The Value of Health Information Exchange in Care Delivery May 11, - - PDF document

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The Value of Health Information Exchange in Care Delivery

May 11, 2018

Introductions

Alana Sutherland

Program Manager Maryland Health Care Commission (MHCC)

Advancing health information technology (health IT) statewide Sheena Patel

Manager of Provider Relations Chesapeake Regional Information System for our Patients (CRISP)

Enabling appropriate and secure data sharing for the health care community

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Agenda

 Overview of health IT  Progression of health IT and the current landscape  Benefits of health IT  Expectations for health IT in the near future

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Section 1: Setting the Stage

Introduction to Health IT

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What is Health IT?

Health IT is:

Electronic Health Record (EHR) An electronic version of a patient’s health record + Health Information Exchange (HIE) An organization that facilitates secure electronic exchange of health information between providers + Telehealth The delivery of health services using telecommunications and related technologies

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Health IT in Context

 Health IT is central to modernizing health care  EHRs and HIE are integral components of health IT  Telehealth and mHealth are other mechanisms for providing care and sharing health information

 mHealth is the use of smartphones, tablets, or

• ther mobile devices to deliver health services

 Other health IT solutions include personal health records (PHRs), patient portals, and electronic advance directives

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How did we get here?

 Drivers for the prioritization of health IT nationally include:

 Rising health care costs  Concerns about preventable medical errors  Variability in the quality of care  Fragmented communication among health care providers  Lack of health care consumer engagement

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Foundation for Health Care Reform

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Health IT Infrastructure

Value‐based purchasing Reduce preventable readmissions Reduce hospital acquired conditions Bundled payments Innovative care delivery Increase health care quality

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Benefits of Health IT

 Comprehensive management of health information  Administrative efficiencies  Reduce duplication and waste  Improve quality through decreased medical errors, increased patient engagement, and better care coordination

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Section 2: The Current Landscape

Health IT Components

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Components

• f Health IT

EHRs EHRs HIE HIE Telehealth Telehealth

EHR Adoption

 All hospitals in Maryland have adopted an EHR  71 percent of office‐based physicians have adopted an EHR

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33 49 57 64 67 71

34 40 48 51 54

0% 20% 40% 60% 80% 100%

2011 2012 2013 2014 2015 2016 Growth in EHR Adoption Among Office‐Based Physicians, 2011‐2016

Maryland National Sources:

• Maryland Hospital Data ‐ Office of the National Coordinator for Health Information Technology. 'Hospitals Participating in the CMS EHR Incentive

Programs,' Health IT Quick‐Stat #45. dashboard.healthit.gov/quickstats/pages/FIG‐Hospitals‐EHR‐Incentive‐Programs.php. August 2017.

• Maryland Physician Data –Maryland Board of Physicians
• National Physician Data – National Center for Health Statistics (basic EHR) ‐ Office of the National Coordinator for Health Information Technology.

'Office‐based Physician Electronic Health Record Adoption,' Health IT Quick‐Stat #50. dashboard.healthit.gov/quickstats/pages/physician‐ehr‐ adoption‐trends.php. December 2016.

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Goal and Benefits of EHRs

 Goal:To improve efficiency and quality of care, and reduce costs  Benefits:

 Process improvements for documentation and billing  Workflow efficiency  Reduce chart pulls  Increase productivity  Reduce cost of storing records  Improve communication

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EHR Limitations

 Interoperability with legacy systems and external entities

 (Although EHRs are beginning to exchange data

• utside of their own networks)

 Inconsistent adoption across the care continuum  Staff training  Implementation and maintenance costs  Workflow changes

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Goal and Benefits of HIE

 Goal:To make health related information more accessible across disparate electronic health systems  Benefits:

 Streamlines practice processes  Enables timely access to patient information  Supports care continuity  Improves care transitions  Creates administrative efficiencies

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HIE Adoption

 All hospitals in Maryland are connected to CRISP  One in ten primary care practices and one in twenty specialty practices are connected (as of 2017)

16 Sources:

• Maryland Physician Data ‐ MHCC, “CRISP Connectivity – Ambulatory Practices”, November 2017. Available at:

http://mhcc.maryland.gov/mhcc/pages/hit/hit/documents/HIT_CRISPAmbConnBrief_20171130.pdf.

