1. IMPACT: Planning for Go-Live S&I Framework Longitudinal Coordination of Care Pilots Workgroup Meeting March 10 th, 2014 Larry Garber, MD

2. IMPACT Grant February 2011 – HHS/ONC awarded $1.7M HIE Challenge Grant to state of Massachusetts (MTC/MeHI): I mproving M assachusetts P ost- A cute C are T ransfers ( IMPACT) 2

3. IMPACT Objectives & Strategies Facilitate developing a national standard of data elements for transitions across the continuum of care Develop software tools to acquire/view/edit/send these data elements (LAND & SEE) Develop consumer-oriented translator Integrate and validate tools into Worcester County using Learning Collaborative methodology Measure outcomes 3

4. Pilot Sites to Test the Datasets Selection Criteria: –High volume of patient transfers with other pilot sites –Experience with Transitions of Care tools/initiatives 16 Winning Pilot Sites: –St Vincent Hospital and UMass Memorial Healthcare –Reliant Medical Group (formerly known as Fallon Clinic) and Family Health Center of Worcester (FQHC) –2 Home Health agencies (VNA Care Network & Overlook VNA) –1 Inpatient Rehab Facility (Fairlawn) –1 Payer (Fallon Community Health Plan) –8 Skilled Nursing and Extended Care Facilities 4

5. Legal Issues Data Use Reciprocal Service Agreement (DURSA) between pilot sites and State HIE/HISP (MA HIway) Contract between SEE vendor (Lantana) and HIway for testing/support Accessibility waiver 5

6. Poor vision –Should be able to increase font size –We’re encouraging 24” – 27” monitors Color blind –Color shouldn’t be only distinguishing attribute –Added “*” next to red required fields Blind –Navigable 100% using keyboard –All fields have meaningful tags/names that can be read by text-to-speech software 6

7. Software testing Iterative development –End user feedback –Prioritized punch list (pre-, peri-, post-GoLive) Unit testing – each piece Integrated testing – end-to-end Security testing Create support mailbox to send/receive Confirm correct version of web browser –Type, version, corporate polices, certificates Alpha test – 1 site with fake ZZZpatients Beta test – all sites with fake patients 7

8. SNF Receiving Hospital Summary Text-message notification of new webmail message 24x7 (Administrator, Clinical Liaison, DON, DO Admission, DO Social Service?) Do you need to purchase a dedicated phone? Remember that at 3AM when there’s new mail, everyone on the list will get the text message, even those sleeping at home… Who prints the incoming CDA summary document for the paper chart? Same as the person who gets the text message? Where is it printed? Are there printers in convenient locations? Are the PCs configured to use the printer by default? What is done with the printed summary? Are multiple copies needed? Does a copy need to be faxed to a physician or nurse practitioner? Should new CDA with admit date be started? 8

9. Sending Summary to ED/PCP/HH Which prior documents will you copy from? Which sections do you want to copy from prior? Where will other pieces of information come from? What can be cut & pasted? Pharmacy ordering system? What information should be entered for the SBAR vs. a Transfer Summary? Who sends document, how do they know it’s ready and where to send? Do you need to print extra copies (e.g. paper record, PCP, specialists, patient/family, EMS)? 9

10. KeyHIE Transform? Converts MDS (or OASIS) into CDA document mailed back to site’s mailbox How often are MDS’s done? Is there one when you need it? How long is an MDS reliable for? Can SNF MDS’s be distinguished from Long-Term Care patients? Will the incoming document easily show who the patient is? 10

11. Site Configuration Users, UserIDs, Passwords. Who will manage hires/fires (Access Administrator)? What Direct Addresses are in Provider Directory? Which is preferred? Set up Gmail rules to send text Distribute blank CDA document 11

12. Training PowerPoint Video recording of training session Cheat sheet (How to… Where to find…) Pilot site preferred Direct addresses Post-training competency test Train-the-trainer (2 hours) –Scalable –Can still customize workflow for each site –Provides on-site support 12

13. Training 1.What’s the problem we’re solving? 2.How will each user see benefit? 3.Big picture of HIE 4.Big picture of software 5.GUI overview 6.Logical use cases to train details 7.Big picture again 8.Competency test 13

14. Scenarios View received CDA and print it Find and Edit previously received CDA Find previously edited CDA and Send it Start new CDA from scratch Create a CDA from documents received from Hospital and MDS 14

15. Go-Live Support Roll-out pairs of trading partners –Hospitals and SNFs/IRFs/LTACHs –PCPs and ERs –Home Health with Hospitals/SNF/IRF/LTACH On-site support Since low volume, can do dress rehearsal on go-live day with fake patients Identify best practices and software bugs 15

16. Post-GoLive Debrief/Share Best Practices Celebrate Market successes with a press release 16

17. TOMalley@Partners.org Lawrence.Garber@ReliantMedicalGroup.org Questions?