Use Case Impact on Provider Workflow Bio 35 year career in healthcare 20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of IT Clients range from small physician groups to large multihospital organizations ID: 715091
Download Presentation The PPT/PDF document "1 E-Health / Health Information Exchange" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
1
E-Health / Health Information Exchange
Use Case Impact on Provider WorkflowSlide2
Bio
35 year career in healthcare20 years in Consulting with an emphasis on clinical systems and focus on physician adoption of I/T
Clients range from small physician groups to large multi-hospital organizationsConducted over 200 vendor selections for both hospitals and physicians with over 100 EMR engagements ranging from small practices to complete hospital / physician integrated delivery systemsWorked with major HIEs including Chicago, Minneapolis, Wisconsin, Washington DC, New York City and many enterprise HIE projectsSpent 15 years in the vendor community and is former VP of Sales for the physician systems division at BaxterAdjunct Faculty member at University of Wisconsin Milwaukee Healthcare Informatics Graduate program teaching Healthcare I/T Procurement2Slide3
Topics
Evolution of Intra Provider MessagingToday’s Challenges
HIE Use Case Impact on Provider / Patient Workflows3Slide4
Evolution of provider messaging
4Slide5
Not so Distant Past Provider Messaging
5Slide6
Information Access Evolution
6Slide7
Changing Provider I/T Environment
7
2006 5% Physician EMR use to
20%
2011
20%
Physician EMR use to
50%
2015
50%
Physician EMR use to
75%
2011
Value based purchasing (ACO)
Comparative effectiveness / Quality Measures
Care coordination / CCD exchange
Consumer access to their records
Data standards
ICD-IO
SNOMED CT
Rx Norm
LOINC
Others
2011
2015
2019
2019 Slide8
Workflow challenges
8Slide9
Workflows – When You’ve Seen One…You’ve Seen One
Physician adoption / Provider variance – who has an EMR and who doesn't?If I need to send a record summary to the next provider, how do I know what preference they have to receive it?If they have an EMR are they ready to use the CCD as a means of conveying patient records?
Staff adoption and data/document hand off – when will it become efficient?Patient variability – do they want an electronic copy and how do I get it to them?9Slide10
Changing of the Guard
10
OldNewInsurance Card verification / phone callOn line eligibility checkingPatient Medical History InterviewHIE History Access and Patient Interview ValidationReceipt of patient discharge summaries, lab results via fax, triage and clip to the chartElectronic receipt of messages, results and other data from the network to the EMR inbound application
Patient care documented with pen,
paper and Dictaphone
EMR
clinical documentation, voice to data, direct data entry via templates all mapped to SNOMED CT, RxNorm, LOINC etc.
Paper
prescription handed to the patient, medication recorded via written note in the chart
eRx on a handheld
with
review
of online formulary and comparison to current medication history via SureScripts and other sources
Manual checklist of problems,
diagnosis, CPT codes and health maintenance reminders, referral letters, fax of patient records
Electronic
care plan, CCD export to the next provider, consumer, provider and payer access to care plans, consumer patient record portals, PHRs
Manual
calculation of patient activity
Electronic
quality measure reporting, public lab data, disease surveillanceSlide11
Provider System Fragmentation
Email Web Browser
Clinic EMRClinic Portal
Hospital Portal
Diagnostic Systems
Hospital(s)
A, B, C… Home Screens
Hospital(s)
A, B, C...X EMR Screens
Regional
HIE
11
Log-in
Passwords
Patient search
Navigation
FlowsSlide12
HIE Impact on provider workflows
12Slide13
Typical HIE Use Cases / Services
Core ServicesProvider Data Exchange EnginePatient Identity ManagementRecord Locator Service (RLS)
Consent TrackingProvider Directory (Direct)Secure MessagingAudit/Security Management13Common Use Case ExamplesPatient Visit Registry View – RLS ViewerClinical Summary ViewResults Delivery / DocumentsLab Orders / Results (Discrete)CCD ExchangeCCD Publishing to the HIERegistries – Disease, Public Health etc.Public Health ELRPHR ServiceEKG ViewerSlide14
Health Information Exchange
Premise of why ONC / HHS is promoting regional / State HIEsFundamentally changing how we deliver patient care and manage patients over time
