The Mount Sinai Health System
GEDI WISE
Geriatric Emergency Department Innovation in care through
Workforce, Informatics, and Structural Enhancements
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Topics
 Mount Sinai At A Glance
Healthix Health Information Exchange
 Project Scope
 Gedi Wise
 Connexall Setup
 Outcome
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The
Mount
Sinai
Health
System
At
A
Glance
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What is Healthix?
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.
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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
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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
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Patients visiting the ED for conditions that can be treated in lowercost 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.
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Project Goals:
With real-time notification, the expectation is the care manager would be able to:
•
•
•
•
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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.
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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
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Event Notification Service
1. 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.
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Event Notification Service
2. 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.
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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.
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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).
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EN – Systems flow
Integration with
Cisco phones /Email
Other
participating
hospitals
CHP
Healthix
NYP
NYU
Real-time Event
notification
Automate
is utilized
to secure
FTP this file
to Healthix
Subscription file is
extracted from Epic
and sent to Healthix
each day, inclusive
only of the patients
flagged with GEDIWISE FYI flag.
Interface
Engine
Cloverleaf engine
parses out key data
fields from EN and
sends to Connexall
Connexall
CSV file for
analytics
Cloverleaf engine
parses out key data
fields and sends to
Epic In Basket as ADT
messages
Epic
Notification resides
within two places in
Epic:
1. Physician
InBasket
2. Encounter on
the patient’s
chart
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EN – Example of Epic In Basket message
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EN – Systems flow
 Cloverleaf sends MDM message type to Connexall
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Healthcare Informatics Client
 HIC runs a script to parses key data fields
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WTC
Cisco Client
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Email Output Client
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Connexall Setup
SAC View
• Click to edit text
– Second level
• Third level
– Fourth level
» Fifth level
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DAC View
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Email notification output
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Cisco phone
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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
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Project Update
Healthix solutions:
• planned edge server upgrade
• adding dedicated staff to monitor the interfaces
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Connexall Implementation Conclusions
•Deliver notifications with very little maintenance
•Work automatically and in real-time
•Happy end users (Connexall Rocks per ED doctors)
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Thank you
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