Presentation on theme: "Best Practice: Information Exchange"— Presentation transcript:
1 Best Practice: Information Exchange ClaudiaDuring the webcast, you are all joined as participants in listen only mode. You can hear us, but we can’t hear you.If you have questions or comments during the presentation, please use the chat function at the bottom right hand corner of your screen to share them with us.We will have time to address your questions and comments at the end of the presentation.
2 WSHA Presenters Claudia Sanders Carol Wagner Barbara Gorham Senior VP, Policy DevelopmentCarol WagnerSenior VP,Patient SafetyBarbara GorhamPolicy Director,AccessCLAUDIA IntroSCOTT IntroCAROL IntroBARBARA IntroCLAUDIA – Talk about partners, change slide
3 Additional Presenters WA/ACEPEDIETIM introSTEPHEN introNATHAN introCLAUDIA TAKE OVERDr. StephenAndersonAdam Green
4 Webcast Objectives Overview on ER is for Emergencies Best Practice: Information ExchangeOne Implementation: EDIEA fast timeline!How we can helpQuestions and commentsClaudia
5 Redirecting Care to the Most Appropriate Setting An OpportunityRedirecting Care to the Most Appropriate SettingCarolWe have a tremendous opportunity here.Instead of losing millions of dollars in payments, we can be part of transforming our system to direct care to the most appropriate setting.By redirecting care, we will help eliminate cost.
6 Partnering for Change Washington State Hospital Association Washington State Medical AssociationWashington Chapter of the American College of Emergency PhysiciansCarolTOSS TO CLAUDIA
7 State Approaches to Curbing ER Use WhenWhatImpactStatusOriginal proposal3-visit limit on unnecessary useCuts payments to providersWon lawsuit; policy abandonedRevised proposalNo-payment for unnecessary visitsCuts payment to providersDelayed by the Governor just prior to implementationCurrent policyAdoption of best practicesImproves care delivery and reliance on ER as source of carePassed in latest state budgetClaudia$38 million ANNUAL cut we were facing as of April 1.We now have the opportunity to take $31 million out of the system.
8 If UnsuccessfulRevert to the no-payment policy. $38 million in annual cuts!Claudia
9 Seven Best Practices Barbara The budget proviso passed by the legislature requires hospitals to adopt seven best practices to reduce unnecessary ER use. If a sufficient number of hospitals do so by June 15, 2012, we will avoid the no-payment policy; if not, the state will implement the no-payment policy on July 1, 2012.
10 A) Electronic Health Information Goal: Exchange patient information among Emergency DepartmentsIdentify frequent usersGet access to treatment plansUse in providing careExceptions for CAHs, hoping all will participateBarbaraOne of the central elements of these best practices is the adoption of an electronic health information system to exchange information about patients using the emergency room. Such a system will allow hospitals to identify frequent users when they come into the ER. It will also provide access to the patient’s treatment plans to provide the best care possible. We are encouraging all hospitals to adopt this system because it will greatly improve care, especially for frequent users of the ER. Although the costs are reasonable, if it is a burden for critical access hospitals to adopt this system, they will be given an exception for this particular best practice.
11 Exchange Helpful for Other Best Practices To identify Patient Review and Coordination (PRC) clientsTo make PRC care plans available to ER physiciansTo provide feedback and help with performance measurementBarbaraThe information exchange system will also help hospitals implement some of the other best practices. First and foremost, it will help ER physicians identify patients enrolled in the Patient Review and Coordination (or PRC) program. This is a state program that locks frequent users into one hospital, one pharmacy, and one primary care physician to help address their issues in a coordinated way. It is crucial, if we are going to reduce unnecessary ER visits, to know who these people are when they come into the ER and direct them to appropriate care.The electronic information exchange will also make PRC clients’ care plans available to ER physicians. These care plans do things like make it very clear if a patient should not be prescribed narcotics. Exchanging this information in particular will greatly improve our system of delivering care.Finally, the electronic information exchange will give us data to help us evaluate whether the best practices are working. This feedback is necessary if we are to avoid reversion to the no-payment policy during the next legislative session.
12 Implementing an Electronic Information System BarbaraIf all of the hospitals within a region are on the same electronic medical record system, it may be possible to use that system to exchange information about emergency department visits, and we are working with hospitals to explore this option. Another solution is for hospitals to purchase an internet-based product called the Emergency Department Information Exchange, or EDIE. I am going to briefly explain what EDIE is, then turn it over to Adam Green to provide a lot more information about what EDIE is and how it works.
