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February 2013 Drs. Larry Garber and Terry O’Malley

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1 February 2013 Drs. Larry Garber and Terry O’Malley
3/27/2017 IMPACT - Connecting Long Term and Post-Acute Care Organizations to the Healthcare System of the Future February 2013 Drs. Larry Garber and Terry O’Malley

2 Agenda Problems with care transitions
What is Long Term and Post-Acute Care (LTPAC)? IMPACT – addressing LTPAC needs ONC’s S&I Framework - Developing national standards for transitions of care datasets LAND & SEE – software to facilitate integrating LTPAC into electronic health information exchanges (HIE)

3 Communication & Adverse Events
Poor care coordination increases the chance that a patient will suffer from a medication error or other health care mistake by 140% (Lu, et al., 2011) Communication failures between providers contribute to nearly 70% of medical errors and adverse events in health care (Gandhi, et al., 2000) 150,000 preventable ADEs ($8 Billion nationwide wasted) each year occur at the time of admission due to inadequate knowledge of outpatient medication history (Stiell, et al., 2003)

4 Problems With ED Visits
Physicians in the Emergency Department (ED) lack important or critical patient information 32% of the time 15% of ED admissions could be avoided if the ED had outpatient information (Stiell, et al., 2003)

5 Problems After Hospital Discharge
3/27/2017 Problems After Hospital Discharge 1.5 Million preventable adverse events annually nationwide from discharge treatment plans not followed (Forster, et al., 2003) When multiple physicians are treating a patient following a hospital discharge, 78% of the time information about the patient’s care is missing (van Walraven, et al., 2008) 20% of Medicare patients are readmitted within 30 days. Preventable readmissions waste $26B nationwide annually (McCarthy, et al., 2009) Medicare patients who, on average, see over 6 different physicians each year (Berenson & Horvath, 2002)

6 Ambulatory Care is Just as Bad
68% of specialists receive no information from the referring PCP prior to referral visits 25% of PCPs do not receive timely post-referral information from specialists (Gandhi, et al., 2000)

7 Is Massachusetts Different?
Preventable readmissions waste $577 Million in Massachusetts annually MA ranks 35th in the nation on measures of quality relating to coordination of care, such as preventable hospitalizations for chronic conditions and hospital readmissions (McCarthy, et al., 2009)

8 National care transitions experts overwhelmingly identified “improving information flow and exchange” as the most important tool to improve care transitions (ONC, 2011)

9 An Odd Twist of Fate 2008 – Economy crashed
2009 – ARRA passes, including the Health Information Technology for Economic and Clinical Health $27 Billion for hospital and MD practice EHRs Must use the EHR in a “Meaningful” way, including improved communication with others that have EHRs But Long Term and Post-Acute Care was left out! Payment over 5-6 years (medicare vs. Pedi) Does not include Advanced Practitioners except for Medicaid, but they need to hit 30%. May include hospitalists if they do their discharges in Epic, at least initially, if more than 10% of their billing is for observation patients. Dr. Goyal estimates it may be 20%. Doesn’t include our geriatricians.

10 Yet Post-acute Care Costs are
Rising faster than acute care costs Rate of growth far outpacing acute care. LTPAC doubled over 8 years c/w 40% increase ($96B  $135B) for hospitals over same period of time. Second, sick and complex patients go to all different levels of LTPAC care. STACHs, short term acute care hospitals distribute their patients widely. NEXT Source: MedPAC, 2011 10

11 What is LTPAC?

12 Outpatient Testing/Pharmacy/DME
The Spectrum of Care High Acute Care Hospital Psych Hospital Emergency Department PACE Home Health LTACH Outpt. Rehab Adult Day Care Intensity of Care Outpt. Behav. Health CBS IRF SNF Hospice Facility Urgent Care Physician Office Nursing Home Outpatient Testing/Pharmacy/DME Home Hospice Assist Living Living at Home Low Acuity of Illness High Adapted from Derr and Wolf, 2012

