Standardized Interoperable Information and Low Cost Connections to HIE

1. Standardized Interoperable Information andLow Cost Connections to HIE The Bridge Between LTSS and The Rest of Health Care Terrence O’Malley, MD tomalley@mgh.harvard.edu Lawrence Garber, MD Lawrence.garber@reliantmedicalgroup.org

2. Why we need a bridge • Complex societal conditions cause, exacerbate or result from complex health problems • Chronic mental illness • Dementia • Functional impairment • Criminal justice issues • Homelessness • Drug and alcohol abuse.

3. Requires collaboration between Health Care and LTSS • Solutions to these issues lie in the convergence of Health care and Long Term Support Services (LTSS) • Addressing the social determinants of health becomes an essential strategy to attain the Triple Aim

4. Laying the foundation • Collaboration and coordination between Health Care and LTSS requires: • The exchange of standardized and interoperable information • A shared IT platform • A sound business case for each stakeholder to support the alignment of these two systems

5. Standardized and Interoperable Data: CDA Documents: • CDA = Clinical Document Architecture • International standard to exchange patient data • Library of reusable data element “templates” combined to form CDA documents: e.g. • Continuity of Care Document (CCD) • Progress Note Document • Discharge Summary Document • Components can be reused and exchanged as parts of other documents

6. CDAs built with reusable templates Consult Note • Patient Physical Exam • Pressure Ulcer Stage • # of Pressure Ulcers Plan of Treatment • Instructions • Procedures • Nutrition Recommendations 6

7. CDAs built with reusable templates Transfer Summary • Patient Physical Exam • Pressure Ulcer Stage • # of Pressure Ulcers Plan of Treatment • Instructions • Procedures • Nutrition Recommendations 7

8. Create a Common IT Platform via HIE • LAND(“Local” Adaptor for Network Distribution) for sites with EHRs. Connects to the HIE through an interface which gathers, transforms, and securely transfers data into and out of the EHR via Rhapsody, a proprietary interface sold by Orion. $$ • SEE (“Surrogate EHR Environment”) for sites without EHRs. Connects to the HIE using a secure exchange via Direct through a web browser. Converts CDA documents to “human readable” form. Open source, Java Script. For free from MA.

9. SEE- The LTSS Connection to HIE • Acts as destination for routed CDA documents • Non-EHR users able to use SEE to view, edit, send CDA documents via HIE or Direct to next site of service • Can create a new document by copying an entire document and editing it, and/or importing sections from multiple documents because C-CDA data elements are reusable! • Can use SEE for other workflows (referral management, enrollment, transfers of care) • Multiple staff can work on the new document at the same time • SEE users can print copies of the document for the paper record, family or ambulance transport 9

10. Further testing of C-CDA, LAND & SEE • Central Massachusetts IMPACT ePilot starting in September 2014 • Electronic exchange of full Transfer of Care dataset by SNFs, HHAs with PCPs and EDs • Electronic exchange of CCDs by other organizations • >10,000 document transfers/month • SEE available for free fall of 2014