Electronic Referral Management P owered by Direct Kansas City Safety Net Providers

1. Electronic Referral Management Powered by Direct Kansas City Safety Net Providers Debbie Joyce, Truman Medical Centers Lisa Millerd, Samuel U. Rodgers Health Center Hannah Luetke-Stahlman, MetroCARE of Greater Kansas City Derek Zaun, Cerner Corporation Health Care is too Important to Stay the Same

2. Powered by Direct - What is Direct? The Direct Project specifies a simple, secure, scalable, standards-based transportation mechanism that enables participants to send encrypted health information directly to known, trusted recipients over the Internet. b.wells@direct.aclinic.org h.elthie@direct.ahospital.org • Industry standard, developed in partnership with the federal government, ensuring universal interoperability and security. • Direct is a transport protocol for health information exchange that leverages secure email and a trust fabric. • Secure email is S/MIME using x.509 digital certificates. (“https:\\”) • MIME is standard email messages. • Email messages can include structured or unstructured attachments, i.e. CCD, CCR, PDF, JPG, HL7 lab results • http://wiki.directproject.org/

3. What is Direct - Simplified • Think of Direct as Electricity or Phone Lines • Phone lines needed before your phone works • Electricity needed for your toaster/radio to work • Simply a secure transportation vehicle • Allows separate organizations to securely and reliably exchange sensitive information • No custom or expensive interfaces required • Given an address, just like an email address (drbob@direct.ahospital.org) • Uses for Direct? • It’s not just email • Start with any workflow that involves fax/phone/paper • Ad Hoc communication, Referrals, Results Delivery, HIE Contribution • No limit to uses, be creative

4. KC Safety Net Providers - Powered by Direct

5. Representing KC Safety Net - Who are we? Truman Medical Centers An academic health center providing accessible, state-of-the-art quality healthcare to our community regardless of the ability to pay. MetroCARE of Greater Kansas City • A charitable non-profit for the residents of Jackson, Clay and Platte Counties. Connect low-income, uninsured patients to over 850 volunteer physicians in 45 specialties in their private offices. Samuel U. Rodgers Health Center A Federally Qualified Health Center providing quality, compassionate and affordable healthcare for all. Proudly offering translation services in over 30 languages.

6. Why Automate Patient Referrals between Providers? Why electronic referral management? • Improve the accuracy and timeliness of secure information exchange across disparate providers to reduce the costs and improve the patient experience and health outcome. • Because our loved ones and ourselves will likely be a patient one day • Patient stories

7. Key Learning Objectives for today • Challenges • Understand the challenges of electronically referring patients between different providers • Benefits • Describe problems of traditional fax/phone/paper methods • Benefits gained by using E-Referrals powered by Direct • Current and Future • Explain how disparate facilities are currently connecting with Cerner Direct Referrals and the future outlook as Direct adoption expands

8. Challenges of E-Referrals between Providers • Patient Privacy – HIPAA • Secure transfer of PHI is required • Costs • Connecting disparate systems • Vendor enhancement/upgrade fees • Staff implementation/training costs • Organizational Differences • Different EMR systems • Different policies and agendas • Requires collaboration and teamwork approach SOLUTION must be EMR agnostic, LOW-COST and EASY to use & implement!!

9. Problems with traditional phone/fax/paper methods • Inaccurate/Missing data • Data written down wrong over phone or mistyped during data entry • Fax failed or pages missing on transmission • Paper lost in transit • Was it delivered and who is working on it? • No delivery confirmation with fax delivery • Uncertainty on delivery leads to resubmission/duplicate • Unsure who to contact or if it is being worked on • Manual methods take longer • Manual data entry • Missing information requires phone call • Costs • Fax/Printer maintenance/toner • Paper costs

10. Benefits realized thru E-Referrals powered by Direct • HIPAA Compliant • Simple • Easy, cost effective implementation • Need only a modern browser • Efficient • Communication is greatly improved • Improved turnaround time on appointments • Eliminates time spent on manual paper and fax processes • Easily send results/visit summary (“Close the loop”) • Eliminates use of spreadsheets for tracking referrals • Improve Referral Relationships • Delivery is confirmed by receiver and contact person is known • Improves customer service with referring organization • Maintain/increase revenue by increased referrals • Patient Care • Improves quality of care and experience for the patient • Accurate and timely information

11. Look at the Numbers – RAND Study on E-Referrals 2007-2008 71.9% of PCPs believed that e-Referral improved overall clinical care 89% reported improved tracking of referrals over paper-based 73% believed it improved pre-visit work-ups Inability of specialist to discern reason for the referral dropped significantly when using e-referral. Only 9.5% of e-referrals were unclear as compared to 38% of paper referrals. Use of e-Referrals led to lower rates of follow-up visitsfor specialty surgical visits (rate of follow-up visits deemed avoidable were lowered by 44.7%) Led to decreased wait times for new appointments, presumably by decreases in inappropriate referrals. RAND Study on E-Referrals 2007-2008 Data Sources: Implementation of an Electronic Referral System for Outpatient Specialty Care http://www.rand.org/content/dam/rand/pubs/reprints/2012/RAND_RP1433.pdf

12. Current Implementation – Cerner Direct Referrals Portal Results received at referring provider. Referral loop has been closed and referral is now complete.

13. Future Implementation – Portal + Direct embedded in EMR

14. KC Safety Net Providers - Powered by Direct

15. What will the next year bring for Direct? • Direct-enabled web portals will play a key part as interim and long-term solutions for interoperability • 360 Exchange Industry Work Group is helping to shape interoperability standards for referralsand care coordination using Direct secure messaging • Vendors will develop new Direct-enabled solutions and embed Direct into existing solutions to improve efficiencies in various workflows • Trust between Direct HISP vendors will be more prevalent and make Direct secure messaging ubiquitous

16. “Increased use of Direct should go a long way toward replacing the slow and inefficient way most providers currently share information via phone, fax, and mail—ultimately improving patient care and outcomes.” Farzad Mostashari, MD, ScM, ONC National Coordinator for Health Information Technology The Office of the National Coordinator for Health Information Technology

17. Electronic Referral Management powered by Direct Debbie Joyce - Truman Medical Centers - debra.joyce@tmcmed.org Lisa Millerd - Samuel U. Rodgers Health Center - lmillerd@rodgershealth.org Hannah Luetke-Stahlman - MetroCARE of Greater KC - hannah@metromedkc.org Derek Zaun - Cerner Corporation - derek.zaun@cerner.com Questions?