1. Best Practice: Information Exchange
Claudia
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2. WSHA Presenters Claudia Sanders Carol Wagner Barbara Gorham Senior VP,
Policy Development
Carol Wagner
Senior VP,
Patient Safety
Barbara Gorham
Policy Director,
Access
CLAUDIA Intro
SCOTT Intro
CAROL Intro
BARBARA Intro
CLAUDIA – Talk about partners, change slide

3. Additional Presenters
WA/ACEP
EDIE
TIM intro
STEPHEN intro
NATHAN intro
CLAUDIA TAKE OVER
Dr. Stephen
Anderson
Adam Green

4. Webcast Objectives Overview on ER is for Emergencies
Best Practice: Information Exchange
One Implementation: EDIE
A fast timeline!
How we can help
Questions and comments
Claudia

5. Redirecting Care to the Most Appropriate Setting
An Opportunity
Redirecting Care to the Most Appropriate Setting
Carol
We 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 Association
Washington Chapter of the American College of Emergency Physicians
Carol
TOSS TO CLAUDIA

7. State Approaches to Curbing ER Use
When
What
Impact
Status
Original proposal
3-visit limit on unnecessary use
Cuts payments to providers
Won lawsuit; policy abandoned
Revised proposal
No-payment for unnecessary visits
Cuts payment to providers
Delayed by the Governor just prior to implementation
Current policy
Adoption of best practices
Improves care delivery and reliance on ER as source of care
Passed in latest state budget
Claudia
$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 Unsuccessful
Revert 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 Departments
Identify frequent users
Get access to treatment plans
Use in providing care
Exceptions for CAHs, hoping all will participate
Barbara
One 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) clients
To make PRC care plans available to ER physicians
To provide feedback and help with performance measurement
Barbara
The 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
Barbara
If 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 using
EDIE can:
Notify ED physician of frequency of ED visits and summary of ED discharges for past 12 months
Share guidelines for patient with other hospitals
Load patient’s treatment plan, so ED physicians can view
Costs:
Depends on number of ED visits
Set up plus interface, plus $1,000 to $35,000 a year
Barbara
EDIE 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 ED
Working in Washington State since 2008
Recent Washington Related Activities
Opioid Abuse Workgroup
Data share agreement with HCA
Data share agreement with Molina Healthcare
Prescription Monitoring Program Pilot

17. What is EDIE? EDIE is EDIE is Not
A collaborative case management framework for all types of special needs patients
A targeted tool for proactively notifying interested parties and stake holders of relevant patient-specific events or behavior
A low-cost, automated solution for sharing actionable information to otherwise disparate parties
EDIE is Not
An Electronic Medical Record
A fully-featured Health Information Exchange
A 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 PRC
Allows care managers to attribute care plans to a patient that can be shared across all participating facilities
Allows care managers to alert PCPs of care plan creation and other patient factors concerning ED utilization
Generates reports on patient utilization and other measures
Relays PRC information to EDs and care managers

19. How Does EDIE Work? EDIE Notification Methods Transmitted Information
Fax
SMS
Phone
Notification Methods
Web
Notification 4.
Patient Health Information
Transmitted Information 3.
Patient Event Occurs (i.e. patient visits ED)
Hospital sends EDIE patient data
EDIE evaluates data against all patient criteria
Patient Level
The care management program Level
Facility Level
EDIE sends out Notifications determined by criteria
EDIE continues to receive data from other various sources to evaluate patient events against 2. 1.
EDIE
Provider Facilities
Health Plans 5.
Additional Data Sources

20. How Does EDIE Work? Mental Health Provider Hospital Notifications EDIE4. 2. 1.
EDIE 3.
Primary Care Provider
Clinic

21. What Does a Notification Look Like?
Patient Identifier
Notification Reason
Patient PRC Alert
PRC Contact Information
PRC Providers
Other Providers
Care Guidelines
PCP Guidelines
ED Guidelines
Other Notes

22. What Does a Notification Look Like?
3 Month Visit List
Date / Time
Location
Diagnoses
12 Month Visit List
Visit Counts
Non Emergent Visits*
Facilities
Narcotic 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 Section
Care Guideline Section
Investigation Section

24. What Does EDIE Look Like?
Patient Demographics
Name / Gender / DoB
MRN / Address
Patient Alias
Visit History Graph
Timeline
Facility Composition
3 Month Visit List
Date/Tim
Facility
Diagnoses
12 Month Visit List
Visits (Aggregate)
NE Dx Visits 2. 1. 3. 4. 5.

25. What Does EDIE Look Like?
Care Guidelines
From PCP
From ED
Patient History
Radiation Alerts
Overdose Alerts
Medical / Social Hx
Open Text Fields
Supports Copy/Paste
Customize to Patient needs 2. 1. 3.

26. What Does EDIE Look Like?
Listed Payers
Current Providers
Recent Dx List
Recent Narcotic Prescriptions 1. 2. 3. 4.

27. Who is Using EDIE? Also Boise, north Idaho, Portland
Also Idaho and Oregon
Also Boise, north Idaho, Portland

28. Who is Using EDIE? 30 Facilities currently live (20 in work)
1.3M ED visits going through EDIE
900,000 in real time
400, 000 from HCA & Molina Healthcare
Over 3,000 care guidelines in EDIE
Over 40,000 Notifications Issued (annually)
All PRC patients in EDIE

29. What Does it Take to Get EDIE?
Legal / Compliance
Review & Execute Agreements
Business Associate Agreement
Data share Agreement
License Agreement
HIPAA?
Reviewed by John Christiansen, Esq
Timeline & Dependencies
Typical one to three weeks lead time from facility
CMT lead time one to two days for counter signing

30. What Does it Take to Get EDIE?
IT / IS
Uplink (Facility to EDIE Data Flow)
Standard Connections (VPN & HL7)
Hands on keyboard time – 10 to 15 hours
Downlink (EDIE to Facility Data Flow)
Multiple delivery methods supported
Low tech fax – zero IT resources to set up
High tech EMR integration – preferred method, no extra fees to set up
Hands on Keyboard time – depends on delivery method
Timeline & Dependencies
Is IT managed in-house or remotely
Notification delivery method (fax vs EMR)
Typical lead time two to four weeks

31. What Does it Take to Get EDIE?
Training
Training Sessions for both SMEs and general users
Online training sessions for flexibility and timeliness
EDIE User Account Creation
Initial user accounts created by CMT
Facility manages users after go-live
ED Workflow / Process Changes
Facility responsible for internal workflow / process changes
CMT works with care managers during and after go-live
Timeline & Dependencies
Two to three weeks including training and after go-live support

32. What Does it Take to Get EDIE?
All key steps can be done concurrently
CMT has capacity to support onboarding all remaining hospitals within mandated timeline
CMT has never been the constraining factor to an implementation
Bottom 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 Facility
Determined by complexity and size of setup and integration
Discounts for multiple facilities on same IT network
Waived for CAH
Cost of Integration (Internal/Third-party)
Subscription: < $1,000 - $35,000 per year
Determined primarily by size of ED
Includes on going support and incremental updates to product
‘EDIE Light’ Service
Discontinued due to lack of interest
Unable to upload care plans

34. Common Questions
My 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 system
In place since early 2012
Steve

36. Training ER Physicians at Auburn
Steve

37. Quick Action Needed!
Hospitals must submit attestations and best practice checklists to HCA by June 15, 2012
Claudia
Business 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 adam.green@collectivemedicaltech.com
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
Claudia
We 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.