13 Traditional Long-Term and Post-Acute Care (LTPAC)
High PACE Home Health LTACH Intensity of Care IRF SNF Hospice Facility Nursing Home Home Hospice Assist Living Living at Home Low Acuity of Illness High Adapted from Derr and Wolf, 2012

14 Outpatient Testing/Pharmacy/DME
IMPACT’s View of LTPAC High PACE Home Health LTACH Outpt. Rehab Adult Day Care Intensity of Care Outpt. Behav. Health CBS IRF SNF Hospice Facility Urgent Care Physician Office Nursing Home Outpatient Testing/Pharmacy/DME Home Hospice Assist Living Living at Home Low Acuity of Illness High Adapted from Derr and Wolf, 2012

15 Outpatient Testing/Pharmacy/DME
The Spectrum of Care High Acute Care Hospital Psych Hospital Emergency Department PACE Home Health LTACH Outpt. Rehab Adult Day Care Intensity of Care Outpt. Behav. Health CBS IRF SNF Hospice Facility Urgent Care Physician Office Nursing Home Outpatient Testing/Pharmacy/DME Home Hospice Assist Living Living at Home Low Acuity of Illness High Adapted from Derr and Wolf, 2012

16 How is LTPAC Different Than Acute Care or Typical Office-Base Care?

17 Type of LTPAC Patient Closer to end of life
Greater number of health concerns, meds, healthcare providers, and care settings Reduced cognitive capabilities Increased risk of adverse events Reduced mobility; increased risk of falls Increased transportation issues/costs Less financial and social support More legal issues

18 Type of LTPAC Organization
Limited financial and human resources Fewer incentives for EHRs or HIE participation Less likely to have risk-sharing contracts Not part of HITECH/Meaningful Use Limited technological infrastructure: LAN/WIFI IT Security/Policies/Backup/Redundancy EHR, if present, likely to be ASP model Being asked to care for increasingly more complex patients

19 MU’s Impact on LTPAC Meaningful Use defines the datasets that Hospitals send when patients are discharged ~40% of Medicare patients are discharged to traditional LTPAC settings (SNF, Home Health, Inpatient Rehab Facility, etc…) These patients are the sickest population and account for ~80% of Medicare costs Sources:

20 IMPACT Grant February 2011 – HHS/ONC awarded $1.7M HIE Challenge Grant to state of Massachusetts (MTC/MeHI): Improving Massachusetts Post-Acute Care Transfers (IMPACT)

21 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) Integrate and validate tools into Worcester County using Learning Collaborative methodology Measure outcomes

22 Developing National Standards to Support LTPAC Needs

23 Datasets for Care Transitions
Traditionally – What the sender thinks is important to the receiver Future – Also take into account what the receiver says they need

24 MA DPH Universal Transfer Form
3/27/2017 MA DPH Universal Transfer Form Started with DPH’s 3-pg Discharge Form Sought input from LTPAC “receivers” Reviewed existing forms and datasets: MDS OASIS IRF-PAI INTERACT Sought expert opinions Resulted in 7-page UTF

25 Massachusetts Paper UTF Pilot
3/27/2017 Massachusetts Paper UTF Pilot Too Long! Already done. Found to be too long. Need to define subsets for various transitions

