The Role of Health Information Exchange
in Reducing Avoidable Hospital
Readmissions
Candy Hanson, Program Manager, Stratis Health
&
Coral Lindahl, Point Click Care Coordinator, Ebenezer
Ridges
March 28, 2014
Participants: 1-866-639-0744, no code needed
The Role of Health Information Exchange
in Reducing Avoidable Hospital
Readmissions
Candy Hanson, Program Manager
Stratis Health
Coral Lindahl, Point Click Care Coordinator
Ebenezer Ridges
March 28, 2014
Objectives
• Learn the basics of health information exchange
between hospitals and other exchange partners
• Learn about the HITPAC project
• Learn about the value of health information exchange
in reducing avoidable hospital readmissions
• Learn about the strategies your organization can
consider as you prepare for the future of health
information exchange
3
Minnesota HITPAC is:
Centers for Medicare &
Medicaid Services' Special
Innovation Project: Health
Information Technology for
Post-Acute Care Providers
(HITPAC)
Collaboration between 3
Fairview Hospitals and 10
skilled nursing facilities
4
Minnesota HITPAC Communities
Community 1A
Fairview Ridges Hospital
Fairview Southdale Hospital
Augustana Minneapolis
BHC Innsbruck
Ebenezer Ridges
Martin Luther
St. Gertrude's
The Colony of Eden Prairie
Community 1B
Fairview Lakes Hospital
Birchwood Health Care
Ecumen North Branch
GoldenLiving Rush City
Margaret S. Parmly
5
Two Main Focus Areas:
Transitions of
Care
Improving
Medication
Management
Electronic
Health
Record/EHR
towards
Health
Information
Exchange/HIE
6
HIE Value Opportunities (health.ahrq.gov)
• Immediate access to outside records which improves
the quality and safety of patient care and saved time
• Timing of “sharability” of electronic health records
especially in emergency
• Value of most recent information
• Potential to minimize redundant data entry
7
HIE: Information “pull” (“Connect”)
• “Connect”: a national standard that enables “pull” queries
• A primary care provider recommends a procedure for their
patient, a resident at a long-term care facility
– The hospital wants to pull patient record information at
admission
– The provider wants to pull results of the procedure
– The LTC facility wants to pull updated med list upon return
HIE Services
Hospital
Directory
PID RLS
Provider
Clinic
IdM
Security
Consent
Manager
Long-Term
Care
8
HIE: Information “push” (“Direct”)
• “Direct”: a national standard for “push” transactions
• e-mail with a trust and security layer:
– Trust: you may only correspond with addresses with whom
you’ve established mutual trust
– Security: Confidentiality, Integrity and Authenticity
• Direct is a standards-compliant, secure, directed
clinical messaging standard
–
–
–
–
–
HIPAA-compliant
Meaningful Use-compliant
Simple
Low-cost
No added legal framework or consent management required
9
Direct: “push” example
Lab to clinic: Lab receives order from clinic and
responds with lab report
10
Focus our time ensuring:
• The right data is being exchanged
– Proper fields to produce meaningful Patient Assessment and
Discharge Summary documents
• An acceptable “container/document” is being used for
the data
– The ideal being a standards-based “Continuity of Care
Document” (CCD), exchanged system to system
• An acceptable means of secure transport is used
– Exchange may already be happening, system-to-system; if
not, a standards-based solution (such as Direct) may have to
be brought into the solution set
11
What is in a Standards Based CCD?
