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Standardized Interoperable Information and Low 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. Why we need a bridge.
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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
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.
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
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
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
CDAs built with reusable templates Consult Note • Patient Physical Exam • Pressure Ulcer Stage • # of Pressure Ulcers Plan of Treatment • Instructions • Procedures • Nutrition Recommendations 6
CDAs built with reusable templates Transfer Summary • Patient Physical Exam • Pressure Ulcer Stage • # of Pressure Ulcers Plan of Treatment • Instructions • Procedures • Nutrition Recommendations 7
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.
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
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