26 14x14 Sender (left column) to Receiver (top) = 196 possibly transition types
Sender-Receiver grid. 11x11. The sites across the top are the same as those down the left hand column. The result is a 121 cell grid. It includes the traditional PAC sites: LTACs, IRFs, SNFs, HHA, Hospice. And some “non-traditional” PAC sites including the PCP in the office, Community Based Service providers, the ASAPs, and most importantly, the Patient and Family at home. At the other end of the grid are three Acute Care Hospital sites that send the most patients to PAC and receive the most patients from PAC sites: the in-patient unit, ED and outpatient testing and treatment areas. The grid could have easily been enlarged to include outpatient therapy, pharmacists, ALFs, foster homes, and many other sites. We proceeded on the assumption that data sets identified for these high volume transitions would likely include the information required by the lower volume transitiions. Every site is both a “sender” and a “receiver” The next task was to prioritize among these 121 possible transitions. For this we applied three parameters, each ranked high, medium and low. The first was volume. The second, the clinical instability of the patient. And the third, the time-value or “Acuity” of the information. How quickly did the receiver need the information. These are clinical parameters. We could have gotten a different result using cost data. Applying these parameters results in my favorite grid where red is high, yellow medium and blue low. The transitions on this grid, then look like this. NEXT 26

27 Black circles = highest priority Green circles = high priority
Prioritize Transitions by Volume, Clinical Instability and Time-Value of Information Cells with three “red” (=high) scores are highest priority. Those with two “high” scores are next. (Medium is “yellow” and “low” is blue). Using this approach, there are 16 highest priority transitions and 33 high priority transitions out of The black and grey cells are very rare and not scored. I don’t expect to be able to read this grid but there are three priority areas: on the left are the transfers FROM PAC to the ACH, across the top are transitions FROM the ACH to PAC sites, and in the middle are transitions among PAC sites. Pulling the colors out gives the following grid with black as highest and green as next highest transitions. NEXT Black circles = highest priority Green circles = high priority 27

28 “Receiver” Data Element Survey
1135 Transition surveys completed Largest survey of Receivers’ needs 46 Organizations completing evaluation 12 Different types of user roles

29 11 Types of Organizations

30 3/27/2017 12 User Roles

31 Findings from Survey Identified for each transition which data elements are required, optional, or not needed Each of the data elements is valuable to at least one type of Receiver Many data elements are not valuable in certain care transition

32 A single paper form can’t represent this variability in data needs
49 Documents Is Too Many! Here are the priority transitions based on the criteria in the title. The individual scoring of each cell has been removed leaving only the “circle”. The next grid indicates the essential receiver “roll-groups” Black circles = highest priority Green circles = high priority 32

33 Five Transition Datasets
Report from Outpatient testing, treatment, or procedure Referral to Outpatient testing, treatment, or procedure (including for transport) Shared Care Encounter Summary (Office Visit, Consultation Summary, Return from the ED to the referring facility) Consultation Request Clinical Summary (Referral to a consultant or the ED) Permanent or long-term Transfer of Care to a different facility or care team or Home Health Agency

34 Five Transition Datasets
Shared Care Encounter Summary: Office Visit to PHR Consultant to PCP ED to PCP, SNF, etc… 5 – Transfer of Care Summary 4 – Consultation Request Clinical Summary 3 – Shared Care Encounter Summary 2 – Test/Procedure Request 1 – Test/Procedure Report Consultation Request: PCP to Consultant PCP, SNF, etc… to ED Transfer of Care: Hospital to SNF, PCP, HHA, etc… SNF, PCP, etc… to HHA PCP to new PCP

35 Five Transition Datasets
5 4 2 3 1 Here are the priority transitions based on the criteria in the title. The individual scoring of each cell has been removed leaving only the “circle”. The next grid indicates the essential receiver “roll-groups”

36 Additional Contributor Input
State (Massachusetts) MA Universal Transfer Form workgroup Boston’s Hebrew Senior Life eTransfer Form IMPACT learning collaborative participants MA Coalition for the Prevention of Medical Errors MA Wound Care Committee Home Care Alliance of MA (HCA) National NY’s eMOLST Multi-State/Multi-Vendor EHR/HIE Interoperability Workgroup Substance Abuse, Mental Health Services Agency (SAMHSA) Administration for Community Living (ACL) Aging Disability Resource Centers (ADRC) National Council for Community Behavioral Healthcare National Association for Homecare and Hospice (NAHC) Transfer of Care & CCD/CDA Consolidation Initiatives (ONC’s S&I Framework) Longitudinal Coordination of Care Work Group (ONC S&I Framework) ONC Beacon Communities and LTPAC Workgroups Assistant Secretary for Planning and Evaluation (ASPE)/Geisinger MDS HIE Centers for Medicare & Medicaid Services (CMS)(MDS/OASIS/IRF-PAI/CARE) INTERACT (Interventions to Reduce Acute Care Transfers) Transfer Forms from Ohio, Rhode Island, New York, and New Jersey