(CCD = Summary of Care Document)
•
•
•
•
•
•
•
•
General Header Section
Allergies Section
Medications Section
Problem Section
Procedures Section
Results Section
Advance Directives Section
Encounters Section
•
•
•
•
•
•
•
•
Family History Section
Functional Status Section
Immunizations Section
Medical Equipment Section
Payers Section
Plan of Care Section
Social History Section
Vital Signs Section
Taken from: HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, DSTU Release 1.1
12
Improve quality and coordination of care
through the effective use of health
information technology (HIT) during
care transitions
Leverage standardized patient
assessment content to facilitate health
information exchange (HIE) with
hospitals
Reduce medical errors by improving the
medication management process
through the use of EHR functionality
13
Current and Future State Process
Mapping
•
14
Medication Management Lessons
• Current hybrid processes have many potential
opportunities for improvement
• Medication reconciliation is a different activity than
medication review
• Medication reconciliation needs to be a “shared
responsibility” going forward
15
Prospective Medication Review (PMR)
Pilot
• Implemented in our project
• Workflow redesign which improve patient safety,
and will impact skilled nursing facility staff time,
hospital staff time, dispensing pharmacy staff
time
• Medication reconciliation done at “preadmission” once SNF staff inform hospital that
they can accept a resident
• Dispensing pharmacy will screen for 7+ items
• Analytics
16
Exchange Results
•
•
•
•
42 SNF to hospital test exchanges
10 hospital to SNF test exchanges
2 SNF to pharmacy test exchanges
Actual health information exchanged achieved with
PMR pilot participants
17
Lessons Learned
• There is a wide array of EHR functionality
• There currently exists largely hybrid health records
(paper/electronic mix) in SNFs
• View only access does not equal interoperability
(although it is an HIE strategy to get there)
• The span of LTPAC vendors who can produce a CCD is
variable
• Laws and rules that pre-date EHR use contribute to
problematic workflows
18
Lessons Learned (continued)
• The value of interoperability still needs to be realized
• Privacy and security practices in an EHR/HIE
environment will continue to need much attention
• There need to be hard stops across the health care
continuum for medications that are prescribed without
an indication or diagnosis
• Pharmacy needs to play a bigger role in medication
reconciliation
• There is much optimization work to do
19
Health Information Technology:
Minnesota QIO Implementation
From a Provider Perspective
20
Ebenezer Ridges Care Center
• Located in Burnsville, MN
• South metro location
• 104 skilled nursing home with 12 TCU beds
• On a campus consisting of: Assisted Living,
Independent Living, Adult Day Care and Child Day
Care
• Part of the Fairview System
21
Ebenezer Ridges Care Center
• We started using PointClickCare (PCC) in 2005
• We started with Billing & MDS progress notes; then
moved to Care Plans, Assessments, EMAR, and
Point of Care (POC)
• We scan lab results, POLST
• We have a Super User – Coral Lindahl, RN-BC
22
HITPAC Project
• We were asked to participate with Stratis Health and
Fairview
• We received the key roles and expectations in April
• We started with a readiness survey to help Stratis
Health start the workflow process
23
HITPAC Project … continued
• We worked with Point Click Care to generate a CCD
within our EHR
• We also shared information during our weekly calls to
discuss potential medication errors related to transfer
of information
• We have a press release that explained our
participation in the project
24
HITPAC Goals that we agreed to:
• Have a successful electronic exchange of data from
the hospital to the skilled nursing facility
• Create a best practice workflow to reduce medication
errors
25
HITPAC
• We shared our information of how we currently
receive information:
• Fax
• E-mail
• EPIC access
• Webinars along the way
• We also discussed where there are potential areas
for errors
26
HITPAC
• We have worked with our project coach – Julie
Jacobs
• An audit on our utilization from the consulting group
that Stratis Health uses was offered
• We chose to get our scorecard from PCC for
optimization.
27
HITPAC
• A gap analysis was compiled and presented to us
from Julie at Stratis Health
28
HITPAC Gap Analysis and
Recommendations
Project Overview
• The long term post acute care (LTPAC) setting is highly
impacted by numerous transfers of care; over 40% of
hospital discharges are to post-acute settings and are
among the heaviest users of medications. Nearly 12 million
medically complex Americans need long-term and post
acute care services in nursing homes, home health, or
other settings. CMS estimates that over 18% of Medicare
patients are re-hospitalized within 30 days of discharge and
that 13% of all admissions costing $12 billion dollars are
potentially avoidable.
29
HITPAC Gap Analysis and
Recommendations… continued
• Health information technology (HIT) and electronic
records have the potential to improve the efficiency in the
LTPAC settings by reducing medical errors, improving
communication, and the overall quality of patient care.
The goals of this project are to assist post acute
providers to advance the use of HIT systems, continue to
encourage the overall adoption of electronic health
records (EHR)s in long term care settings, and to
standardize health information exchange (HIE) between
hospitals and LTPAC.