• Maryland Hospital Data – MHCC, “Health Information Technology, An Assessment of Maryland Acute Care Hospitals”, March 2018. Available at:

http://mhcc.maryland.gov/mhcc/pages/hit/hit/documents/HIT_2016_Hosp_HealthIT_Assess_MD_Rpt_20180315.pdf.

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EHR + HIE

 Interoperability is the ability of two or more components to exchange and use information  EHR and HIE interoperability is associated with:

 Improved workflow efficiency  Streamlined claims processing  Better quality of patient care  Patient safety and cost savings

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HIE

Hospitals Imaging Public Agencies Long Term Care & Community

EHR

Payors Labs & Pharmacies Patients Other Physicians

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Goal and Benefits of Telehealth

 Goal:To improve access to care, engage patients, and reduce costs  Benefits:

 Increase access to physicians and allow physicians to expand their reach  Reduce travel time and cost for patients  Reduce emergency department admissions and hospital stays  Improve chronic care management

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Telehealth Includes

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 Live video  Store‐and‐forward  Remote patient monitoring  mHealth

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Telehealth Technology & Devices

21 Digital Spirometer

Telehealth Adoption

 Maryland hospitals lead the nation in telehealth adoption  One in five office‐based physicians reporting planning to adopt telehealth

22 Sources:

• Maryland Physician Data ‐ MHCC, “Office‐Based Physicians, Adoption of Telehealth”, April 2018. Available at:

http://mhcc.maryland.gov/mhcc/pages/hit/hit/documents/HIT_Telehealth_Adoption_Brf_20180404.pdf.

• Maryland Hospital Data – MHCC, “Health Information Technology, An Assessment of Maryland Acute Care Hospitals”, March 2018. Available at:

http://mhcc.maryland.gov/mhcc/pages/hit/hit/documents/HIT_2016_Hosp_HealthIT_Assess_MD_Rpt_20180315.pdf.

61% 64% 77% 88% 5% 6% 7% 7%

2013 2014 2015 2016

Telehealth Adoption

Hospitals Office‐Based Physicians

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Telehealth Limitations

 Reimbursement challenges  Incorporating telehealth into the workflow  Licensing  Liability insurance  Acquiring new equipment

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Additional Health IT Features ‐ PHRs

 Goal: Increase patient engagement and patient access to their health information  Benefits: Allow patients to create and manage their health information through:

 Secure email communication with providers  Automated alerts  Automated reminders

 Limitations:

 Requires commitment from patients to manage their information  Lack of provider engagement  May not work well with a provider’s EHR

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Additional Health IT Features – Patient Portals

 Goal: Increase patient engagement and patient access to their health information  Benefits: A patient portal is tied to a provider’s EHR and may allow a patient to:

 Exchange secure emails  Request prescription refills  Schedule appointments  Check benefits and coverage  Update contact information  Make payments  Download and complete forms  View educational materials

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Patient Portals (cont.)

 Practice staff play an important role in encouraging patients to sign up and use patient portals  Limitations:

 Health care consumers typically have to access multiple unconnected portals for each of their providers  Concerns regarding security  Patient technological access and skills, and health literacy

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Additional Health IT Features – Electronic Advance Directives

 Goal: To increase access to advance directives to ensure patients receive care that is consistent with their values, goals, and preferences  Benefits:

 Makes advance directives available at the time and point of care  Eases decision‐making burden on families

 Available through CRISP when you use MyDirectives, a free web‐based application

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Section 3: Looking Forward

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Where is health IT going?