Patient care and management should not be encumbered by provincial provider attitudes that they are in control of their patient’s recordsPatients are to be empowered to take an active role in their care, management and outcomesData for quality measurement knows no boundaries of IDN, Physician Group or any other provider type…but rather centers around the totality of patient data and consistency of information analytics across the industry and the life of the patient14ONC – HIT Strategic Plan Draft March 2011…the Medicare and Medicaid EHR Incentive Programs reward eligible providers who digitize health care information and share it electronically across provider settings. These requirements will grow stronger in future stages. Second, ongoing payment reforms initiated by the Affordable Care Act – including accountable care organizations, medical home models, and bundled payments – are an even more important potential driver of provider motivation to exchange information. Slide15
Meaningful use of EHRs – across the continuum
Implementation of Health Information Exchange (HIE) to support continuity of careCare Coordiation through access to patient centric community care plans
Agile and thin I/T applications that can be modified over time without major system disruptionSemantic interoperability of systems and reducing the cost of fragmentationAnalytics supporting fundamental health care delivery changeTactical Delivery of Long Range ONC I/T Vision15Slide16
Typical Hospital View of Their Service Community
16Slide17
ONC View of The Service Community
17Slide18
Goal: Data and Information Exchange
Point of Care
Clinical Information / Data Analytics
Care Continuum
18Slide19
Traditional Workflow Example
Patient calls for doctor appointment
Patient is sent forms to fill out and bring into officePatient arrives at clinic with formsForms are reviewed by staff and entered tin to the systemPatient is “roomed” and vitals written in chartPatient previous test results arrived via fax and clipped to chart for clinician reviewPhysician conducts exam and annotates findings in chartProvides written Rx to the patientPhysician indicates treatment plan to nurse who in turn orders tests and instructs patient further
Printed and hand written instructions provided to the patient
19
Tomorrow’s Workflow
Patient registers via the web and fills out HRA and other documents
Patient arrives and checks in via kiosk
Hospital distributed results from prior days testing via HIE to the clinic EMR messaging inbox
Patient is roomed with digital feeds of vitals to EMR
Medical Assistant confirms all new information from HIE that shows last weeks ED visit that was not known by this clinic
Physician conducts exam, documents in EMR and uses eRX tool that shows a previous script from the ED that he was not aware of and confirms with the patient that they are taking the medication
Physician enters electronic order for testing to be done at the hospital
Patient asks for electronic copy of the visit record and also asks that the record not be disclosed to Provider “x” as her ex-husband is a physician at that location
Assistant logs onto the HIE and indicates how Consent has been modifiedSlide20
Provider Workflow Challenge
Multiple loginsVariable workflows for common functionsRecord completeness
Data differences among systems- e.g. allergies, current medsVenue differences- ED, walk in clinics office, specialist, inpatientError correctionCommon format for clinical documentationPatient consent20Slide21
HIE Patient Consent Issues
Opt in- Opt out changesEmergency careBehavior health
“Peyton Place” issuesClinical documentation inconsistencies- patient correctionsPatient self-consent/assignmentBreak the glass provisions 21Slide22
Managing the future
22Slide23
Physicians Want “One Stop Shopping”
23
Security (Sign-on) Privacy Policies Consent Policies Data Integrity (Trust) Error Correction (Trust)Auditing (Risk) Change Management (Standards)Slide24
Wrap Up
Challenge your organization to assess the impact of your decisions on the “patient centric” processUnderstand the workflow implications for your providers with special emphasis on affiliated physiciansPatient movement among providers is not going to disappear so understand that you are a part of the patient’s provider community
Accountable care, care coordination and disease management will require much greater consistency of information exchange among providers…are you part of the solution or a part of the problem?24Slide25
Patient Centric Approach to I/T
25Slide26
Thanks !
Health Information Consulting, LLCMike Mytych
mmytych@hicllc.com262-253-911026