Vendor Plan Share, Panel Discussion: Clinical Data Exchange by leveraging the EHR

Transcription

1 A LEADING PROVIDER OF CLINICAL DATA EXCHANGE SOLUTIONS Vendor Plan Share, Panel Discussion: Clinical Data Exchange by leveraging the EHR Jack Redding, Senior Vice President, Sales and Marketing September 21, 2016

2 The Value to Health Plans of Securing EHR Data Real Time Non-Claims Based Current, Retrospective and Bi-directional Hospital/Physician/HIE Clinical Data: Admission, Discharge, and Transfer/ Mobile Alerts Laboratory CCD s -Continuity of Care Documents Discharge Instructions Confidential & Proprietary 2

3 Why EHR Data is important to Health Plans Quality Improved HEDIS scores Attain targeted Star Ratings Reduction in manual chart reviews Reconciliation of discharge instructions Proprietary and Confidential 3

4 Why EHR Data is important to Health Plans Risk Management Increased Risk Adjustment Factors Identification and closure of gaps in care via bi-directional clinical data exchange Member retention Proprietary and Confidential 4

5 Why EHR Data is important to Health Plans Support development of value based contracting Network Management Enable defensible reconciliation of value based contracts Improved clinical coordination with providers Support Quality Payment Programs (MACRA) Proprietary and Confidential 5

6 Why EHR Data is important to Health Plans Maximize member clinical outcomes through quality and coordination of care Clinical Management Real time identification of new diagnoses and exacerbation of existing conditions Reduction in avoidable utilization Proprietary and Confidential 6

7 What EHR Data is Important to Health Plans Positive compliance impacts on 16+ NCQA HEDIS quality measures Lab data increased our performance on HbA1c control by 17.6% Lab data increased our rates on Annual Monitoring for Patients with Persistent Meds from 25 th to almost 90 th percentile of performance Three critical dimensions of life experience Pleasure Engagement Meaning Proprietary and Confidential 7

8 C-CDA Structure HL7 Implementation Guide for CDA Release 2: IHE Health Story Consolidation, Release US Realm Document Templates: 9 Continuity of Care Document (CCD) Consultation Note Diagnostic Imaging Report (DIR) Discharge Summary History and Physical (H&P) Operative Note Procedure Note Progress Note Unstructured Document Section Templates: 60 Document Template Continuity 0f Care Document (CCD) History & Physical (H&P) Allergies Medications Problem List Procedures Results Allergies Medications Problem List Procedures Results Family History Immunizations Assessments Section Template(s) Family History Functional Status Immunizations Medical Equipment Assessment and Plan Plan of Care Social History Vital Signs History of Present Illness History of Present Illness Advance Directives Encounters Plan of Care Payers Chief Complaint Reason for Visit Review of Systems Physical Exam General Status Entry Templates: 82 Proprietary and Confidential 8

9 The Business Problem Status Quo: Limited, Disconnected, Fragmented Clinical Data Exchange Patient health information utilized in care management originates across a diverse range of EHR systems found in practices and health systems Care coordination places demands on a clinical data exchange system s capabilities beyond those of traditional interface engines EHR and other clinical systems typically have no knowledge of the patient as a member of a health plan. Patient insurance information is typically held in registration or financial systems independent of the EHR CDA CCD structure and content vary across EHR systems

10 The Technical Challenge HL7 implemented differently across LIS, ADT, RIS, & EHR vendors Recipients of data typically want updates only, while most EHR systems provide entire patient history on each CCD generation Lab results present a unique set of issues due to the varying hierarchy across the spectrum of test report types Reflex, Micro, AP, Molecular, & Genetics Key data elements needed by an EHR to match a results report or referral data to a patient are often not included in the HL7 or CCD result transmission from the departmental systems

11 VARIABILITY OF CCD IMPLEMENTATION

12 DISCRETE VS READABLE Discrete data in HL7 and CCD often not usable in downstream systems due to multi-dimension structure of some sections Platform provides transformation functionality to support both: Discrete data to structured readable content Readable structured content to discrete data

13 PATIENT FILTERING Patient Identity Management Capability is Key to Addressing Shortcomings of EHR Systems Deterministic matching currently meeting demands of clinical data exchange Option for on-site deployment of first level patient matching and filtering when needed Platform leverages both health plan eligibility information and ADT feeds to accomplish filtering Platform provides capabilities to manage common matching challenges including: Common spellings and typographical errors Nicknames and alternate name spellings Hyphenated names Inconsistent address components Partial data Secondary identifiers like phone and

14 Standardized/Controlled Vocabularies ICD-10 ICD-9 CPT4 LOINC Local lab code LOINC Local lab code CPT4 NDC RxNorm RxNorm Snomed Local provider identifier NPI UCUM Local units of measure SNOMED CT to CPT4 SNOMED CT to ICD(9,10)

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16 Detecting Early Diabetes: Data Sources

17 What are the Discovered Risk Factors? for diagnosis/onset of diabetes two years from now (549 Risk Factors)

18 Clinical Data Secured and Sent in Health Plans Required Format Confidential & Proprietary 18

19 Physician and Hospital CCD Data Exchange Single or Bi-Directional CCD Data From Physician Group to Health Plan and Health Plan back to Physician Group Physician Group EHR System Secure Messages and Files Identity Validation Aggregation, Normalization, Member Match Direct VPN, SFTP Health Plan Proprietary and Confidential 19

20 Halfpenny Technologies Differentiators 16 years of experience Building clinical data exchange solutions Pre-built, standard interfaces for leading healthcare IT systems Vendor Agnostic Work with any designated format Clinical domain expertise Well-versed in standardizing clinical data Single Source for all Clinical Data Lab, ADT, CCD/C-CDA Fully-managed service 24x7x365 Support Sent in Health Plan Required Layout Speed to Execution 20

21 Halfpenny Technologies Team Thank You! Jack Redding SVP, Sales and Marketing Office: x151 Linda Groff VP and GM, Health Plan Market Cell: Patti Milsop Sr. Business Development Executive Office: Cell: Proprietary and Confidential 21