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 Automating clinical, financial, and administrative transactions

 To improve quality, prevent errors, and improve efficiency

 Increasing interoperability

 Demand for interoperability is expected to continue to increase

 Health care reform is driving the evolution of electronic exchange of health information

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Alana Sutherland Email: Alana.Sutherland@Maryland.gov Phone: 410‐764‐3330 Website: mhcc.maryland.gov/ Facebook: www.facebook.com/mhcc.md Twitter: www.twitter.com/mhccmd

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7160 Columbia Gateway Drive, Suite. 230 Columbia, MD 21046 877.952.7477 | info@crisphealth.org www.crisphealth.org

May 11, 2018

Services for Ambulatory Practices and Care Coordination

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Learning Objectives

1) Understand the technology and connectivity enabling CRISP 2) Determine how the CRISP core services assist ambulatory practices and care coordination activities

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About CRISP

Regional Health Information Exchange (HIE) serving Maryland and the District of Columbia, and collaborating with Delaware, Northern Virginia, Pennsylvania, and West Virginia Vision: To advance health and wellness by deploying health information technology solutions adopted through cooperation and collaboration

Data source or attribute #

Live hospitals 91 Live clinical data feeds 261 (lab, rad, ADT, CCD) Live ENS practices +1,000 Long-term and post- acute care facilities 205 Standalone labs and radiology centers 16 Unique patients in index +16 million Patient searches +400,000/mo Encounter alerts sent +2,500,000/mo

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Mission and Guiding Principles

• 1. Begin with a manageable scope and remain incremental.
• 2. Create opportunities to cooperate even while participating healthcare
• rganizations still compete in other ways.
• 3. Affirm that competition and market‐mechanisms spur innovation and

improvement.

• 4. Promote and enable consumers’ control over their own health information.
• 5. Use best practices and standards.
• 6. Serve our region’s entire healthcare community.

We will enable and support the healthcare community of Maryland and

• ur region to appropriately and securely share data in order to facilitate

care, reduce costs, and improve health outcomes.

Mission Guiding Principles

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Services

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CRISP Core Services

• 1. POINT OF CARE: Clinical Query Portal & In-context Information
• Search for your patients’ prior hospital records (e.g., labs, radiology reports, etc.)
• Monitor the prescribing and dispensing of PDMP drugs
• Determine other members of your patient’s care team
• Be alerted to important conditions or treatment information
• 2. CARE COORDINATION: Encounter Notification Service (ENS)
• Be notified when your patient is hospitalized in any regional hospital
• Receive special notification about ED visits that are potential readmissions
• Know when your MCO member is in the ED
• 3. POPULATION HEALTH: CRISP Reporting Services (CRS) –

Hospital-Based

• Use Case Mix data and Medicare claims data to:
• Identify patients who could benefit from services
• Measure performance of initiatives for QI and program reporting
• Coordinate with peers on behalf of patients who see multiple providers
• 4. PUBLIC HEALTH SUPPORT: Partnerships with Maryland MDH, District of

Columbia DHCF, and West Virginia through the WVHIN

• 5. PROGRAM ADMINISTRATION: Technical and administrative support for

Care Redesign Programs

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Prescription Drug Monitoring Program

PDMP data is available in the portal as well as the Unified Landing Page for Pharmacy users; additional features include sorting and multiple patient selection

Manual patient search to view Prescription Drug Monitoring Program, labs, radiology results, recent encounters, and documents

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Clinical Query Portal

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Encounter Notification Service

Real-time or batch alerts to appropriate providers based

• n treatment and

care management relationships

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PROMPT Census View

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CRISP In-Context

Critical data available at the point of care through API, FHIR,

• r CCDA; single-

sign-on to patient record

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CRISP In-Context

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Epic App Orchard

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Care Programs

• Patient panels submitted manually or automatically

in ADT feeds can include care program data such as care teams, contact information, and program enrollment

• Program metadata, without PHI, can be submitted

to CRISP to show services available to all patients enrolled in that program, ACO, or payer plan

• Information can include services offered, 24hr support

numbers, regions served, and other similar information

• CRISP matches patients to panels to a program

directory in real-time to display comprehensive information

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Levels of Participation

• 1. Practice signs a participation agreement, enabling

clinical query portal access and the ability to submit patient panels and receive event notifications.

• 2. Practice establishes an ADT feed to CRISP to share

basic event information.

• 3. Practice establishes a CCD feed to CRISP, sharing

in-depth clinical data.

• 4. Practice and CRISP establish bi-directional feed to

allow CRISP data natively in the practice EMR.

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Questions and Discussion

Sheena Patel, MD, CMPE Manager of Provider Relations Phone: 443.430.2990 Email: sheena.patel@crisphealth.org

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