13 One Possibility: EDIE Emergency Department Information Exchange (EDIE) 30 hospitals in Washington already usingEDIE can:Notify ED physician of frequency of ED visits and summary of ED discharges for past 12 monthsShare guidelines for patient with other hospitalsLoad patient’s treatment plan, so ED physicians can viewCosts:Depends on number of ED visitsSet up plus interface, plus $1,000 to $35,000 a yearBarbaraEDIE is already used by 30 hospitals in Washington. Within minutes, it notifies the ED physician of the frequency of a patient’s ED visits and provides a summary of ED discharges for the past 12 months. It also allows any ER physician to see a patient’s care guidelines and their treatment plans.The costs of EDIE depends on the number of ED visits; the more patients a hospital sees in a year, the higher the setup cost and annual subscription fees. Setup ranges from $1,500 to $5,000. Annual subscription fees are $1,000 to $35,000 a year. There may also be additional fees to integrate your electronic medical record system with EDIE, so you can receive notifications electronically. But you can also receive EDIE notifications by fax and avoid these integration fees.I am now going to turn it over to Adam Green to tell you more.
14 The Emergency Department Information Exchange WSHA Web Conference Friday 27, 2012
15 Agenda Background What is EDIE? What does EDIE do? How does EDIE work? What does EDIE & EDIE Notifications look like?Who is using EDIE?What does it take to get EDIE?How much does EDIE cost?Additional Questions and Q&A
16 Background Collective Medical Technologies Founded in 2005 Focus on utilization in the EDWorking in Washington State since 2008Recent Washington Related ActivitiesOpioid Abuse WorkgroupData share agreement with HCAData share agreement with Molina HealthcarePrescription Monitoring Program Pilot
17 What is EDIE? EDIE is EDIE is Not A collaborative case management framework for all types of special needs patientsA targeted tool for proactively notifying interested parties and stake holders of relevant patient-specific events or behaviorA low-cost, automated solution for sharing actionable information to otherwise disparate partiesEDIE is NotAn Electronic Medical RecordA fully-featured Health Information ExchangeA punitive tool to prevent or withhold treatment to the patient
18 What does EDIE do?Notifies EDs of high utilization patients or patients enrolled in care management programs and PRCAllows care managers to attribute care plans to a patient that can be shared across all participating facilitiesAllows care managers to alert PCPs of care plan creation and other patient factors concerning ED utilizationGenerates reports on patient utilization and other measuresRelays PRC information to EDs and care managers
19 How Does EDIE Work? EDIE Notification Methods Transmitted Information FaxSMSPhoneNotification MethodsWebNotification4.Patient Health InformationTransmitted Information3.Patient Event Occurs (i.e. patient visits ED)Hospital sends EDIE patient dataEDIE evaluates data against all patient criteriaPatient LevelThe care management program LevelFacility LevelEDIE sends out Notifications determined by criteriaEDIE continues to receive data from other various sources to evaluate patient events against2.1.EDIEProvider FacilitiesHealth Plans5.Additional Data Sources
20 How Does EDIE Work? Mental Health Provider Hospital Notifications EDIE 4.2.1.EDIE3.Primary Care ProviderClinic
21 What Does a Notification Look Like? Patient IdentifierNotification ReasonPatient PRC AlertPRC Contact InformationPRC ProvidersOther ProvidersCare GuidelinesPCP GuidelinesED GuidelinesOther Notes
22 What Does a Notification Look Like? 3 Month Visit ListDate / TimeLocationDiagnoses12 Month Visit ListVisit CountsNon Emergent Visits*FacilitiesNarcotic Prescriptions (In Work)PDMP Data (Pilot in Progress)* Non emergent visits as indicated by HCA NE Dx List
23 What Does EDIE Look Like? Patient / Visit Summary SectionCare Guideline SectionInvestigation Section
24 What Does EDIE Look Like? Patient DemographicsName / Gender / DoBMRN / AddressPatient AliasVisit History GraphTimelineFacility Composition3 Month Visit ListDate/TimFacilityDiagnoses12 Month Visit ListVisits (Aggregate)NE Dx Visits22.214.171.124.5.
25 What Does EDIE Look Like? Care GuidelinesFrom PCPFrom EDPatient HistoryRadiation AlertsOverdose AlertsMedical / Social HxOpen Text FieldsSupports Copy/PasteCustomize to Patient needs2.1.3.