37 Two Care Plan Datasets Transfer of Care Consultation Request Care Plan
Home Health Plan of Care (CMS-485) Shared Care Encounter Summary

38 Situation-specific Data Elements
5 – Transfer of Care Summary 5 – Transfer of Care Summary 4 – Consultation Request Clinical Summary Variable Base on Situations: Setting Diagnoses Medications Treatments Procedures 3 – Shared Care Encounter Summary Care Plan 5 – Transfer of Care Summary 2 – Test/Procedure Request 1 – Test/Procedure Report 5 – Transfer of Care Summary 5 – Transfer of Care Summary 5 – Transfer of Care Summary

39 Care Plan Permeates Datasets
5 – Transfer of Care Summary 4 – Consultation Request Clinical Summary 3 – Shared Care Encounter Summary Care Plan 2 – Test/Procedure Request 1 – Test/Procedure Report

40 How do they compare to CCD?
175 element CCD 325 element IMPACT for basic LTPAC needs 480+ elements for Longitudinal Coordination of Care

41 Testing the IMPACT Dataset

42 Pilot Sites to Test the Datasets
9/2011 – Applications sent to 34 organizations 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 Long Term Acute Care Hospital (Kindred Parkview) 1 Inpatient Rehab Facility (Fairlawn) 8 Skilled Nursing and Extended Care Facilities

43 Nursing Facility Pilot Sites
3/27/2017 Nursing Facility Pilot Sites Beaumont Rehabilitation of Westborough Christopher House of Worcester Holy Trinity Nursing & Rehab Jewish Healthcare Center LifeCare Center of Auburn (+EMR) Millbury Healthcare Center Notre Dame LTC Radius Healthcare Center Worcester Lifecare Center of Auburn – has an EMR Jewish Healthcare and Millbury are transitioning to an EMR

44 IMPACT Learning Collaborative: Testing the Care Transitions Datasets 16 organization, 40 participants, 6 meetings over 2 months, and several hundred patient transfers…

45 Learning Collaborative Surveys
Surveys directly on envelopes carrying IMPACT packet, filled out by sender as well as receiver. Online survey at completion of pilot

46 Analyzing data elements helped

47 Senders found the data

48 Receivers got most of their needs

49 Home Care needed even more!
3/27/2017 Home Care needed even more! Notice that the SNF Discharge Summary was frequently missing. This may be a timing issue. Also, some of these are actual orders which is unusual during non-LTPAC transfers. Also, having multiple possible vendors is unique to home care situations, as opposed to facilities that have their preferred vendors

50 Comment from Pilot Site Survey
“While we knew what ED's and hospitals required, we didn't realize Home Health Agencies needed much more than what we typically sent.” -Skilled Nursing Facility

51 Advancing Interoperable HIE
Identify need for electronic HIE Identify gaps in HIE standards Fill gaps in standards: Work with ONC S&I, HL7, other Standards Development Organizations (SDOs) Ballot Needed Standards Regular/On-going communication with CMS, ONC, HIT Policy and Standards Committee regarding need for and status of standards

