrieval ServiceRetrieval ServiceRetrieval ServiceRetrieval Service

What What What What is this?

Kno2’s on-demand record retrieval service

allows you to search for and obtain

patient records from surrounding

participating hospitals, health systems,

clinics and physician offices through a web

browser without having to pick up the

phone or fill out or fax a records request.

Who Who Who Who is eligible?

Any provider or healthcare organization

involved in the treatment of patients

(COVID and NON-COVID) that does not

already have accessibility to the record

retrieval service through their EHR is

eligible to participate.

For For For For how long?

Through the cessation of each emergency

declaration by State or a Federal lift,

whichever is longer. All States are eligible,

even if they have not declared a state of

emergency within the State, as many are

handling overflow from surrounding areas

of non-COVID-19 patients.

How How How How to get started?

New Customers

Sign up online

https://kno2.com/register/covid-19

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DemonstrationHand Off

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Panel Discussion and Q&A

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Where to go from here

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• With a clear message that the federal government is requiring

interoperability across the care continuum, post-acute

providers, large and small, are no longer exempt.

• The infrastructure is there; national networks are in place now

• Push messaging and query are established and functioning

today

• Enable remote health and transition to online connected

communication

• Take advantage of On-Demand Record Retrieval Services

(query) at no charge during COVID-19

• Connect to the APTA PT Registry

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Contact [email protected]

if your EHR is not on this list

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