5/10/2018 The Value of Health Information Exchange in Care Delivery May 11, 2018 Sheena Patel Alana Sutherland Manager of Provider Relations Program Manager Chesapeake Regional Maryland Health Care Information System for our Commission (MHCC) Patients (CRISP) Introductions Advancing health Enabling appropriate information technology and secure data (health IT) statewide sharing for the health care community 2 1
5/10/2018 Overview of health IT Progression of health IT and the current landscape Agenda Benefits of health IT Expectations for health IT in the near future 3 Section 1: Setting the Stage Introduction to Health IT 4 2
5/10/2018 Health IT is: Electronic Health Record (EHR) An electronic version of a patient’s health record + What is Health Information Exchange (HIE) Health IT? An organization that facilitates secure electronic exchange of health information between providers + Telehealth The delivery of health services using telecommunications and related technologies 5 Health IT is central to modernizing health care EHRs and HIE are integral components of health IT Telehealth and mHealth are other mechanisms Health IT in for providing care and sharing health information Context mHealth is the use of smartphones, tablets, or other mobile devices to deliver health services Other health IT solutions include personal health records (PHRs), patient portals, and electronic advance directives 6 3
5/10/2018 Drivers for the prioritization of health IT nationally include: Rising health care costs Concerns about preventable medical errors How did we Variability in the quality of care get here? Fragmented communication among health care providers Lack of health care consumer engagement 7 Increase health care quality Reduce hospital acquired Value ‐ based purchasing Innovative care delivery Reduce preventable Bundled payments Foundation readmissions conditions for Health Care Reform Health IT Infrastructure 8 4
5/10/2018 Comprehensive management of health information Administrative efficiencies Benefits of Reduce duplication and waste Health IT Improve quality through decreased medical errors, increased patient engagement, and better care coordination 9 Section 2: The Current Landscape Health IT Components 10 5
5/10/2018 EHRs EHRs Components HIE HIE of Health IT Telehealth Telehealth 11 All hospitals in Maryland have adopted an EHR 71 percent of office ‐ based physicians have adopted an EHR Growth in EHR Adoption Among Office ‐ Based Physicians, 2011 ‐ 2016 100% 71 80% 67 EHR Adoption 64 57 49 60% 33 40% 54 51 48 40 20% 34 0% 2011 2012 2013 2014 2015 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 ‐ 12 adoption ‐ trends.php. December 2016. 6
5/10/2018 Goal: To improve efficiency and quality of care, and reduce costs Benefits: Process improvements for documentation and Goal and billing Workflow efficiency Benefits of Reduce chart pulls EHRs Increase productivity Reduce cost of storing records Improve communication 13 Interoperability with legacy systems and external entities (Although EHRs are beginning to exchange data outside of their own networks) EHR Inconsistent adoption across the care continuum Limitations Staff training Implementation and maintenance costs Workflow changes 14 7
5/10/2018 Goal: To make health related information more accessible across disparate electronic health systems Benefits: Goal and Streamlines practice processes Benefits of Enables timely access to patient information HIE Supports care continuity Improves care transitions Creates administrative efficiencies 15 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) HIE Adoption 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: 16 http://mhcc.maryland.gov/mhcc/pages/hit/hit/documents/HIT_2016_Hosp_HealthIT_Assess_MD_Rpt_20180315.pdf. 8
5/10/2018 Interoperability is the ability of two or more components to exchange and use information EHR and HIE interoperability is associated with: Improved workflow efficiency EHR + HIE Streamlined claims processing Better quality of patient care Patient safety and cost savings 17 Hospitals Payors Labs & Imaging Pharmacies HIE EHR Public Patients Agencies Long Term Other Care & Physicians Community 18 9
5/10/2018 Goal: To improve access to care, engage patients, and reduce costs Benefits: Goal and Increase access to physicians and allow physicians to expand their reach Benefits of Reduce travel time and cost for patients Telehealth Reduce emergency department admissions and hospital stays Improve chronic care management 19 Live video Store ‐ and ‐ forward Remote patient monitoring mHealth Telehealth Includes 20 10
5/10/2018 Telehealth Technology & Devices Digital Spirometer 21 Maryland hospitals lead the nation in telehealth adoption One in five office ‐ based physicians reporting planning to adopt telehealth Telehealth Adoption Telehealth 88% 77% 64% Adoption 61% 7% 7% 5% 6% 2013 2014 2015 2016 Hospitals Office ‐ Based Physicians 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. 22 11
5/10/2018 Reimbursement challenges Incorporating telehealth into the workflow Telehealth Licensing Limitations Liability insurance Acquiring new equipment 23 Goal: Increase patient engagement and patient access to their health information Additional Benefits: Allow patients to create and manage Health IT their health information through: Features ‐ Secure email communication with providers Automated alerts Automated reminders PHRs Limitations: Requires commitment from patients to manage their information Lack of provider engagement May not work well with a provider’s EHR 24 12
5/10/2018 Goal: Increase patient engagement and patient access to their health information Additional Benefits: A patient portal is tied to a provider’s Health IT EHR and may allow a patient to: Features – Exchange secure emails Request prescription refills Patient Schedule appointments Portals Check benefits and coverage Update contact information Make payments Download and complete forms View educational materials 25 Practice staff play an important role in encouraging patients to sign up and use patient portals Limitations: Patient Health care consumers typically have to access Portals (cont.) multiple unconnected portals for each of their providers Concerns regarding security Patient technological access and skills, and health literacy 26 13
5/10/2018 Goal: To increase access to advance directives to ensure patients receive care that is Additional consistent with their values, goals, and Health IT preferences Features – Benefits: Makes advance directives available at the time and point of care Electronic Eases decision ‐ making burden on families Advance Available through CRISP when you use Directives MyDirectives, a free web ‐ based application 27 Section 3: Looking Forward 28 14
5/10/2018 Automating clinical, financial, and administrative transactions To improve quality, prevent errors, and improve Where is efficiency health IT Increasing interoperability Demand for interoperability is expected to continue going? to increase Health care reform is driving the evolution of electronic exchange of health information 29 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 30 15
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