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
Click to edit Master title styleWebinar Operations
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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]
Click to edit Master title stylePresenter Bio
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).
Contact: [email protected]
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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.
Contact: [email protected]
Click to edit Master title stylePresenter Bio
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.
Contact: [email protected]
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How Interoperability Can Protect and Grow Referrals, Enable Virtual Health,
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Click to edit Master title stylePresenter Bio
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.
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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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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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How Interoperability Can Protect and Grow Referrals, Enable Virtual Health,
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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
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And the question is….
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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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How Interoperability Can Protect and Grow Referrals, Enable Virtual Health,
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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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