30
HITPAC Gap Analysis and
Recommendations… continued
To this end, and to understand the opportunities that
might be present in reaching these goals, we collected
information for this report from two LTPAC
communities, consisting of 3 hospitals and 10 postacute care facilities in Minnesota. The following data
gathering tools were used:
• HITPAC Education and Technical Assistance
Readiness Interviews
• Weekly project calls with recruited communities
• Workflow Process mapping
• Gap Analysis
31
HITPAC Gap Analysis and
Recommendations… continued
Findings:
• Limited LTPAC EHR functionality
• Interoperability
• CCD
• Medication Reconciliation and e-Prescribing
LTPAC and Acute Care Facilities:
• Gaps in medication reconciliation procedures
• Diagnosis Codes - underutilized
• Gaps in privacy and security practices in
transitions of care
32
HITPAC Gap Analysis and
Recommendations… continued
Early Recommendations
• All EHRs generate and consume a Continuity of
Care Document (CCD)
• 225 Data points mapped to date
• Current state-MDS, OASIS, Interact, other
proprietary formats
EHR Configuration and training related to Medication
Management, Clinical Decision Support and ePrescribing tools
33
HITPAC Gap Analysis and
Recommendations… continued
• Medication Libraries
• Predictive text
• Electronically generated reports
• Order Sets, Diagnosis code – driven
Best practice around Medication Reconciliation
• Pharmacy consults
• EHR Clinical Decision Support tools
34
How are we different?
1. Readiness to work with a CCD
2. Experience with PCC and where we are next
3. There was value for us in using the CCD – 90% of
our admissions come from a Fairview hospital
35
How Can Other LTPAC providers prepare?
• Look at what you are able to do with your current
EHR
• Be willing to sit down and look at your current
exchange of information – are there areas of
improvement?
• Set a plan 
36
Barriers
•
•
•
•
Having someone understand the language of the
technology
Redesigning the workflow process
Your EHR vendor ready for the CCD
Having partners ready to exchange
37
Best Practices for EHR culture
• Have a technology interest
• Have a curiosity around quality – how do you collect
data, what do you do with the data, what are you
trying to improve?
38
Key Lessons
•
•
•
We are farther ahead than we thought
There is a lot of work to do
It can be done
39
HITPAC Web Page
http://www.stratishealth.org/providers/HITPAC.html
40
Our Key Collaborators…
Aging Services of Minnesota
Care Providers of Minnesota
CHIC (Community Health Information Collaborative)
Minnesota Alliance for Patient Safety
Minnesota Department of Health
Minnesota Hospital Association
LeadingAge /Center for Aging Services Technology
41
How can care settings prepare themselves
for the EHR/HIE environment?
• Commit to a establishing/sustaining an EHR/HIE
culture (don’t be intimidated by the new language)
• Invest in resource(s) that lead in EHR/HIE culture in
your organization
• Assess your current EHR environment (computer
skills, attitudes, and beliefs about an EHR
environment)
42
Best Practices Ideas for EHR optimization:
• Organizations should consider investing in a
•
•
•
“Super User”/nurse informaticist environment
Find/establish best practices that support an
electronic environment
Use the resources/tools that are available to you
now
Collaborate within your trade association for support
and resources
43
Questions?
Candy Hanson
Program Manager
Health Information Technology for Post Acute Care (HITPAC)
Stratis Health
952-853-8524
chanson@stratishealth.org
www.stratishealth.org
Coral Lindahl
Point Click Care Coordinator
Ebenezer Ridges
952-898-8465
codell1@fairview.org
www.fairviewebenezer.org
This material was prepared by Stratis Health, the Minnesota Medicare Quality Improvement Organization, under contract with the
Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials
do not necessarily reflect CMS policy. 10SOW-MN-SIP-HIT-14-04 032514
44
Upcoming RARE Events….
Stay tuned for the next RARE Webinar in April 2014.
RARE Action Learning Day – June 17, 2014,
Crown Plaza Hotel, Plymouth, MN
Stay tuned for more details!
Future webinars…
To suggest future topics for this series,
Reducing Avoidable Readmissions
Effectively “RARE” Networking
Webinars, contact Kathy Cummings,
kcummings@icsi.org