Electronic Referral Management
Powered by Direct
Kansas City Safety Net Providers
Debbie Joyce, Truman Medical Centers
Lisa Millerd, Samuel U. Rodgers Health Center
Hannah Luetke-Stahlman, MetroCARE of Greater Kansas City
Derek Zaun, Cerner Corporation
Health Care is too Important to Stay the Same
Powered by Direct - What is Direct?
The Direct Project specifies a simple, secure,
scalable, standards-based transportation
mechanism that enables participants to send
encrypted health information directly to known,
trusted recipients over the Internet.
b.wells@direct.aclinic.org
h.elthie@direct.ahospital.org
Industry standard, developed in partnership with the federal government, ensuring universal
interoperability and security.
Direct is a transport protocol for health information exchange that leverages secure email and
a trust fabric.
Secure email is S/MIME using x.509 digital certificates. (“https:\\”)
MIME is standard email messages.
Email messages can include structured or unstructured attachments, i.e. CCD, CCR, PDF,
JPG, HL7 lab results
http://wiki.directproject.org/
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
What is Direct - Simplified
Think of Direct as Electricity or Phone Lines
• Phone lines needed before your phone works
• Electricity needed for your toaster/radio to work
Simply a secure transportation vehicle
• Allows separate organizations to securely and reliably exchange sensitive
information
• No custom or expensive interfaces required
• Given an address, just like an email address (drbob@direct.ahospital.org)
Uses for Direct?
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It’s not just email
Start with any workflow that involves fax/phone/paper
Ad Hoc communication, Referrals, Results Delivery, HIE Contribution
No limit to uses, be creative
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
KC Safety Net Providers - Powered by Direct
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Representing KC Safety Net - Who are we?
Truman Medical Centers
•
An academic health center providing accessible, stateof-the-art quality healthcare to our community
regardless of the ability to pay.
MetroCARE of Greater Kansas City
•
A charitable non-profit for the residents of Jackson, Clay
and Platte Counties. Connect low-income, uninsured
patients to over 850 volunteer physicians in 45
specialties in their private offices.
Samuel U. Rodgers Health Center
•
A Federally Qualified Health Center providing quality,
compassionate and affordable healthcare for all.
Proudly offering translation services in over 30
languages.
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Why Automate Patient Referrals between Providers?
Why electronic referral
management?
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Improve the accuracy and timeliness of
secure information exchange across
disparate providers to reduce the costs and
improve the patient experience and health
outcome.
•
Because our loved ones and ourselves will
likely be a patient one day
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Patient stories
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Key Learning Objectives for today
Challenges
1.
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Understand the challenges of electronically referring patients
between different providers
Benefits
2.
•
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Describe problems of traditional fax/phone/paper methods
Benefits gained by using E-Referrals powered by Direct
Current and Future
3.
•
Explain how disparate facilities are currently connecting with
Cerner Direct Referrals and the future outlook as Direct
adoption expands
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Challenges of E-Referrals between Providers
• Patient Privacy – HIPAA
• Secure transfer of PHI is required
• Costs
• Connecting disparate systems
• Vendor enhancement/upgrade fees
• Staff implementation/training costs
• Organizational Differences
• Different EMR systems
• Different policies and agendas
• Requires collaboration and teamwork approach
SOLUTION must be EMR agnostic, LOW-COST
and EASY to use & implement!!
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Problems with traditional phone/fax/paper methods
Inaccurate/Missing data
• Data written down wrong over phone or mistyped during data entry
• Fax failed or pages missing on transmission
• Paper lost in transit
Was it delivered and who is working on it?
• No delivery confirmation with fax delivery
• Uncertainty on delivery leads to resubmission/duplicate
• Unsure who to contact or if it is being worked on
Manual methods take longer
• Manual data entry
• Missing information requires phone call
Costs
• Fax/Printer maintenance/toner
• Paper costs
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Benefits realized thru E-Referrals powered by Direct
HIPAA Compliant
Simple
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Easy, cost effective implementation
Need only a modern browser
Efficient
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Communication is greatly improved
Improved turnaround time on appointments
Eliminates time spent on manual paper and fax processes
Easily send results/visit summary (“Close the loop”)
Eliminates use of spreadsheets for tracking referrals
Improve Referral Relationships
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Delivery is confirmed by receiver and contact person is known
Improves customer service with referring organization
Maintain/increase revenue by increased referrals
Patient Care
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Improves quality of care and experience for the patient
Accurate and timely information
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Look at the Numbers – RAND Study on E-Referrals 2007-2008
RAND Study on E-Referrals 2007-2008
Data Sources:
• 71.9% of PCPs believed that e-Referral improved
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overall clinical care
89% reported improved tracking of referrals over
paper-based
73% believed it improved pre-visit work-ups
Inability of specialist to discern reason for the
referral dropped significantly when using e-referral.
Only 9.5% of e-referrals were unclear as compared
to 38% of paper referrals.
Use of e-Referrals led to lower rates of follow-up
visits for specialty surgical visits (rate of follow-up
visits deemed avoidable were lowered by 44.7%)
Led to decreased wait times for new appointments,
presumably by decreases in inappropriate referrals.
Implementation of an Electronic
Referral System for Outpatient
Specialty Care
http://www.rand.org/content/da
m/rand/pubs/reprints/2012/RA
ND_RP1433.pdf
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Current Implementation – Cerner Direct Referrals Portal
Results received at referring provider.
Referral loop has been closed and
referral is now complete.
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
Future Implementation – Portal + Direct embedded in EMR
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
KC Safety Net Providers - Powered by Direct
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
What will the next year bring for Direct?
Direct-enabled web portals will play a key part as
interim and long-term solutions for interoperability
360 Exchange Industry Work Group is helping to shape
interoperability standards for referrals and care
coordination using Direct secure messaging
Vendors will develop new Direct-enabled solutions and
embed Direct into existing solutions to improve
efficiencies in various workflows
Trust between Direct HISP vendors will be more
prevalent and make Direct secure messaging ubiquitous
© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.
“Increased use of Direct should go a long way
toward replacing the slow and inefficient way most
providers currently share information via phone,
fax, and mail—ultimately improving patient care
and outcomes.”
Farzad Mostashari, MD, ScM,
ONC National Coordinator for Health Information Technology
The Office of the National Coordinator
for Health Information Technology
Electronic Referral Management powered by Direct
Questions?
Debbie Joyce - Truman Medical Centers - debra.joyce@tmcmed.org
Lisa Millerd - Samuel U. Rodgers Health Center - lmillerd@rodgershealth.org
Hannah Luetke-Stahlman - MetroCARE of Greater KC - hannah@metromedkc.org
Derek Zaun - Cerner Corporation - derek.zaun@cerner.com