Real-World Experience
With Secure Messaging
Presented by:
WEDI Healthcare Secure Messaging SWG
Session Objective
The communication of PHI:
– between clinical sites
– between providers and consumers
– between providers and payers
– between providers and HIEs, and
– between consumers and payers
is most often an inefficient and manual process that adds
unnecessary time and cost to the nation’s healthcare
system.
Secure Healthcare Messaging via Direct has the ability to
provide an efficient and safe method of moving data.
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Learning Objectives
This session will share:
real world experience with Direct secure messaging within
healthcare to assist audience members to:
1. Better understand the availability of and how Direct secure
messaging is being used within healthcare.
2. Be able to identify current and future use case scenarios
that could enhance patient care and wellness through the
use of secure messaging.
3. Understand the objectives of and know how to sign up
and become a part of the WEDI Secure Messaging
Workgroup.
3
Panelist
Doreen Espinoza, Vice President of Regulatory Affairs and Privacy Officer, Utah
Health Information Network
Case Study: Payer to Provider –Provider exchange of supporting medical
documentation via Direct.
Ryan Bramble, Director of Integration – CRISP - Ryan.Bramble@Crisphealth.org
Case Study: Provider Notifications and Secure Data Exchange via Direct
Messaging
Cindy Throop, MSW, Center for the Advancement of Health IT, RTI
International
Case Study: Behavioral Health data exchange using secure messaging
Real-World Experience
With Secure Messaging
Doreen Espinoza, Vice President of Regulatory
Affairs and Privacy Officer, Utah Health
Information Network
Case Study: Payer to Provider –Provider
exchange of supporting medical documentation
via Direct.
USE Case I
Utah Medicaid has an “Emergency Only”
program which requires all services to have
additional documentation for payment:
Participants: University of Utah and Utah
Medicaid
Payload: Delivery of Clinical data to support an
Emergency Only claim
Results
• Number of Exchanges ~1400 per year
• Dollar amount represented
– $800,000 to $900 average at $7500
• What is impact to the provider
– Tracking, timeliness (30 to 14 days), open line of
communication
– Dropped AR 23% for this program in the last
quarter
Use Case II
Long Term Care entities must prior authorize all
stays for Medicaid clients.
Participants: Long Term Care Entities and
Medicaid
Payload: Long Term Care Prior Authorization and
additional documents
Results
• Number of Exchanges 4953+
– Prior Auth and medical record 4.9 million records
• Dollar amount represented
– 180-120 per day charge with a yearly cost of
401 million dollars
• What is the impact to the payer
– Savings of postage, copy costs, time for
processing
– Streamlining and quality of data
Impact to Provider
• Reduction of processing time from
90 days to 15
• Reduction of time for preparing the forms and
sending the appropriate medical records
• Improved communication with Payer
• Cost savings associated with time spent
gathering information and office supplies
including envelops and stamps
Real-World Experience With
Secure Messaging
Ryan Bramble, Director of Integration – CRISP Ryan.Bramble@Crisphealth.org
Case Study:
Provider Notifications and Secure Data Exchange
via Direct Messaging
Encounter Notification Service
(ENS)
•
CRISP currently receives information pertaining to ER
visits and admissions in real-time:
–
–
–
–
All Maryland hospitals
Most D.C. hospitals
All Delaware hospitals (in partnership with DHIN)
Over 40 Long Term Care Sites
•
CRISP has the ability to communicate this information,
in the form of real time alerts sent via DIRECT to PCPs,
care coordinators, and others responsible for patient
care.
•
There are currently over 2,000,000 patients subscribed
to by provider organization with in ENS resulting in
