E-Health / Health Information Exchange Use Case Impact on Provider Workflow

1. E-Health / Health Information Exchange Use Case Impact on Provider Workflow

2. Bio • 35 year career in healthcare • 20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T • Clients range from small physician groups to large multi-hospital organizations • Conducted over 200 vendor selections for both hospitals and physicians with over 100 EMR engagements ranging from small practices to complete hospital / physician integrated delivery systems • Worked with major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City and many enterprise HIE projects • Spent 15 years in the vendor community and is former VP of Sales for the physician systems division at Baxter • Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement

3. Topics • Evolution of Intra Provider Messaging • Today’s Challenges • HIE Use Case Impact on Provider / Patient Workflows

4. Evolution of provider messaging

5. Not so Distant Past Provider Messaging

6. Information Access Evolution

7. Changing Provider I/T Environment 2006 2011 5% Physician EMR use to 20% 2011 2015 20% Physician EMR use to 50% 2015 2019 50% Physician EMR use to 75% 2019 2011 • Value based purchasing (ACO) • Comparative effectiveness / Quality Measures • Care coordination / CCD exchange • Consumer access to their records • Data standards • ICD-IO • SNOMED CT • Rx Norm • LOINC • Others

8. Workflow challenges

9. Workflows – When You’ve Seen One…You’ve Seen One • Physician adoption / Provider variance – who has an EMR and who doesn't? • If I need to send a record summary to the next provider, how do I know what preference they have to receive it? • If they have an EMR are they ready to use the CCD as a means of conveying patient records? • Staff adoption and data/document hand off – when will it become efficient? • Patient variability – do they want an electronic copy and how do I get it to them?

10. Changing of the Guard

11. Provider System Fragmentation Email Web Browser Clinic EMR Clinic Portal • Log-in • Passwords • Patient search • Navigation • Flows Hospital Portal Diagnostic Systems Hospital(s) A, B, C… Home Screens Hospital(s) A, B, C...X EMR Screens Regional HIE

12. HIE Impact on provider workflows

13. Typical HIE Use Cases / Services Core Services • Provider Data Exchange Engine • Patient Identity Management • Record Locator Service (RLS) • Consent Tracking • Provider Directory (Direct) • Secure Messaging • Audit/Security Management Common Use Case Examples • Patient Visit Registry View – RLS Viewer • Clinical Summary View • Results Delivery / Documents • Lab Orders / Results (Discrete) • CCD Exchange • CCD Publishing to the HIE • Registries – Disease, Public Health etc. • Public Health ELR • PHR Service • EKG Viewer

14. Health Information Exchange Premise of why ONC / HHS is promoting regional / State HIEs • Fundamentally changing how we deliver patient care and manage patients over time • Patient care and management should not be encumbered by provincial provider attitudes that they are in control of their patient’s records • Patients are to be empowered to take an active role in their care, management and outcomes • Data for quality measurement knows no boundaries of IDN, Physician Group or any other provider type…but rather centers around the totality of patient data and consistency of information analytics across the industry and the life of the patient ONC – HIT Strategic Plan Draft March 2011 …the Medicare and Medicaid EHR Incentive Programs reward eligible providers who digitize health care information and share it electronically across provider settings. These requirements will grow stronger in future stages. Second, ongoing payment reforms initiated by the Affordable Care Act – including accountable care organizations, medical home models, and bundled payments – are an even more important potential driver of provider motivation to exchange information.

15. Tactical Delivery of Long Range ONC I/T Vision • Meaningful use of EHRs – across the continuum • Implementation of Health Information Exchange (HIE) to support continuity of care • Care Coordiation through access to patient centric community care plans • Agile and thin I/T applications that can be modified over time without major system disruption • Semantic interoperability of systems and reducing the cost of fragmentation • Analytics supporting fundamental health care delivery change

16. Typical Hospital View of Their Service Community

17. ONC View of The Service Community

18. Goal: Data and Information Exchange Clinical Information / Data Analytics Care Continuum Point of Care

19. Traditional Workflow Example • Patient calls for doctor appointment • Patient is sent forms to fill out and bring into office • Patient arrives at clinic with forms • Forms are reviewed by staff and entered tin to the system • Patient is “roomed” and vitals written in chart • Patient previous test results arrived via fax and clipped to chart for clinician review • Physician conducts exam and annotates findings in chart • Provides written Rx to the patient • Physician indicates treatment plan to nurse who in turn orders tests and instructs patient further • Printed and hand written instructions provided to the patient Tomorrow’s Workflow • Patient registers via the web and fills out HRA and other documents • Patient arrives and checks in via kiosk • Hospital distributed results from prior days testing via HIE to the clinic EMR messaging inbox • Patient is roomed with digital feeds of vitals to EMR • Medical Assistant confirms all new information from HIE that shows last weeks ED visit that was not known by this clinic • Physician conducts exam, documents in EMR and uses eRX tool that shows a previous script from the ED that he was not aware of and confirms with the patient that they are taking the medication • Physician enters electronic order for testing to be done at the hospital • Patient asks for electronic copy of the visit record and also asks that the record not be disclosed to Provider “x” as her ex-husband is a physician at that location • Assistant logs onto the HIE and indicates how Consent has been modified

20. Provider Workflow Challenge • Multiple logins • Variable workflows for common functions • Record completeness • Data differences among systems- e.g. allergies, current meds • Venue differences- ED, walk in clinics office, specialist, inpatient • Error correction • Common format for clinical documentation • Patient consent

21. HIE Patient Consent Issues • Opt in- Opt out changes • Emergency care • Behavior health • “Peyton Place” issues • Clinical documentation inconsistencies- patient corrections • Patient self-consent/assignment • Break the glass provisions

22. Managing the future

23. Physicians Want “One Stop Shopping” • Security (Sign-on) • Privacy Policies • Consent Policies • Data Integrity (Trust) • Error Correction (Trust) • Auditing (Risk) • Change Management (Standards)

24. Wrap Up • Challenge your organization to assess the impact of your decisions on the “patient centric” process • Understand the workflow implications for your providers with special emphasis on affiliated physicians • Patient movement among providers is not going to disappear so understand that you are a part of the patient’s provider community • Accountable care, care coordination and disease management will require much greater consistency of information exchange among providers…are you part of the solution or a part of the problem?

25. Patient Centric Approach to I/T

26. Thanks ! Health Information Consulting, LLC Mike Mytych mmytych@hicllc.com 262-253-9110