1. Improving Massachusetts Partnering And
IMPACT 2.0:
Improving Massachusetts Partnering And
Care Transitions
MeHI Grantee Forum
November 1st, 2016

2. Reliant Medical Group’s Interfacesto
50+ Community MDs to
other Sites
to non-Epic Sites
1 Home Health Agency
IHE XCPD
XCA
CDAs
Transcription
and
Dragon
5 Hospitals
+ 8 SNFs
Direct CDAs
Reliant’s EHR &
Data Warehouse
Ancillaries
(Surescripts, Quest Lab, MUSE EKG,
Infinitt PACs + Powerscribe)
Mckesson &
Patient References
4 Payers
MA DPH
Immunization Registry
Clark
Mailing
Service
MAeHC
Specialized
Registry
~40% Patients
Clinician
References
Appt Reminder IVR

3. Reliant’s Electronic Exchanges
5/11/2018
As of September 2016
High volume because of
“Hassle-Free HIE”
None from Arkansas, Alabama, or Tennessee

4. Improving Communication with ER
90 seconds after ED registration, Reliant’s CCD is automatically loaded into ED’s EHR
ADT for Reliant Patients
CCD with Hospital MRN
Reliant Medical
Group’s EHR
St. Vincent Hospital &
Milford Regional Med Ctr
CCD with Hospital MRN
Reliant receives ADT transactions from us via a JCAPS interface.  There are filters in place to make sure we only send ADT to Reliant when the patient of interest is known to us as a Reliant patient.
When Reliant detects that a patient is in the ED (by virtue of the ADT), their system searches for information regarding that patient.  If any is found, Epic creates a CCD transaction.  The CCD is sent to us via the Massachusetts HIE.  Within the CCD, Reliant sends us the Meditech account number for the ED visit.
When we receive this CCD from the HIWay, JCAPS sends this transaction to a device maintained by the HIWay that is called the “Converter.”  The Converter takes the CCD transaction and converts the message into an HL7 MDM message.  The converter then returns this info to JCAPS.
JCAPS then converts this HL7 MDM-formatted message into an HL7 ORU-formatted message.  This is the format Meditech can recognize.  JCAPS sends this ORU message to Meditech’s ITS application.  The message can be processed automatically because it contains our Meditech account number.
Meditech ITS accepts the ORU message, and then sends it back out to JCAPS.  This time, JCAPS takes the ITS ORU message and sends it to MedHost, just as it would for any other ITS message (like an Xray report) for an ED patient.
MedHost takes the ITS report and places it against the visit of interest (by virtue of the account number) with a visual indicator in MedHost that there is a new report.  MedHost treats it like it would any other radiology-style report.
This entire process takes mere seconds.  The outcome is that shortly after ED registration, MedHost receives a Reliant / Epic patient summary report and makes it available to all MedHost users, often before the patient is even in an ED bed.
John
Outside Record Icon in SVH MedHost Bed Board blinks
ED Registration

5. Automated ToC/Summary
Discharge Planner enters name of SNF which sets the Direct address for SVH’s CCD
Discharge CCD
Webmail - SNF
St. Vincent Hospital
Discharge CCD
Webmail - SNF
Discharge Planner
Webmail - SNF

6. Coordinating Care with Hospital
ER and hospital Discharge Notes file into EHR as well as InBasket of PCP and Care manager
ER and hospital lab/rad/procedure notes file silently into EHR, EXCEPT for those resulted after discharge which also go to physician InBasket
Remember, we don’t own any hospitals.

7. Alerts for follow-up appointments
Hospital ADT monitored for hospital discharges
3 Days later, EHR checks to see if follow-up appointment took place or is scheduled
If none, an InBasket message is automatically sent to PCP’s appointment secretary

