Better Outcomes. Delivered. Five Misconceptions. about Rural Hospitals and Health Information Exchange and Success Stories that Prove Them Wrong

Transcription

1 Better Outcomes. Delivered. Five Misconceptions about Rural Hospitals and Health Information Exchange and Success Stories that Prove Them Wrong June 2017

2 Agenda Introductions Problem Statement A Little Background 5 Misconceptions Discussion Q&A

3 Who We Are Deb Hemler Director of Sales and Customer Relationship Management Indiana Health Information Exchange Crista Miller Clinical IT Coordinator Putnam County Hospital Beth Jump Chief Information Officer Logansport Memorial Hospital Kimberly Sodowsky Clinical Informatics Coordinator Logansport Memorial Hospital

4 The Problem Many rural hospitals do not participate in HIEs for various reasons.

5 A Little Background About how we got to where we are

6 In The Beginning 2012 we started with the ER Teaching nursing

7 OUR Utilization of Repository In the Beginning Stumbled

8 Re-evaluated Question Who would benefit? How to train? Training Materials needed? Answer Providers ER Hospitalists Surgeons NP s Care Coordinators Care Management Nursing Ward Medical Sec. Hands on training sessions User Manual

9 In the Works Currently Training WMS Key RN s in ICU and Med/Surg New Providers Future Surgeons Revisit ER New Providers-Onboarding Cardiac Rehab

10 Go-Live Fall of 2012 after implementation of EMR Departments Utilizing ED Pre-Op Oncology Case Manager Quality Manager

11 Short-sighted on Roll-Out Should have included more departments All Unit Clerk ICU Med-Surg Pain Management Office Staff Hospitalists and Hospitalist NP

12 Re-Trained and Expanded Departments Since Fall of 2016 Re-trained all Inpatient and Emergency Department staff Re-trained Provider Office staff Working to train our Prompt Care staff New hires

13 Five Misconceptions About Health Information Exchanges

14 MISCONCEPTION #1 HIE data is only valuable in the Emergency Department

15 There are a lot of times that a patient gets admitted to LMH and they have had significant episodes of care at a different facility. Often we do not have these records in eclinical for one reason or another. Careweb allows me to access some of these records which can have a profound impact on how I manage the patient. It can cut down on unnecessary testing if the testing has recently been done at the other hospital, and it can help direct my care based on the knowledge of what has already been done. It is also very helpful in people that I transfer. I like to keep track of the patients I send down to Indy to see what the final diagnosis ended up being or how they managed the patient differently. I can access those records in real time and that gives me immediate feedback on how I could have managed the patient. Benjamin Anderson, DO Hospitalist It s a great resource.

16 Provider-to-Provider Value Patients with recent MI-stenting presenting to LMH ER our providers have comparative changes to know how to treat the presentation of chest pain or who to call to do a provider-to-provider on Plan of Care.

17 Oncology Looks up information on new patient consults and referrals before Oncologist sees the patient for the first time Labs, procedures, radiology reports, any previous visits Example Case Found a cancer history on a patient that did not report that they had a previous history

18 MISCONCEPTION #2 Physicians are the only users of HIE data

19 Pain Management Group Uses IHIE: to retrieve urine drug screens To find latest or last image reports to prevent re-imaging & comparisons Emergency Department visits looking for narcotic prescriptions Rachel Barrier Manager, PCH Pain Management Love it. It s great, because we can go to it first to get information rather than waiting on a medical records department somewhere to give us requested information.

20 Pain Management Testimonial PMG patient reported being in another area hospital for an illness, staff looked up visit records in IHIE and found that patient was admitted for intentional overdose. Staff was able to find provider notes from the other hospital in IHIE PMG patient went to 3 different Emergency Departments in 3 days looking for prescriptions. Staff was able to hold patient accountable for his behavior. IHIE allowed staff to see what medications the patient received at each hospital.

