IMPACT: Planning for Go-Live

1. IMPACT: Planning for Go-Live S&I Framework Longitudinal Coordination of Care Pilots Workgroup Meeting March 10th, 2014 Larry Garber, MD

2. IMPACT Grant February 2011 – HHS/ONC awarded $1.7M HIE Challenge Grant to state of Massachusetts (MTC/MeHI): Improving Massachusetts Post-Acute Care Transfers (IMPACT)

3. IMPACT Objectives & Strategies • Facilitate developing a national standard of data elements for transitions across the continuum of care • Develop software tools to acquire/view/edit/send these data elements (LAND & SEE) • Develop consumer-oriented translator • Integrate and validate tools into Worcester County using Learning Collaborative methodology • Measure outcomes

4. Pilot Sites to Test the Datasets • Selection Criteria: • High volume of patient transfers with other pilot sites • Experience with Transitions of Care tools/initiatives • 16 Winning Pilot Sites: • St Vincent Hospital and UMass Memorial Healthcare • Reliant Medical Group (formerly known as Fallon Clinic) and Family Health Center of Worcester (FQHC) • 2 Home Health agencies (VNA Care Network & Overlook VNA) • 1 Inpatient Rehab Facility (Fairlawn) • 1 Payer (Fallon Community Health Plan) • 8 Skilled Nursing and Extended Care Facilities

5. Legal Issues • Data Use Reciprocal Service Agreement (DURSA) between pilot sites and State HIE/HISP (MA HIway) • Contract between SEE vendor (Lantana) and HIway for testing/support • Accessibility waiver

6. Accessibility waiver • Poor vision • Should be able to increase font size • We’re encouraging 24” – 27” monitors • Color blind • Color shouldn’t be only distinguishing attribute • Added “*” next to red required fields • Blind • Navigable 100% using keyboard • All fields have meaningful tags/names that can be read by text-to-speech software

7. Software testing • Iterative development • End user feedback • Prioritized punch list (pre-, peri-, post-GoLive) • Unit testing – each piece • Integrated testing – end-to-end • Security testing • Create support mailbox to send/receive • Confirm correct version of web browser • Type, version, corporate polices, certificates • Alpha test – 1 site with fake ZZZpatients • Beta test – all sites with fake patients

8. SNF Receiving Hospital Summary • Text-message notification of new webmail message 24x7 (Administrator, Clinical Liaison, DON, DO Admission, DO Social Service?)  Do you need to purchase a dedicated phone?  Remember that at 3AM when there’s new mail, everyone on the list will get the text message, even those sleeping at home… • Who prints the incoming CDA summary document for the paper chart?  Same as the person who gets the text message? • Where is it printed? Are there printers in convenient locations? Are the PCs configured to use the printer by default? • What is done with the printed summary?  Are multiple copies needed?  Does a copy need to be faxed to a physician or nurse practitioner? • Should new CDA with admit date be started?

9. Sending Summary to ED/PCP/HH • Which prior documents will you copy from? • Which sections do you want to copy from prior? • Where will other pieces of information come from? What can be cut & pasted? Pharmacy ordering system? • What information should be entered for the SBAR vs. a Transfer Summary? • Who sends document, how do they know it’s ready and where to send? • Do you need to print extra copies (e.g. paper record, PCP, specialists, patient/family, EMS)?

10. KeyHIE Transform? • Converts MDS (or OASIS) into CDA document mailed back to site’s mailbox • How often are MDS’s done? Is there one when you need it? How long is an MDS reliable for? • Can SNF MDS’s be distinguished from Long-Term Care patients? • Will the incoming document easily show who the patient is?

11. Site Configuration • Users, UserIDs, Passwords. Who will manage hires/fires (Access Administrator)? • What Direct Addresses are in Provider Directory? Which is preferred? • Set up Gmail rules to send text • Distribute blank CDA document

12. Training • PowerPoint • Video recording of training session • Cheat sheet (How to… Where to find…) • Pilot site preferred Direct addresses • Post-training competency test • Train-the-trainer (2 hours) • Scalable • Can still customize workflow for each site • Provides on-site support

13. Training • What’s the problem we’re solving? • How will each user see benefit? • Big picture of HIE • Big picture of software • GUI overview • Logical use cases to train details • Big picture again • Competency test

14. Scenarios • View received CDA and print it • Find and Edit previously received CDA • Find previously edited CDA and Send it • Start new CDA from scratch • Create a CDA from documents received from Hospital and MDS

15. Go-Live Support • Roll-out pairs of trading partners • Hospitals and SNFs/IRFs/LTACHs • PCPs and ERs • Home Health with Hospitals/SNF/IRF/LTACH • On-site support • Since low volume, can do dress rehearsal on go-live day with fake patients • Identify best practices and software bugs

16. Post-GoLive • Debrief/Share Best Practices • Celebrate • Market successes with a press release

17. Questions? TOMalley@Partners.org Lawrence.Garber@ReliantMedicalGroup.org