8. Alerts for monitoring of medications
After hospital discharge, medication claims data and CCD are automatically reviewed along with past and future labs
Alerts sent to Pharmacist to do home visit
Alerts sent to PCP’s InBasket suggesting dose checking, monitoring or D/C
Here are all of the other strategies for medication monitoring:
Reminders for ordering labs related to medication monitoring:
o   When placing a new order – October 2012
o   Pre-CPE – SmartSet directs staff to order the correct lab monitoring for lipid meds, diabetic meds, thyroid meds, seizure meds, and diuretics – (Holden/Westboro/NLA 11/10/2010, May St 1/2/2011, Plant 1/22/11, Auburn 2/23/11, Webster 3/31/11, Millbury/Milford 4/13/11, Spencer 9/24/11)
o   At time of renewal – Manually since 2006.  Automated January 2012 (Westborough pilot, Wed., Jan. 25, 2012; Live at all sites, Wed., Feb. 15, 2012)
Reminders to go to the lab for tests that have been ordered:
o   On After Visit Summary when ordered during that visit – Since 2006
o   Automated Telephone reminder – Since 2006 (General reminder when associated with an office visit, which has a brief mention to get lab tests at end), and the specific lab test reminder for non-visit-associated labs on March 8, 2010
o   Lab no-show letter – Since October 1, 2008
o   BPA Alert during visit that patient should go to lab for labs already ordered – May 5, 2012
o   On After Visit Summary if ordered during prior visit – June 1, 2012?
o   Visible in MyChart with expected date – June 4, 2012

9. Looking to the Future: HaSSLE-FREE HIE Across Central MassACHUSETTS and MetroWest with IMPACT 2.0 and

10. Federated Opt-In Consent HIE since 2009
Connects Reliant with UMass HealthAlliance
Master Patient Index and Relationship Listing Service has >1 Million patients
~5,000 patients consented to exchange medical records
~150,000 documents exchanged

11. tools for IMPACT
Master Patient Index (MPI) – uniquely identifies each consented patient in the community
Relationship Listing Service (RLS) – records which organizations a patient has a relationship with AND consented to release their records
Significant Event Notification Documents (SEND) – sends “alerts” (ADT or C-CDA +/- “You’ve Got Mail” ) based on the event (e.g. ER visit ADT, or specialist visit CCD), RLS consents, and each organizations’ subscription to information
Gather Event-Triggered data (GET) – sends “query alerts” and sets up time-limited subscriptions for data to automatically be sent as the result of an event (e.g. ER visit) based on RLS consents

12. Subscriptions Nursing Facility Webmail Care Manager PCP EMS
CCD
CCD
PCP & Specialist notes
EMS
Consent
SEND/GET
SAFEHealth
MPI/RLS/SEND/GET
Home Health
CCD
SEND
CCD
Webmail
Acute and
42 CFR Part 2
Hospitals
CCD S
Registration (ADT)
CCD via MA HIway
(“Direct” message)
Subscribed Alerts
Nursing Facility

13. CCD to EMS Before Seeing Patient
Paramedics
EMS Database
Dispatchers
IMPACT 2.0
Name/DOB/Address
Problem
SAFEHealth
MPI/RLS/SEND/GET
Reliant Med Group
PCP
Care
Manager
CCD Patient Summary
MA Prescription Monitoring Program
PMP Query

14. IMPACT 2.0 Collaborators Nursing Facility Webmail
Reliant Medical Group
Family Health Center Worcester
Vital EMS
Care Manager
PCP
CCD
CCD
PCP & Specialist notes
EMS
Consent
SEND/GET
SAFEHealth
MPI/RLS/SEND/GET
Home Health
CCD
SEND
VNACare Network
CCD
Acute and
42 CFR Part 2
Hospitals
Webmail
CCD
Registration (ADT)
CCD via MA HIway
(“Direct” message)
Subscribed Alerts
AdCare Hospital
MetroWest Medical Center
Milford Regional Medical Center
St. Vincent Hospital
UMass Memorial Medical Center
Nursing Facility
Holy Trinity, Notre Dame,
Jewish Healthcare, Life Care Center Auburn
Worcester Rehab, Beaumont Westborough (controls)

15. Metrics # and % of patients consented (>10K so far)
# and % of notifications sent
# and % of documents transferred
# and % of EMS transports avoided
Total cost of care
ED visits
Hospital admissions
30-day hospital readmissions
Quantity of opiates prescribed in ERs compared to controls

16. IMPACT 2.0 Status St. Vincent Hospital - Live
Milford Regional Medical Center – Live
UMass Memorial Medical Center - Testing
MetroWest Medical Center – Testing
AdCare Hospital – Testing
Other sites – Planning
Fully live – March 2017

17. Questions?
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