21 Benefits of Using a Repository Melinda Turner, LPN Care Manager Available data collected by other physicians to assist in efficient H&P s and medication challenges. Comparative assessments and documentation by specialist that help expedite patients current admission plan by having immediate access to tests, documentation and outcomes from prior stay and not waiting on a fax

22 Case Management Scenario Patient presented to LMH ER and case management was called for patient nursing home placement. There was no reason for medical admission so it would be a nursing home placement from ER but patient could not afford private pay and family had already checked 2 facilities in town. Patient had recently been discharged from an Indy hospital. Upon reviewing information on INPC case management found a discharge summary that proved the patient had been an inpatient at a facility for 4 nights which established what was needed for the patients insurance to pay for the NH stay. So the patient went from ER to NH facility and was safe.

23 MISCONCEPTION #3 HIE products and services are too cumbersome to fit into my workflow

24 been very helpful in locating radiology documents that the providers would like to review and add to the patient s chart. Also, the discharge summary is often accessible sooner than when we receive the document by fax which allows us to contact the patient sooner following discharge. It would be great if a larger percentage of hospitals participated. Leanne Schaller, RN Care Coordinator

25 Care Coordinators & Case Management Developed training material Training session Rounded back with a training session with our Repository Vendor for Question & Answer Care Coordinators Ask vendor for specific documents From specific facilities Showed interest Usage grow Value in product developed Patient outcome improved

26 Hospitalist Program Nurse Practitioner Uses it almost daily before rounds and as needed, checks for labs, x-rays, procedures, and previous discharge summaries for newly admitted patients Keeps from duplicating testing Learns history for patients that are poor historians Sharon Nicoson NP - Hospitalist

27 MISCONCEPTION #4 HIE products and services don t have significant value

28 Office Practices Getting new patient historical records Especially prior mammograms and surgeries Example Case a new diabetic patient came to the provider and said that all the diabetic medications have made him sick but he could not list what meds had been tried so far, staff was able to look at previous medication fill list, and provider prescribed a medication that had not been previously tried Looking up information that may be needed for insurance preauthorization (procedure results, lab results anything that may help in getting the pre-authorization approved)

29 Emergency Department Loves it Unit clerks are the biggest users Retrieves old records for other hospital visits, can see hospital hopping behavior Labs and radiology reports Poor historians Example Case Had a recent patient who had scans in Indy but did not know what scans or where, found the CT-scan reports from the week before the patient presented to PCH ED

30 Significant Value Repository assisted in establishing the plan of care for a patient that came to LMH ER admitted for Sepsis with foot wounds: Patient stated, had something done at a Ft. Wayne hospital and I m not sure but I had to take a lot of pills and they said my feet was bad. Upon review of repository, found out patient was actually at 2 different hospitals: Reports for I&D, Surgeons, Cardiologist and Vascular Doctor s. Assessments and multiple studies already completed with recommendation for patient to have bilateral amputation r/t vascular impairment w multiple comorbidities. With this knowledge the patient was not put thru duplicate testing - only a biopsy. this allowed the Case Manager to complete the plan of care and the patient was placed at the most appropriate level of care. Assisted in cost effective and expedition of patient care.

31 MISCONCEPTION #5 HIE are a vendor/ehr

32 What is HIE? Clinical Data HIE Hospital Payer Physician Lab/Imaging Center Long-term Care FQHC/CHC Other Healthcare Orgs Data, Services, Value

33 Health Data Sources Physician Hospitals Physician Offices How HIE Produces Value IHIE Health Information Exchange Value-Added Services Clinical Data Repository (INPC ) - MPI & Record Locator Service - Longitudinal Patient View - SSO with patient context Clinical Results Delivery (D4D) - Web-based portal or EMR delivery ACO & Population Health Mgmt. - Clinical Event Notifications (ADT Alerts) - Clinical values report Patient Physician Labs/ Imaging Centers Public Health Public Health Integration and Automation - Bio-surveillance - Communicable Disease Reporting - Immunizations Physician Payers Data Repository Data Stewardship Federal Government Services - SSA Disability Determination - VA s VLER Program Outpatient Rx Meaningful Use Supporting Services - Transitions of Care - Public Health Integration

34 Questions & Discussion Do you have any other conceptions about HIEs? Which of the 5 misconceptions did you identify with? What other challenges might you face in participating in an HIE?

35 Thank you!