over 3,000 notifications per day most of which are sent
via DIRECT.
What is the Market?
•
•
•
•
•
•
•
•
•
•
Primary Care Providers
Hospitals (for readmission tracking)
Accountable Care Organizations (ACOs)
Care Coordination organizations
Health Enterprise Zones (HEZs)
Behavioral Health
Primary Care Medical Home (PCMH)
Commercial Payers
Medicaid Managed Care Organizations
Medicare Coordination of Care
How does it work?
A patient goes to the
hospital
Hospital Registration
At registration the hospital asks the patient for basic
information (name, DOB, etc.) and the reason for the visit.
The registrar enters that information into an Electronic
Medical Record.
When the registrar is completed
entering that information, and pushes
‘save’, a copy of that information is
immediately sent to CRISP
How does it work?
When enrolling in CRISP ENS, the organization must supply
CRISP with a list of patients they wish to be alerted on or set
up a ADT feed to CRISP.
A provider can subscribe to any patient they have a treatment or care
coordination relationship with, and that they have seen at least once in the
previous 18 months.
CRISP chose to have providers choose the patient’s to follow instead of
relying on PCP information captured at patient registration.
Provider selected patient attribution is more timely and reliable than other
sources.
How does it work?
Notification can be sent at customizable times, options include:
• Real-time secure DIRECT message within 15 minutes of event
• Daily Excel Summary sent via secure DIRECT message once or twice a
day
There are also several ways to receive the alerts
• Through CRISP’s web-based DIRECT service (www.crispdirect.org)
• Via HISP to HISP trust into the provider’s DIRECT platform of choice
• HL7, SFTP, other secure protocols
What does it look like?
SOURCE_MRN
958
959
960
961
962
963
964
965
966
967
968
969
970
971
972
973
974
975
976
977
978
979
980
981
982
983
984
985
986
987
988
989
990
991
992
FNAME
Mario
Petey
Anna
Paul
Anna
Gail
Paige
Bob
Walter
Nick
Barb
Buck
Greta
Ira
Shonda
Brock
Maya
Rick
Pete
Monty
Sal
Sue
Cliff
Barb
Mickey
Terry
Cory
Robin
Jimmy
Daffy
Daisy
Fred
Barney
Wilma
Don
MNAME LNAME
Speedwagon
Cruiser
Sthesia
Molive
Mull
Forcewind
Turner
Frapples
Melon
Bocker
Ackue
Kinnear
Life
Membrit
Leer
Lee
Didas
O'Shea
Sariya
Carlo
Monella
Vaneer
Hanger
Dwyer
Mouse
Aki
Ander
Banks
Changa
Duck
Duck
Flinstone
Rubble
Flinstone
Stairs
GENDER
M
M
F
M
F
F
F
M
M
M
F
M
F
M
F
M
F
M
M
M
M
F
M
F
M
M
M
F
M
M
F
M
M
F
M
DOB
02/03/1875
02/03/1876
02/03/1877
02/03/1878
02/03/1879
02/03/1880
02/03/1881
02/03/1882
02/03/1883
02/03/1884
02/03/1885
02/03/1886
02/03/1887
02/03/1888
02/03/1889
02/03/1890
02/03/1891
02/03/1892
02/03/1893
02/03/1894
02/03/1895
02/03/1896
02/03/1897
02/03/1898
02/03/1899
02/03/1900
02/03/1901
02/03/1902
02/03/1903
02/03/1904
02/03/1905
02/03/1906
02/03/1907
02/03/1908
02/03/1909
ADDR1
1234 Main Street
1235 Main Street
1236 Main Street
1237 Main Street
1238 Main Street
1239 Main Street
1240 Main Street
1241 Main Street
1242 Main Street
1243 Main Street
1244 Main Street
1245 Main Street
1246 Main Street
1247 Main Street
1248 Main Street
1249 Main Street
1250 Main Street
1251 Main Street
1252 Main Street
1253 Main Street
1254 Main Street
1255 Main Street
1256 Main Street
1257 Main Street
1258 Main Street
1259 Main Street
1260 Main Street
1261 Main Street
1262 Main Street
1263 Main Street
1264 Main Street
1265 Main Street
1266 Main Street
1267 Main Street
1268 Main Street
ADDR2 CITY
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Baltimore
Westminster
Towson
Frederick
Salisbury
Note – This is a snapshot, not the full spreadsheet.
STATE ZIP
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
MD
21212
MD
21075
MD
21204
MD
20177
MD
22136
How can it help PCPs?
Case Study: Readmission rates at Johns Hopkins Community Physicians since
implementing ENS to schedule 7-day follow up appointments
How can it help PCPs?
Code
•
•
•
99496


