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Regional Health-Data Sharing Extends to Food & NutritionSession 71, February 12, 2019
Martin Lupinetti, President, HealthShare Exchange
Sue Daugherty, RD, LDN Chief Executive Officer, MANNA
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Martin Lupinetti, President, HealthShare Exchange
Has no real or apparent conflicts of interest to report.
Sue Daugherty, RD, LDN, Chief Executive Officer, MANNA
Has no real or apparent conflicts of interest to report.
Conflict of Interest
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• Meet HealthShare Exchange (HSX). What are its goals?
• Meet MANNA. What are its challenges?
• Why HSX and MANNA are natural partners.
• The current exchange of information.
• Benefits to MANNA and its consumer clients.
• Benefits to HSX and its health information exchange members.
• Next steps.
Agenda
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• Recognize the importance of nutrition to healthcare outcomes
• Describe the role of MANNA and similar nutrition-support services for significantly ill, economically disadvantaged individuals
• Identify the challenges inherent for such community-service organizations in staying up to date on their clients medical statuses
• Recognize how a health information exchange (HIE) can help such organizations in receiving and accessing recent medical information on the patients they serve
• List the prospective outcomes and benefits of partnerships between HIEs and nutrition support services in such areas as client health, service efficiency and lowered healthcare costs
Learning Objectives
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A regional nonprofit healthcare data
aggregator
• Providing health information exchange to the Greater
Philadelphia area and Delaware Valley, including
southeastern Pennsylvania and the southern New
Jersey
• Population health data services
• Healthcare data innovation platform
HealthShare Exchange (HSX)
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A Data Source Growing Daily
Service coverage expanding as current members and
participants become connected.
• More than 8 million patients in the HSX Clinical Data Repository
• 14,000+ physicians and other practitioners in the HSX Provider Directory
• 95% messages sentvia HSX are inter-health system
• 4+ million patients tracked using HSX Encounter Notification Service (ENS)
• 150+ participating entities operating more than 2,000 facilities: hospitals, health plans, and other provider organizations
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Encounter Notification Service (ENS)
• Alerts sent to member when patient is
admitted at, or discharged or transferred
from, a regional medical center
Clinical Data Repository
• Aggregated recent medical record data from
hospital/health systems, insurers/health
plans, and practitioners
HSX: Health Information Exchange Services
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HSX data quality review
HSX uses a rigorous quality
monitoring program
• Standardization
facilitates clinical use
• Dependable, tidy data opens
door for volume use in the
medical service region
Award winning: HSX recognized for its data
quality by Strategic Health
Information Exchange
Collaborative (SHIEC), the
national trade organization of
health information exchanges
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Achieve greater impact on health of consumers• Expand the breadth of informed health teams
• Provide them more information
• Help them share and educate
Engage non-medical community health services
organizations that are at the forefront of needs and in
immediate contact with the served population in order
to:• Push the benefits of care alerts and patient clinical information
downstream to these service organizations
• Enrich the region’s clinical data repository with information and
updates returned to HSX by these community organizations
HSX opportunities and future directions
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Other consumer benefits –– a two-sided platform
MANNA will soon be able to show clients how to take advantage of consumer apps running on
HSX data
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MANNA
Photo Credits: Generocity.org 1/28/2013 (Left), Generocity.org 8/2/2013 (Center), PhillyMag.com 1/3/2013 (Right)
MANNA uses nutrition to improve health for people with
serious illnesses who need nourishment to heal. By providing
medically tailored meals and nutrition education, we empower
people to improve their health and quality of life.
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MANNA
• Metropolitan Area Neighborhood Nutrition Alliance
• Nonprofit founded in 1990 to serve the HIV+ community
• Expanded in 2006 to help all individuals suffering from critical
illnesses
• Services provided:
o Home-delivered meals
o Shipped meals
o Nutrition counseling
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Services
Meals
• Provide three meals per day, seven days aweek, which are home delivered once a week
• Prepared under the guidance of a chef with input from registered dietitians (RDs); cooked by caring volunteers in our kitchen with fresh ingredients; then frozen
• 11 diet modification options (up to 3 modifications selected with RDs input)
Nutrition Counseling
• Provided by RDs who are licensed in Pennsylvania and accredited by the Academy of Nutrition and Dietetics
• Diet education, nutrition counseling and evaluations offered in office or by phone
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MANNA’s Research
Food as Medicine: Reducing Health Care Costs with Comprehensive Medical Nutrition Therapy
• Pilot study to compare key health care costs of
MANNA’s clients compared to a control group of
individuals who had not received the service
• Tracked average monthly health care expenditures of
65 MANNA clients before, during and after receiving
MANNA services
• Results published in Journal of Primary Care and
Community Health
• Full study can be found on MANNA’s website
www.mannapa.org
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• Average monthly health care costs for MANNA clients decreased 62%
($30,000) from pre-MANNA costs
• In HIV/AIDS patients, costs decreased by 80%—an average of $20,000
less per patient per month
• Number of average monthly visits to hospital and length of stay reduced
by 37%
• Monthly inpatient hospital costs decreased by 30% over six months,
following initiation of MANNA services
• Costs of inpatient hospitalization of MANNA clients reduced by 40% and
HMO paid an average of $12,000 less per month
• MANNA clients 20% more likely to be released from hospital to home
than to long-term care
MANNA’s Research Results
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MANNA’s Challenge: Collecting health information
• Need to stay up to date on health status of clients in order to
adjust to clients’ food-as-medicine needso Clients may experience sudden hospitalizations or changes in
health status
o Cannot rely on patient self-reported information
• MANNA reliant on the primary care provider for client’s up-
to-date medical and nutrition related information.o Challenges with getting PCP offices to fill out the referral form in
full Same for getting updated medical information during program
recertification process
o MANNA must fax and phone busy provider offices to achieve
compliance with these requests, and often must pursue essential
information that is missing.