26 What Does EDIE Look Like? Listed PayersCurrent ProvidersRecent Dx ListRecent Narcotic Prescriptions126.96.36.199.
27 Who is Using EDIE? Also Boise, north Idaho, Portland Also Idaho and OregonAlso Boise, north Idaho, Portland
28 Who is Using EDIE? 30 Facilities currently live (20 in work) 1.3M ED visits going through EDIE900,000 in real time400, 000 from HCA & Molina HealthcareOver 3,000 care guidelines in EDIEOver 40,000 Notifications Issued (annually)All PRC patients in EDIE
29 What Does it Take to Get EDIE? Legal / ComplianceReview & Execute AgreementsBusiness Associate AgreementData share AgreementLicense AgreementHIPAA?Reviewed by John Christiansen, EsqTimeline & DependenciesTypical one to three weeks lead time from facilityCMT lead time one to two days for counter signing
30 What Does it Take to Get EDIE? IT / ISUplink (Facility to EDIE Data Flow)Standard Connections (VPN & HL7)Hands on keyboard time – 10 to 15 hoursDownlink (EDIE to Facility Data Flow)Multiple delivery methods supportedLow tech fax – zero IT resources to set upHigh tech EMR integration – preferred method, no extra fees to set upHands on Keyboard time – depends on delivery methodTimeline & DependenciesIs IT managed in-house or remotelyNotification delivery method (fax vs EMR)Typical lead time two to four weeks
31 What Does it Take to Get EDIE? TrainingTraining Sessions for both SMEs and general usersOnline training sessions for flexibility and timelinessEDIE User Account CreationInitial user accounts created by CMTFacility manages users after go-liveED Workflow / Process ChangesFacility responsible for internal workflow / process changesCMT works with care managers during and after go-liveTimeline & DependenciesTwo to three weeks including training and after go-live support
32 What Does it Take to Get EDIE? All key steps can be done concurrentlyCMT has capacity to support onboarding all remaining hospitals within mandated timelineCMT has never been the constraining factor to an implementationBottom line – If a hospital wants to fast track EDIE implementation CMT is ready to accommodate
33 How Much Does EDIE Cost? Full EDIE Service ‘EDIE Light’ Service EDIE Setup / Integration: $1,500 - $5,000 per FacilityDetermined by complexity and size of setup and integrationDiscounts for multiple facilities on same IT networkWaived for CAHCost of Integration (Internal/Third-party)Subscription: < $1,000 - $35,000 per yearDetermined primarily by size of EDIncludes on going support and incremental updates to product‘EDIE Light’ ServiceDiscontinued due to lack of interestUnable to upload care plans
34 Common QuestionsMy hospital uses X for an EMR, can EDIE connect to it?Can EDIE send Prescription Monitoring Program notifications?Can EDIE connect to my hospital’s HIE?What information does EDIE get from the HCA?Which best practices can EDIE help address?Claudia –Thank Adam,hand off to Steve
35 Experience at Auburn Very valuable tool Used by all ED providers Using full systemIn place since early 2012Steve
37 Quick Action Needed!Hospitals must submit attestations and best practice checklists to HCA by June 15, 2012ClaudiaBusiness as usual will not work
38 If Unsuccessful in Signing Up If hospitals representing at least 75% of Medicaid ER visits do not sign up, the state will revert to the no-payment policy.Claudia
39 Next Steps How We Will Help Carol WSHA is here to help hospitals with implementation every step of the way.Our work is threefold:We will continue to work with our partners, WSMA and WA/ACEP, and the Health Care Authority to develop metrics to measure the results of these efforts.We are working to provide hospitals with the information they need to be successful in this effort. We have two additional webcasts scheduled, one on the Prescription Monitoring Program and another on the Patient Review and Coordination program.Our final role is to track attestations to ensure that we avoid triggering the State’s no-payment policy.
40 Direct Contact on EDIE Adam Green firstname.lastname@example.org For more information on the EDIE program, contact Adam Green, by ing
41 For More Information www.wsha.org/0443.cfm Carol Wagner, Senior VP, Patient Safety(206) ,Amber Theel, Director, Patient Safety(206) ,Carol
42 Questions and Comments ClaudiaWe have a number of comments and questions.Remember, you can ask questions by using the chat function at the bottom right hand corner of your screen. Simply type in your question and hit the send button.