52 New World of Standards Development
National Coordinator for Health IT (ONC) Office of the Deputy National Coordinator for Programs & Policy Office of the Deputy National Coordinator for Operations Office of the Chief Privacy Officer Office of Economic Analysis & Modeling Office of the Chief Scientist Office of Policy & Planning HIT Policy Committee Defines “Meaningful Use” of EHRs Office of Science & Technology (formerly known as the Office of Standards and Interoperability (S&I)) S&I Framework convenes public and private experts, and proposes HIT/HIE standards HL7 ballots standards Secretary of HHS makes standards part of “Meaningful Use” and EHR Certification Office of Provider Adoption Support IMPACT Office of State & Community Programs

53 S&I’s Longitudinal Coordination of Care WG
Longitudinal Coordination of Care Workgroup Providing subject matter expertise and coordination of SWGs Developing systems view to identify interoperability gaps and prioritize activities LTPAC Care Transition Sub-Workgroup Patient Assessment Summary Sub-Workgroup Longitudinal Care Plan Sub-Workgroup Identifying the key business and technical challenges that inhibit long-term care data exchanges Defining data elements for LTPAC information exchange using a single standard for LTPAC transfer summaries Establishing the standards for the exchange of Patient Assessment Summary (PAS) documents Providing consultation to transformation tool being developed by Geisinger to transform the non- interoperable MDSv3 and OASIS-C into an interoperable clinical document (CCD+) Near-Term: Developing an implementation guide to standardize the exchange of the Home Health Plan of Care (former CMS 485 form) Long-Term: Identify and develop key functional requirements and data sets that would support a longitudinal care plan

54 Original S&I ToC Use Case
Scenario 1 - Provider to provider: User Story 1 - Hospital/ED to PCP Discharge Instructions Discharge Summary User Story 2 - Closed Loop Referral Consult Request Consult Summary Scenario 2 - Provider to patient: User Story 1 - Discharge Instructions and Discharge Summary to patient’s PHR User Story 2 - Closed Loop Referral where copies of Consult Request and Consult Summary are sent to patient’s PHR

55 Relationship to S&I ToC Scenarios
5 – Transfer of Care Summary Type 3 Dataset: Scenario 1 & 2/User Story 2 Consult Summary 4 – Consultation Request Clinical Summary 3 – Shared Care Encounter Summary Care Plan 2 – Test/Procedure Request 1 – Test/Procedure Report Type 4 Dataset: Scenario 1 & 2/User Story 2 Consult Request Type 5 Dataset: Scenario 1 & 2/User Story 1

56 LTPAC “Poster Child” Scenarios
Type 3 Dataset: Scenario 1 & 2/User Story 2 Consult Summary ED to SNF 5 – Transfer of Care Summary 5 – Transfer of Care Summary 4 – Consultation Request Clinical Summary 3 – Shared Care Encounter Summary Plan of Care 2 – Test/Procedure Request HH POC (CMS-485) 1 – Test/Procedure Report Anticoagulation CHF Type 4 Dataset: Scenario 1 & 2/User Story 2 Consult Request SNF to ED Type 5 Dataset: Scenario 1 & 2/User Story 1 Hospital to Home Health Agency HHA  PCP (HH POC Subset)

57 Scenario 2 - Between care team members during shared care :
S&I Care Plan Use Case Scenario 1 - Complete handoff of care from the sending care team to a receiving care team (Hospital to SNF) Scenario 2 - Between care team members during shared care : User Story 1 – Between PCP and Home Health Agency for HH Plan of Care (CMS-485) User Story 2 – Between PCP and outside Physical Therapist Scenario 3 – Between providers and patient

58 Timeline for Standards Development
October 2012 MA HIway go-live in 10 large sites with CCD and LAND February Preliminary Implementation Guide completed May Pilot electronic Transfer of Care Datasets between 16 central Massachusetts organizations using MA HIway, LAND & SEE July Finish Implementation Guides using the S&I Framework and Lantana, incorporating pilot feedback November HL7 Balloted/Reconciled/Published Implementation Guides in Consolidated CDA