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“We’ve had a significant need for more timely data on patient visits to the
hospital, especially their interface with emergency departments.”
–– Ann Hoskins, MANNA’s Director of Policy & Institutional Affairs.
• MANNA reliant on hospitalization updates from
client or PCPo Cannot deliver meals if client not home to receive them-
missed delivery
o Missed deliveries can result in cancellation of services
• Need to coordinate meal suspension when clients
are hospitalized o Temporarily suspend meals
o Goal is to resume meal delivery as soon as the client is
discharged home –– aids in readmission
MANNA’s Challenge: Receiving hospitalization updates
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HSX and MANNA Partnership
• Nutritional support is fast
becoming one of the most
recognized social determinants
for success of medical care.
• MANNA joins HSX as a
participating member – June
2018o First non-medical, community
healthcare services organization
to begin accessing health
information with HSX
o MANNA dietary staff begins
incorporating client updates and
look-ups into daily workflow
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• MANNA meets HSX participation agreement and HIPAA definition of a
“healthcare provider” providing “treatment”
• MANNA’s dieticians access HSX data only after receipt of a physician order for
patient dietary services
• MANNA’s consent form approved
• Encounter notifications –– delivered to MANNA through Direct secure
messaging
• Clinical Data Repository –– MANNA security administrator identified to
establish account; training for log-on and use for authorized MANNA staffers
• MANNA establishing Notice of Privacy Practice and policies and procedures regarding Breach Notification.
Permissions, agreements, privacy and security
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Encounter Notification Service
• Provides electronic alerts to MANNA when one of its clients
has a healthcare encounter at one of the region’s medical
facilities
• MANNA notified within 24 hours if a client is admitted to a
hospital (emergency department or inpatient), transferred
within a health system, or discharged
Service used by MANNA
“Taking advantage of HealthShare Exchange’s data feed will allow us to
be an even more-active ongoing partner in our clients’ medical status.
We look forward to using these real-time updates coming from HSX to
ensure that our clients’ needs are met quickly and efficiently.”
–– Nicole Laverty, RD, LDN, Director, Nutrition & Client Services at MANNA.
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ENS data content
The encounter alerts that MANNA receives daily through HSX carry
key clinical information on health events for its clients
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Clinical Data Repository
• MANNA can query recent client medical information from HSX
o Via a portal to a database of detailed reports on recent patient medical care
In the standardized Continuity of Care Document (CCD) format
• Documents carry vital information including allergies and medication list
Service used by MANNA
“Joining our health information exchange means we can better
address the complexities of each client’s health –– from the ways
we tailor their meals to fit their needs, to what our dietitians address
in their nutrition counseling sessions,”
–– Tonya Cooper, RD LDN, Manager, Nutrition & Client Services.
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Filling the Gaps in Needed Information
• Intake Process
o MANNA no longer completely dependent on PCP & ambulatory provider offices for recent medical information on its clients.
When staff members receives a patient referral that lacks adequate information, they query HSX’s CDR to search for data needed.
• Continued services
o MANNA can likewise confirm information needed for recertification of services.
• MANNA’s staff reconciles information received from providers with health data coming from HSX’s data repository to identify any concerning inconsistencies.
Benefits to MANNA
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Guiding modifications in
nutritional support services
• With daily updates, MANNA able to adjust choice of food
modifications to clients accordingly
o Dietitians at MANNA can update a client’s indicated diet and
required food restrictions in prompt coordination with the person’s
medical care
• Scheduling issues are also reduced
o Staff awareness when clients are at the hospital and not home.
o MANNA delivers a full week’s food to its clients, and so the new
knowledge helps to reduce failed deliveries
o Staff know discharge dates and can set resumption of delivery
for when the client arrives home
Benefits to MANNA
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Beyond the region
• The HSX arrangement benefits both MANNA’s philanthropic-supported patients and its insurance-contracted patients
o Shipping program
Delivery footprint in 78% of the counties in Pennsylvania.
• This benefit expands as HSX offers access to data from Pennsylvania’s statewide network of HIEs (P3N)
• MANNA’s data also supports population health and research measurements on the impact of nutritional support on specific disease states.
Benefits to MANNA
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• MANNA will provide data back to HSX, including dietary
and nutritional counseling notes
o These are updates that can become part of the
patient’s medical record in the regional data
repository, available to all participating members.
• HSX demonstrates a model for health information
exchanges to partner with non-medical, community
healthcare services organization
Benefits to HSX
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HSX-MANNA health information exchange
• MANNA will undergo additional technical onboarding
o Permit its client information system to upload its own encounter information back to the HSX CDR
o Enhance and update the repository with information coming from the nutritional support and counseling process
• Eventually, HSX will set up connectivity to provide data directly into MANNA’s client information system
Next Steps
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• Support each other’s complementary missions
• Track data showing that even more-timely intervention and
proactive customization of services at the individual level will
expand health efficiencies and health gains.
– Results in better health outcomes for the patient.
Benefits to both organizations & patients
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Questions
Please complete online session evaluation
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Martin Lupinetti
President, HealthShare Exchange
email: [email protected]
LinkedIn: https://www.linkedin.com/in/martin-lupinetti-bb645ab
Twitter: @HealthShareExch
Sue Daugherty, RD, LDN
Chief Executive Officer, MANNA
email: [email protected]
LinkedIn: https://www.linkedin.com/in/sue-daugherty-rd-ldn-1368031
Twitter: @MANNANourishes
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