Patient-Centered Data Home

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1 Patient-Centered Data Home Ensuring Quality Care Across State Lines HealthInsight Annual Quality Conference October 18, 2016

2 Quality Care Without Borders Enabling providers using UHIN s Clinical Health Information Exchange (UT) to securely receive electronic notifications and patient summaries when their patients have an encounter at a hospital in Arizona or Western Colorado s provider network.

3 What is Patient-Centered Data Home? A Patient Centered Data Home (PCDH) is: A patient s comprehensive longitudinal health record, in the Health Information Exchange (HIE) area where the patient resides A cost-effective, scalable method of sharing patient data among HIEs Allows for clinical data to follow patients across state lines or HIE borders no matter where they receive care

4 Principle Behind PCDH Data should wrap around a patient - no matter where they receive care! Simple and cost-effective - based upon existing standards and technologies Scalable HIEs query and push data to one another based on patients ZIP codes listed in ADT messages Through the chie, providers can query/pull information from other HIEs based upon a trigger event or notification of hospital admission Data is available when and where it s needed Data becomes part of record in patients PCDH (home) HIE

5 How PCDH Works Patient receives care at hospital or other source outside their home state

6 Benefits of PCDH Allows information to follow patients who cross state lines for care Provides a cost-effective technology for accessing patient data from another state or regional HIE Builds a more comprehensive, longitudinal patient record in the patient s home HIE or PCDH

7 Who Does PCDH Help? Vacationers Rural residents crossing borders for care Referral patterns not based on geo-political boundaries Snowbirds People seeking care away from home for other reasons Availability of/preference for certain specialty providers Hospital connections Proximity to family/other caregivers

8 Tabletop Discussion How can you use notifications of admissions on your patients (in-state and out-of-state)? What follow-up do you think would be necessary? Are there times that no follow-up is needed? What value would notifications of admissions provide your office/practice?

9 Governance Facilitated by pre-existing relationships between HIEs Consent honored and based upon model of each HIE Legal business associate agreements created

10 Importance of HIE to HIE Sharing Puts patient in the center of his/her care Care provider teams in divergent geographies can coordinate care Better results Lower costs Simple and comprehensive data collection Reduces need for unnecessary duplication (e.g. labs and radiology studies) Better medication management Builds more comprehensive longitudinal patient record

11 Tabletop Discussion If hospital discharge notes and care plans were available when you follow up with patients, how would you incorporate their use in your daily routine?

12 Transparency Patient-centric data Identification of treating providers and facilities Individual HIE not emphasized Patient data wraps around the patient Payers have greater visibility Vested in care management Long-term treatment Work to get patients home Improved care coordination

13 Improved Workflow No workflow interruption Providers receive same notifications they re used to Providers don t do any extra steps to get out-of-state notifications Their work with patients isn t interrupted Greater insight into patient s health Event-triggered notifications Access to more records Reduced time with calls/faces Fewer tests/labs

14 Tabletop Discussion What changes to your office s/practice s workflow would need to occur to handle these notifications? How would you implement them?

15 Scalability / Future Spread the wealth - Add more to the connection Nevada Idaho Wyoming Include other types of notifications Long-term, post-acute care services Medications (such as opioid) Include results delivery

16 Thank You Questions? Teresa Rivera