59 Getting Connected: LAND & SEE

60 3/27/2017 LAND & SEE Sites with EHR or electronic assessment tool use these applications to enter data elements LAND (“Local” Adaptor for Network Distribution) acts as a data courier to gather, transform, and securely transfer data if no support for Direct SMTP/SMIME or IHE XDR Non-EHR users complete all of the data fields and routing using a web browser to access their “Surrogate EHR Environment” (SEE) Consider using IHE’s RFD (Retrieve Form for Data Capture) Profile to embed form to capture missing data elements. Alternatively might use CCOW to maintain patient context between EHR and LAND SEE: Acts as a destination for routed CCD+ documents Software hosted by a trusted authority and accessed via a web browser Non-EHR users will be able to use SEE to view, edit, and send CCD+ documents via HIE or Direct to next facility SEE users will also be able to locally print, securely , or fax copies of the CCD+ Local administrator will manage that organization’s UserIDs/Passwords/Roles Investigating integration with MDS, INTERACT, CMS-485 and OASIS. Geisinger is grabbing copies of MDS and OASIS and loading it into KeyHIE

61 Surrogate EHR Environment (SEE)
Acts as destination for routed CCD+ documents Software hosted by trusted authority, accessed via web browser SEE is accessed via the HIE’s web mailbox Non-EHR users able to use SEE to view, edit, send CDA documents via HIE or Direct to next facility Can select document type (e.g. Transfer of Care or INTERACT SBAR) to display section flags indicating their optionality Can reconcile 2 documents to create a third SEE users able to locally print copies of the documents or subsets of the documents Geisinger is grabbing copies of MDS and OASIS and loading it into KeyHIE

62 Using SEE for LTPAC Workflows
SNF patient getting sicker Subset of Transfer of Care dataset that is in SBAR (INTERACT) is flagged for completion by nurse online Can re-use data received from hospital Can re-use clinical assessment data (function, cognition, wound) from last MDS Completed SBAR printed for chart Patient transfer to Emergency Department Can re-use hospital, MDS, OASIS or SBAR data Multiple users (nurse, social worker, clerk, etc…) can work on different sections online at same time Completed ToC dataset sent electronically to ED Subset can be printed for ambulance team

63 LTPAC Communication Today – Paper!
3/27/2017 Home Health Non-standard EHR OASIS PCP Hospital Billing Program MDS Nursing Facility

64 LTPAC Communication with LAND & SEE
3/27/2017 LAND & SEE fill in gaps Home Health SEE CCD+ OASIS Non-standard EHR OASIS CCD+ LAND CCD+ PCP Hospital LAND SEE CCD+ MDS Billing Program MDS Nursing Facility

65 The Future with LTPAC EHR Standards
3/27/2017 Home Health EHR OASIS CCD+ CCD+ CCD+ PCP Hospital EHR MDS CCD+ Nursing Facility

66 Advantages of LAND & SEE
3/27/2017 Most role-based authentication uses EHR, using work that local organizations have already done Most users (docs & nurses) only work out of 1 system Data re-used whenever possible No blended central clinical data repository Case/discharge managers or nurses can control when and where to route documents because they’re the ones that know when and where! Non-EHR users get same HIE transport functionality as EHR users Relatively low-cost to deploy and support Easily scalable and replicable

67 Standard Configurations of LAND
Necessary to support some advanced characteristics of IMPACT: MDS XML documents from Nursing Facilities OASIS XML documents from Home Health agencies Expanded data set beyond what is in a standard CCD

68 Outbound LAND configurations
Merge a standard CCD and a second XML document that contains additional data elements into a “Transfer of Care” CDA document Transform data element transmitted via an HL7 2.x Results interface from an EHR into a “Transfer of Care” CDA document Transform an MDS XML file into a CCD* Transform an OASIS XML file into a CCD* *Exploring the use of Pennsylvania’s “KeyHIE Transform” (AKA “The Gobbler”) as cheaper alternative

