E-HEALTH / HEALTH INFORMATION EXCHANGE
USE CASE IMPACT
ON
PROVIDER WORKFLOW
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Bio
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35 year career in healthcare
20 years in Consulting with an emphasis on clinical systems and focus on
physician adoption of I/T
Clients range from small physician groups to large multi-hospital organizations
Conducted over 200 vendor selections for both hospitals and physicians with
over 100 EMR engagements ranging from small practices to complete hospital /
physician integrated delivery systems
Worked with major HIEs including Chicago, Minneapolis, Wisconsin, Washington
DC, New York City and many enterprise HIE projects
Spent 15 years in the vendor community and is former VP of Sales for the
physician systems division at Baxter
Adjunct Faculty member at University of Wisconsin Milwaukee Healthcare
Informatics Graduate program teaching Healthcare I/T Procurement
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Topics
A. Evolution of Intra Provider Messaging
B. Today’s Challenges
C. HIE Use Case Impact on Provider / Patient Workflows
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EVOLUTION OF PROVIDER
MESSAGING
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Not so Distant Past Provider Messaging
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Information Access Evolution
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Changing Provider I/T Environment
2006
2011
5% Physician EMR use to 20%
2011
2015
20% Physician EMR use to 50%
2015
2019
50% Physician EMR use to 75%
2011
2019
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Value based purchasing (ACO)
Comparative effectiveness / Quality Measures
Care coordination / CCD exchange
Consumer access to their records
Data standards
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ICD-IO
SNOMED CT
Rx Norm
LOINC
Others
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WORKFLOW CHALLENGES
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Workflows – When You’ve Seen One…You’ve Seen
One
 Physician adoption / Provider variance – who has an EMR and who doesn't?
 If I need to send a record summary to the next provider, how do I know what
preference they have to receive it?
 If they have an EMR are they ready to use the CCD as a means of conveying
patient records?
 Staff adoption and data/document hand off – when will it become efficient?
 Patient variability – do they want an electronic copy and how do I get it to them?
HIPAA Compliance
Security
Consent
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Changing of the Guard
Old
New
Insurance Card verification / phone call
On line eligibility checking
Patient Medical History Interview
HIE History Access and Patient Interview Validation
Receipt of patient discharge summaries, lab results
via fax, triage and clip to the chart
Electronic receipt of messages, results and other data
from the network to the EMR inbound application
Patient care documented with pen, paper and
Dictaphone
EMR clinical documentation, voice to data, direct data
entry via templates all mapped to SNOMED CT,
RxNorm, LOINC etc.
Paper prescription handed to the patient, medication
recorded via written note in the chart
eRx on a handheld with review of online formulary
and comparison to current medication history via
SureScripts and other sources
Manual checklist of problems, diagnosis, CPT codes
and health maintenance reminders, referral letters,
fax of patient records
Electronic care plan, CCD export to the next provider,
consumer, provider and payer access to care plans,
consumer patient record portals, PHRs
Manual calculation of patient activity
Electronic quality measure reporting, public lab data,
disease surveillance
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Provider System Fragmentation
Email Web
Browser
•Log-in
•Passwords
•Patient search
•Navigation
•Flows
Clinic EMR
Hospital
Portal
Hospital(s)
A, B, C…
Home
Screens
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Clinic
Portal
Diagnostic
Systems
Hospital(s)
A, B, C...X
EMR
Screens
Regional
HIE
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HIE IMPACT ON PROVIDER
WORKFLOWS
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Typical HIE Use Cases / Services
Core Services
 Provider Data Exchange Engine
 Patient Identity Management
 Record Locator Service (RLS)
 Consent Tracking
 Provider Directory (Direct)
 Secure Messaging
 Audit/Security Management
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Common Use Case Examples
 Patient Visit Registry View – RLS
Viewer
 Clinical Summary View
 Results Delivery / Documents
 Lab Orders / Results (Discrete)
 CCD Exchange
 CCD Publishing to the HIE
 Registries – Disease, Public Health
etc.
