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Improving Transitions Through HIE - National Governors Association

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					Improving Transitions Through HIE

                Claudia Williams
           Director, State HIE Program
Office of the National Coordinator for Health IT
HIE Program Overview




                       2
State HIE Collaborative Program Overview

§ Facilitates and expands the secure electronic movement
  and use of health information
      Federal-State collaboration
§ Prepares States to support their providers in achieving
  HIE MU goals, objectives and measures
      Four year program, total funding available $548 million
§ 56 states/state designated entities and territories
  awarded in March 2010
§ States need an ONC approved State Plan before
  Federal funding can be used for implementation
      48 plans approved to date

                                                                3
State HIE Collaborative Program Principles

    Ensure ALL eligible providers within every state have at least one option
      available to them to meet the three meaningful use requirements.
§     E-prescribing the ability to generate and transmit permissible prescriptions
      electronically (eRx)
            more than 40% are transmitted electronically using certified EHR
            technology
§     Receipt of structured lab results the ability to incorporate clinical lab test
      results into EHR as structured data
            more than 40% of results ordered are incorporated in certified EHR
            technology as structured data
§     Sharing of patient care summaries across unaffiliated organizations the
      ability for every provider to provide a summary care record for each transition of
      care or referral
            more than 50% of transitions of care include a summary of care record

                                                                                           4
State HIE Collaborative Program Goals
§ Foster exchange networks
     Build capacity of local and affinity models
     Reduce cost and complexity, including through shared services
     Policies that encourage exchange
§ Monitor exchange and fill the gaps
     Support the little guy small providers, independent labs
     Avoid closed networks
     Consumer-mediated exchange
§ Ensure exchange across networks
     Every provider has at least one option for meeting health information
     exchange requirements of MU
     Governance and trust
     Common standards to connect the nodes

                                                                             5
Improving Patient Transitions - Now
is the Time




                                      6
 Eye on the prize: better care, better health,
 lower cost
§ Alignment of goals across Federal initiatives
      ACO regulations
      National Quality Strategy
      Federal HIT Strategic Plan
      Meaningful Use
      Partnership for Patients
§ Importance of transitions and care coordination are recurring
  themes
     Importance of care coordination
     Focus on care transitions and medication management
     Role of community-based services
     Engagement of patients and family caregivers

                                                                  7
Today: Unprecedented opportunity to improve
transitions, reduce readmissions across the country

     I Meaningful            II ACO NPRM                   III Partnership for
      Use/HITECH                                                Patients

 Establishes            Emphasizes care                Sets Goal: Reduce
 expectation for        coordination: to               preventable
 informed transitions   improve quality, reduce        readmissions by 20
 Share care summaries   costs                          percent
 when patients
 discharged, referred   Information follows
                                                       Up to $500M
                        patient wherever they
 $83 million already                                   Community-Based Care
                        seek care, inside or
 paid in Medicaid                                      Transitions Program
                        outside the ACO
 incentives (4/2011)

                        Reduced Medicare payments for hospitals with
                         higher than expected readmissions starting in
                                            2013                                 8
Virtuous cycle: goals, payment, programs, standards all
pointing in same clear direction
                                                                                                 Guidance 7/10
 Identifies hospitals                                                                             outlines care
  in top quartile of                                                                               summary
    readmissions                                MU requirements for                           exchange, eRX and
      nationally                                  care coordination                             lab exchange as
                                                                                              three key priorities



                          Partnership for                                 HIE program
                        Patients places focus                             care summary
                             on transition                            exchange one of three
                            improvement                                     priorities




                                   S&I framework                                                50+ vendors
                                                             Direct make transport
                                  initiative improves                                         have committed
  Developing more                                                     easier
                                   summary content                                            to building into
       robust                                                                                  their products,
  specifications for                                                                            25+ state HIE
  summary of care                                                                                programs
     document                                                                                  implementing          9
Safe, effective transitions require


  Medication reconciliation and safe medication practices
  Standardized and accurate communication and
  information exchange between the transferring and the
  receiving provider
  Patient and caregiver involvement
  Person-centered care plans that are shared across
  settings of care
  The sending provider maintaining responsibility for the
  care of the patient until the receiving clinician/location
  confirms the transfer and assumes responsibility

                                                               10
  Readmissions account for $15 B in Medicare
spending annually ($12 B potentially avoidable)


For all Medicare patients who are discharged from the hospital


                     20% 1 in 5 are readmitted in 30 days



                                      34%   1 in 3 are readmitted in 90 days

                                                                     Half of those readmitted did
                                                             50%     not see a physician
                                                                     between discharge and
                                                                     readmission




                                                                                              11
Clear role for HIT & HIE in improving transitions
                           Medication reconciliation before discharge
  Medication management    Medication history lookup when patient transitions

                           List of care team members in EHR
    Transition planning    Complete care summary

     Patient and Family    Share summary with patient and family
        Engagement         Document and share care preferences

                           Send care summary to the next point of care
   Information Exchange    Utilization alert when patient discharged

                           Consult care summary
      Follow up Care       Reminders and alerts

    Health Care Provider   Reminders and alerts
       Engagement
                           Closed loop referrals and shared care plan
   Shared Accountability


                                                                                12
                                                                                  12
There is a need for rapid progress. In CA as across
rest of country--discharge information is rarely shared
electronically




                                           CHCF CA HIT Update
                                                                13
Making Progress this Year
Focus on a few concrete problems
     Medication management
     Patient and family engagement
     Information exchange
Leverage standards to simplify and lower cost
Co-innovate care process and HIT
Leverage Medicaid