69 Inbound LAND configurations
Transform a “Transfer of Care” CDA document into a free-text document Transform a “Transfer of Care” CDA document into a free-text document and transmit it to an EHR via an HL7 2.x Transcription interface Transform a “Transfer of Care” CDA document into discrete data elements and transmit them to an EHR via an HL7 2.x Results interface Transform a “Transfer of Care” CDA document into a standard CCD and a second XML document that contains additional data elements

70 Next Steps for Pilot Sites
Update gap analysis using expanded dataset Catalog which data elements are captured (and by whom using what vocabulary) electronically, on paper, or not at all with current standard process Of those captured electronically (including CCD, MDS & OASIS), identify process (technology & workflow) to make these available to LAND (for Phase 2). Identify workflow to review new documents in SEE Notification by or text message, and to whom? View online vs. print? Who does it and where? Can any of the data elements received be electronically filed discretely for re-use using LAND? Identify workflow to update and send SEE document with current info when discharging to Home Health or ED transfer How can standard and non-standard data elements be collected and added online using SEE to the documents being sent? How will copies be printed for patient and ambulance? Additional computers, printers, or chairs required?

71 IMPACT Timeline for Next Steps
3/27/2017 IMPACT Timeline for Next Steps Dates Activity 9/2012 – 3/2013 Integrate pilot sites into state HIE using LAND & SEE 4/2013 – 5/2013 Pilot site Go-lives with state HIE using LAND & SEE 2/2013 – 9/2013 Ballot updated datasets in S&I Framework and HL7 6/2013 – 7/2013 Make SEE available under Open Source License 4/2013 – 9/2013 Evaluate hospital (re)admissions & total cost of care

72 Sharing LAND & SEE LAND SEE Orion Health’s Rhapsody Integration Engine
We’ll make some standard configurations available SEE Written in JAVA Baseline functionality software and source code that can connect to Orion’s HISP mailbox via API available for free starting ~July 2013 (Apache Version 2.0 vs. MIT open source license) Innovators can develop and charge for enhancements, for example: Integration with other vendors’ HISP mailboxes Automated CDA document reconciliation

73 Disseminating the Seeds
IMPACT Advisory Committee Massachusetts Care Transitions Forum Massachusetts QIO (MassPRO) Worcester Galaxy Worcester Galaxy Another Galaxy Another Galaxy Pilot Sites Core Project Team Pilot Sites Pilot Sites Core IMPACT Team Another Galaxy Core ProjectTeam Pilot Sites Core Project Team Another Galaxy Another Galaxy Pilot Sites Pilot Sites Core Project Team Core Project Team

74 Questions? TOMalley@Partners.org

75 Bibliography Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The Incidence and Severity of Adverse Events Affecting Patients after Discharge from the Hospital. Annals of Internal Medicine 138: Gandhi, Tejal K., Sitting, Dean F., Franklin, Michael, Sussman, Andrew J., Fairchild, David G., and David W. Bates. “Communication Breakdown in the Outpatient Referral Process.” Society of General Internal Medicine (September 2000): doi: /j x. Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform Dec;40(6 Suppl):S40-5. Epub 2007 Sep 7. Lu, C. Y. and E. Roughead. “Determinants of Patient-Reported Medication Errors: A Comparison Among Seven Countries.” International Journal of Clinical Practice (April 6, 2011): 65: 733–740. doi: /j x. Overhage JM, McDonald CJ, et al. A randomized, controlled trial of clinical information shared from another institution. Annals of Emergency Medicine 39[1], Stiell A, Forster AJ, Stiell IG, van Walraven C. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ Nov 11;169(10): Van Walraven, C., Seth, R., Austin, P. & Laupacis, A., Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med, Volume 17, pp Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The Value of Healthcare Information Exchange and Interoperability. Hlth Aff (Millwood) 2005 Jan-Jun;Suppl Web Exclusives:W5-10-W5-18.


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