 Public Health ELR
 PHR Service
 EKG Viewer
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Health Information Exchange
ONC – HIT Strategic Plan Draft March 2011
…the Medicare and Medicaid EHR Incentive Programs reward eligible providers who digitize health care
information and share it electronically across provider settings. These requirements will grow stronger in
future stages. Second, ongoing payment reforms initiated by the Affordable Care Act – including accountable
care organizations, medical home models, and bundled payments – are an even more important potential
driver of provider motivation to exchange information.
Premise of why ONC / HHS is promoting regional / State HIEs
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Fundamentally changing how we deliver patient care and manage patients over time
Patient care and management should not be encumbered by provincial provider attitudes
that they are in control of their patient’s records
Patients are to be empowered to take an active role in their care, management and
outcomes
Data for quality measurement knows no boundaries of IDN, Physician Group or any other
provider type…but rather centers around the totality of patient data and consistency of
information analytics across the industry and the life of the patient
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Tactical Delivery of Long Range ONC I/T Vision
 Meaningful use of EHRs – across the continuum
 Implementation of Health Information Exchange (HIE) to support continuity of
care
 Care Coordiation through access to patient centric community care plans
 Agile and thin I/T applications that can be modified over time without major
system disruption
 Semantic interoperability of systems and reducing the cost of fragmentation
 Analytics supporting fundamental health care delivery change
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Typical Hospital View of Their Service Community
Hospital
Systems
Employed
Physicians
Affiliated
Physicians
Other
Providers
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ONC View of The Service Community
Patient
Physicians
Ancillary
Providers
Hospitals
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Goal: Data and Information Exchange
Clinical
Information /
Data Analytics
Point of Care
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Care Continuum
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Traditional Workflow Example
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Patient calls for doctor appointment
Patient is sent forms to fill out and bring
into office
3. Patient arrives at clinic with forms
4. Forms are reviewed by staff and entered tin
to the system
5. Patient is “roomed” and vitals written in
chart
6. Patient previous test results arrived via fax
and clipped to chart for clinician review
7. Physician conducts exam and annotates
findings in chart
8. Provides written Rx to the patient
9. Physician indicates treatment plan to nurse
who in turn orders tests and instructs
patient further
10. Printed and hand written instructions
provided to the patient
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Tomorrow’s Workflow
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Patient registers via the web and fills out HRA and
other documents
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Patient arrives and checks in via kiosk
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Hospital distributed results from prior days testing
via HIE to the clinic EMR messaging inbox
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Patient is roomed with digital feeds of vitals to EMR
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Medical Assistant confirms all new information from
HIE that shows last weeks ED visit that was not
known by this clinic
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Physician conducts exam, documents in EMR and
uses eRX tool that shows a previous script from the
ED that he was not aware of and confirms with the
patient that they are taking the medication
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Physician enters electronic order for testing to be
done at the hospital
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Patient asks for electronic copy of the visit record
and also asks that the record not be disclosed to
Provider “x” as her ex-husband is a physician at that
location
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Assistant logs onto the HIE and indicates how
Consent has been modified
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Provider Workflow Challenge
 Multiple logins
 Variable workflows for common functions
 Record completeness
 Data differences among systems- e.g. allergies, current meds
 Venue differences- ED, walk in clinics office, specialist, inpatient
 Error correction
 Common format for clinical documentation
 Patient consent
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HIE Patient Consent Issues
 Opt in- Opt out changes
 Emergency care
 Behavior health
 “Peyton Place” issues
 Clinical documentation inconsistencies- patient corrections
 Patient self-consent/assignment
 Break the glass provisions
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MANAGING THE FUTURE
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Physicians Want “One Stop Shopping”
Office
EMR
HIE
 Security (Sign-on)
 Privacy Policies
 Consent Policies
 Data Integrity (Trust)
 Error Correction (Trust)
Auditing (Risk)
 Change Management (Standards)
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Patient
Hospital
EMR
Patient
Messaging
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Wrap Up
 Challenge your organization to assess the impact of your decisions on the
“patient centric” process
 Understand the workflow implications for your providers with special emphasis
on affiliated physicians
 Patient movement among providers is not going to disappear so understand that
you are a part of the patient’s provider community
 Accountable care, care coordination and disease management will require much
greater consistency of information exchange among providers…are you part of
the solution or a part of the problem?
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Patient Centric Approach to I/T
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Thanks !
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Mike Mytych
mmytych@hicllc.com
262-253-9110
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