GEDI WISE

1. The Mount Sinai Health System GEDI WISE Geriatric Emergency Department Innovation in care through Workforce, Informatics, and Structural Enhancements

2. Topics • Mount Sinai At A Glance • Healthix Health Information Exchange • Project Scope • Gedi Wise • Connexall Setup • Outcome

3. The Mount Sinai Health System At A Glance

4. Mount Sinai’s elected Public HIE (health information exchange). Regional Health Information Exchange (RHIO) covering Greater New York. Not-for-profit corporation whose overall mission is to advance interoperable health IT to improve health care quality and safety and reduce costs. Providing technology infrastructure, services and governance in support of health information exchange among its participants. Connecting over 250 hospitals, clinician practices, nursing homes, radiology centers, diagnostic labs, and other providers with information about over 7 million patients. What is Healthix?

5. Patient Consent at Mount Sinai • The HIE consent is captured in the Cerner ED registrations • Once the HIE consent field is initially valued it is populated for all future visits for the patient

6. Identified Need: • Lack of timely information to identify and address at-risk patients being readmitted to the hospital within 30 days of an initial discharge • Patients visiting the ED for conditions that can be treated in lower- cost settings • The result is that an increasing number of these geriatric patients are transitioning poorly back to their residences after their hospital stays, and readmission rates for these patients are high. 

7. Project Goals: • With real-time notification, the expectation is the care manager would be able to: • to prevent the readmission, • execute evidence-based geriatric protocols to improve patient care, • reduce hospitalizations, • return emergency room visits, • medication errors, • loss of reimbursement if patient admitted to another hospital Ultimately, this would reduce the overall cost of care while improving patient care, resulting in measurable clinical and financial benefits for the patient and the hospital.

8. Gedi Wise Project/Program Name: Geriatric Emergency Department Innovations in care through Workforce, Informatics, and Structural Enhancements (GEDI WISE). The focus of Gedi Wise is to provide clinical, workforce, and informatics enhancements to geriatric emergency care that are projected to improve patient outcomes while also producing a cost savings to Medicare and Mount Sinai of over $40 million over the next three years.  Vendors/Departments: Healthix, Inc. MSMC – Connexall, Integration Group/Cloverleaf Engine , ED Department, GEDI-WISE project team Funding: CMMI (Centers for Medicare and Medicaid Innovation) project

9. Event Notification Service • Mt Sinai care managers will identify patients they wish to “subscribe” to, i.e. about whom they would like to receive notifications when the patient has an encounter at another Healthix hospital. This is accomplished by providing an “FYI flag” in Epic that is sent to Healthix in a daily subscription file.

10. Event Notification Service • Mt Sinai registrars request patients’ consent to have access to their health information in Healthix. These values are documented in Cerner ED registration. 3. Mt Sinai sends the consent values on an ADT interface to Healthix via Mount Sinai interface engine. 4. Healthix “listens” for ED visits, hospital admissions and hospital discharges for the patients in the subscription.

11. Event Notification Service 5. Healthix sends an electronic notification to care managers providing them the patient identifier, patient demographics, type of event, place of event and date & time of event. • An event notification is sent to MSMC’s AIG, where it is parsed and sent to a care manager’s Epic In basket, Mount Sinai email address, and to their Cisco phone. • The EN is posted onto the patient’s Epic Chart as an encounter so those not on the patients’ care team can see the encounter information at the outside hospital.

12. Event Notification Service 6. goal: for care managers to intervene in near real time when the patient shows up in another ED, but before they have been admitted, to try to help prevent an avoidable admission by providing disposition planning (i.e. telling the ER doc at other site that we have X, Y and Z services in place and can take responsibility for follow up).

13. EN – Systems flow Integration with Cisco phones /Email CHP Other participating hospitals Cloverleaf engine parses out key data fields from EN and sends to Connexall Connexall Interface Engine Real-time Eventnotification Healthix CSV file for analytics NYP Automate is utilized to secure FTP this file to Healthix NYU Cloverleaf engine parses out key data fields and sends to Epic In Basket as ADT messages Subscription file is extracted from Epic and sent to Healthix each day, inclusive only of the patients flagged with GEDI-WISE FYI flag. Notification resides within two places in Epic: Physician InBasket Encounter on the patient’s chart Epic

14. EN – Example of Epic In Basket message

15. EN – Systems flow • Cloverleaf sends MDM message type to Connexall

16. Healthcare Informatics Client • HIC runs a script to parses key data fields

17. WTC Cisco Client

18. Email Output Client

19. Connexall Setup SAC View • Click to edit text • Second level • Third level • Fourth level • Fifth level

20. DAC View

21. Email notification output

22. Cisco phone

23. Project Update • Healthix technical processing issues: • delays in delivering ADT messages to Mount Sinai due to old edges servers • no dedicated staff to monitor the ADT interface

24. Project Update • Healthix solutions: • planned edge server upgrade • adding dedicated staff to monitor the interfaces

25. Connexall Implementation Conclusions • Deliver notifications with very little maintenance • Work automatically and in real-time • Happy end users (Connexall Rocks per ED doctors)

26. May the force be with you!

27. Thank you