Reimbursement
in non-facility
setting
(approximate)
Communication (direct contact, telephone, electronic) with the patient
and/or caregiver within 2 business days of discharge
Medical decision making of at least moderate complexity during the service
period
Face-to-face visit, within 14 calendar days of discharge
$135
$164
Communication (direct contact, telephone, electronic) with the patient
and/or caregiver within 2 business days of discharge
Medical decision making of high complexity during the service period
Face-to-face visit, within 7 calendar days of discharge
$198
$231
Required elements
•
99495
Reimbursement
in facility setting
(approximate)
•
•
Reimbursements began Jan 1, 2013
CMS estimates that providers will provider the post-discharge TCM service for 5.7 million
discharges in 2013, and AMA RUC estimates that 2 million of these codes will be billed each year
ENS is a critical tool for providers to capture new
payments, which are estimated to total $600M in 2013
How can it help Payors
and MCOs?
Case Study: Cigna HealthSpring implemented ENS and DIRECT to receive
secure hospital notifications. They use ENS to help get in contact with their
members post-hospitalization.
•
•
•
28% reach rate prior to ENS Report
47% member reach rate using ENS
Report
41% Increase in reach rate
How can it help hospitals?
• Hospitals can “auto-subscribe” to receive 30 day readmission alerts for
all of their hospital discharges.
• Hospitals interested need to just identify a recipient for these alerts.
CRISP will use the existing hospital to CRISP ADT feeds to automatically
add discharged patients to a list which we will “watch” for readmissions
• If a patient is readmitted within 30 days, the recipient will receive an
alert to their DIRECT account informing them the patient has been
readmitted and provide information from the hospital where the
readmission occurred.
• If a patient presents in your ED and they are a readmission from another
hospital we will alert your ED in real time with a secure DIRECT message
What’s Next?
• Automatic push of CCD documents from hospitals to ENS
recipients post discharge
– Currently in pilot with 4 hospitals and 10 practices
– CCD is sent to CRISP via DIRECT then pushed to providers based on patient
subscriptions in ENS.
– CCD is sent in both XML (machine readable) and PDF (human readable)
forms
– Recent (September 2014) CMS FAQ permits use of CRISP ENS for a hospital’s
numerator calculation for Meaningful Use Stage 2’s Transitions of Care
Measure. (https://questions.cms.gov/faq.php?faqId=10660)
• Use of analytics to send a risk score to ENS recipients for
each patient currently hospitalized
Real-World Experience With
Secure Messaging
Cindy Throop, MSW, Center for the
Advancement of Health IT
Case Study: Behavioral Health Data Exchange
Using Direct Secure Messaging
Behavioral Health Data
Exchange Using Direct
CINDY TROOP INSERT SLIDES
Why Use Direct?
• Traditional query-based approach to HIE was
not getting the expected traction given the
financial investments provided
• Experiment to see if Direct is a potential
solution for the exchange of behavioral health
data
Expected Efficiencies
NO behavioral health
data exchange
SOME behavioral
health data exchange
REGULAR behavioral
health data exchange
• Improve understanding of policies (42 CFR Part
2 and relevant state policies)
• Establish technical capacity to exchange data in
compliance with 42 CFR Part 2
Impact to Patient Care
• Behavioral health data exchange is an
important step towards primary carebehavioral health integration
• Exchanging information is a prerequisite to
providing coordinated, patient-centered care
• Direct enables granular patient consent;
current query-based HIE cannot currently
handle that
No Boundaries
WA
MT
VT
ND
NH
ME
MN
OR
ID
WI
SD
WY
IA
NE
NV
IL
CA
AZ
PA
OH
UT
CO
NY
MI
IN
WV
KS
MO
OK
NM
NC
TN
AR
SC
MS
TX
VA
KY
AL
GA
LA
FL
AK
HI
interconnected health care ecosystem –
the possibilities are endless
MA
RI
CT
NJ
DE
MD
Healthcare Secure Messaging SWG
Educational References
•15 things to know about DIRECT messaging
•Secure Messaging Terminology Glossary
•Real World Experiences with Secure Messaging –
case studies
Visit: http://www.wedi.org/workgroups/securityprivacy/healthcare-secure-messaging
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Join today! New WEDI SWG
Healthcare Secure Messaging Sub Workgroup
Joining a workgroup is easy –
Sign in at www.wedi.org on the WEDI web site.
Select My Profile
Subscribe to the listserv that corresponds with each
workgroup that you’d like to join OR
Contact Sam Holvey at 202-618-8803 or
sholvey@wedi.org.
3
Panelist Contact Information
Doreen Espinoza, Vice President of Regulatory Affairs and Privacy Officer, Utah
Health Information Network
Email: despinoza@uhin.org
Ryan Bramble, Director of Integration – CRISP
Email: ryan.bramble@crisphealth.org
Cindy Throop, MSW, Center for the Advancement of Health IT, RTI
International
Email: cthroop@rti.org
3
Questions
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Appendix
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What is CRISP?
CRISP is a non-profit health information exchange, or HIE,
organization serving Maryland and the District of Columbia.
Health Information Exchange allows clinical information to move
electronically among disparate health information systems. The goal of HIE
is to deliver the right health information to the right place at the right
time—providing safer, more timely, efficient, effective, equitable, patientcentered care.
CRISP’s Mission: To advance the health and
wellness of our patients by deploying health
information technology solutions adopted through
cooperation and collaboration.
What does CRISP offer to
Providers?
1. Query Portal
– Traditional HIE Query services allowing providers to access
patient information at the time of treatment
2. Maryland Prescription Drug Monitoring Program
(PDMP)
– Access to all controlled dangerous substances dispensed in
Maryland
3. Encounter Notification Service (ENS)
– Real time alerts and CCD documents via DIRECT when a patient
is admitted, transferred, or discharged
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RTI International
History and Mission
180 acre campus
22 buildings
895,000 ft2 in RTP

Independent, not-for-profit research and
development organization

Founded in 1958 through a partnership
between business leaders, state
government, and area universities

Mission: to improve the human condition
by turning knowledge into practice

One of the world’s leading research
institutes
RTI’s Center for the
Advancement of Health IT
provides research and technical
services to advance the
effective use of health IT and
health information exchange to
improve the efficiency and
effectiveness of health care
delivery at home and abroad.