                                                14
Concentrate on a few concrete problems
                            Medication reconciliation before discharge
  Medication management     Medication history lookup when patient transitions

                            List of care team members in EHR
     Transition planning    Complete care summary

     Patient and Family     Share summary with patient and family
        Engagement          Document and share care preferences

                            Send care summary to the next point of care
    Information Exchange    Utilization alert when patient discharged

                            Consult care summary
       Follow up Care       Reminders and alerts

    Health Care Provider    Reminders and alerts
       Engagement
                            Closed loop referrals and shared care plan
    Shared Accountability


                                                                                 15
                                                                                   15
Advance focused solutions
       Area                        Intervention                          Examples

Medication           Medication history lookup, medication   North Carolina Challenge
Management           reconciliation                          Grant, Oklahoma Challenge
                                                             Grant
Patient and Family   Share care summary with patients and    Georgia challenge grant,
Engagement           families                                Indiana Challenge Grant

                     Shared advance directives               Oregon, New York, Maryland
                                                             and Massachusetts
Information          Utilization alerts from ED to medical   Rhode Island
Exchange              home

                     Information sharing with LTPAC          OK, MD, MA, CO
                       providers

                     Closed loop referrals                   MedAllies

                     Giving every provider option for care   ALL
                       summary                                                          16
                                                                                          16
Connect patients to information and to
providers after a hospital stay

  Access to personal health info
  Secure messaging with providers
  Remote monitoring and reminders
  Online patient communities
  Advance directives available electronically




                                                17
Leverage standards to simplify and lower cost
Direct: Key building block for transport
  Standardized. Direct provides a standardized transport mechanism
  for patient care summaries.

  MU-compliant. Direct use cases tied to MU priority areas, including
  patient care summaries.

  Simple. Simplicity helps adoption among low volume practices and
  small, independent providers.

Transitions Content: Make transition information usable




                                                                     18
Beacon co-innovate care process and HIT

§ Reduce hospital utilization, especially from poorly managed
  transitions
§ Use HIT to improve care for individuals with high cost / high
  risk chronic conditions (e.g., DM, CVD, etc.)
§ Connect local hospitals with primary and chronic care settings
§ Engineer electronic continuity and care plans, and incorporate
  them into EHRs and HIEs
§ Build on initial successes by ongoing learning with other
  Beacon Communities and by seeking Community-Based Care
  Transitions funding


                                                                  19
Beacon communities transitions interventions

§ Three tiers of IT focus
     Many Communities are using HIT systems to notify PCPs of
     hospital and/or ER use
     Some are using HIT to provide hospital discharge information
     (e.g., medications, lab values) to next providers (e.g., nursing
     homes, FQHCs, PCPs)
     A few are using HIT to facilitate making appointments for quick
     follow-up (e.g., PCPs to specialists)
§ IT tools are coupled with case management (e.g., self-
  management coaching, medication reconciliation, care
  coordination)


                                                                        20
Leverage Medicaid


  Payment expectation: care summary must accompany
  patient transitions
  Medical homes: Utilization alerts to medical homes,
  align medical home requirements with MU
  Long term care: include in HIE efforts
  Enrollees: Share information with patients
  Efficiency goal for Medicaid: reduce readmissions and
  medication errors


                                                        21
HIE Challenge Grants: Demonstrate the
 How for Improving Acute to Long Term
Care Transitions




                                        22
Incremental innovation so that

  Patients receive seamless, safer, effective, and
  efficient care across multiple care settings
  Long-term and Post-Acute Care (LTPAC) providers
  are included in information exchange efforts
  Providers achieve timely electronic exchange of
  clinical information across care settings
  Transitions to and from acute care settings and
  LTPAC settings are monitored
  Patients and caregivers are empowered to manage
  their care across care settings

                                                     23
 The catalysts for change

Colorado Regional           Massachusetts Technology Park
Health Information          Corporation ($1.72M)
Organization ($1.72M)




                                        MD Department of
                                        Health & Mental
                                        Hygiene ($1.68M)



    Oklahoma Health Care
    Authority ($1.72M)



                                                            24
How is change mobilized for safe and effective
care transitions?

                        Prompt medication reconciliation at every transition
Medication management   Standardize medication reconciliation and patient transfer protocol
                        Engage acute and LTPAC provider communities in care process changes



                        Patient and caregivers are connected to post-acute providers, acute care
  Patient and Family    providers, physicians, pharmacist, and care coordinators
     Engagement         Information is in format that is relevant and accessible to patient and their
                        caregivers



                        Electronic and manual transfer of standardized clinical information related
                        to medication lists, Advance Directives, Functional Status, Allergy lists,
                        Problem Lists, Clinical notes and Discharge Summaries
 Information Exchange   Clinical information leverages existing HIE and CCD standards
                        Improving the workflow and processes associated with care transitions
                        Identify HIT adoption incentives for LTPAC providers


                                                                                             25
Empowering patient preferences through care
transitions
  Advance Directives:
    Most challenging data to share across continuity of
    care; must remain accurate and actionable
    MD and MA Challenge Grantees Aim to develop
    single source of truth for AD so patients/caregivers
    not required to carry paper forms
    ADs integrated two ways: direct into CCD or indirectly
    by harmonizing legislation across multiple entities to
    standardize Advance Care document structure,
    nomenclature and content
    Operational HIE-based Registries in Oregon and
    Rochester, New York
                                                         26
Contact me with any questions, comments!

Claudia Williams
Director, State HIE Program
Office of the National Coordinator for Health IT
(202) 570 6743
claudia.williams@hhs.gov




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