This transcript is intended to provide webinar content in an alternate format to aid accessibility. We apologize for any inaudible or unclear content as a result of audio quality. MDH/Stratis Health E-health Toolkit Training Local Public Health Presented by Kari Guida & Dr. Phil Deering * 1-hr 25 min call * January 28, 2014 Kari Guida: Let s get started; I think we have most of our participants with us. Welcome to the MDH Stratis Health E-health Toolkit Training. Your presenters today will be myself, Kari Guida from the Minnesota Department of Health and Dr. Phil Deering from Stratis Health. Today we ll talk you through and share with you the local public health toolkit that s been developed. This toolkit has been developed in response to an ongoing need that we ve heard from local public health to have tools and resources in order to help them engage with their partners and clients and even with each other using E-health. Our agenda for today: I ll talk about E-health in Minnesota and then we ll take time for questions. All questions should be through the chat function. Then there will be two videos that will share with you, people s thoughts and experiences in using the toolkit and the importance of E-health in our practice today. Next, Phil Deering will take time to walk through what the toolkits are, how to use them and strategies to make them most effective. Finally, we ll have questions at the end Today I ll talk about E-health in Minnesota and my goal is to talk about what it means for you. I m thinking of you, in the broad sense. You as a consumer You as a member of the local public health setting, and You as a local public health provider Today we ll touch on a few topics, including: What is E-health? Drivers of E-health? The progress do we see in Minnesota Resources that are available? Key actions you can take as: professional association consumer Stratis Health 952 854-3306 www.stratishealth.org Page 1
E-health is the adoption and effective use of electronic health records (EHRs) and other health information technology, including health information exchange. We use E-health to: Improve healthcare quality, Increase patient safety, Reduce healthcare costs and Enable individuals and communities to make the best possible decisions Using your raise your hand function, which I think everyone can do, I want you to raise your hand if you ve E-healthed lately. Have you had a prescription e-prescribed? Have you ever communicated with a doctor through the Internet via secure email or patient portal? Have you ever received a text message to remind you to take a medication? Have you requested a summary of your clinic visit? Have you used a mobile app or website to track healthy living activities such as water intake, calories, yoga or meditation? If you have then you ve used E-health. As you can tell, E-health is both in our personal and professional lives. We are experiencing this more and more because of the many drivers of E-health. Some of our drivers of E-health, and there are many, but I m only going to focus on three are 1. Triple aim improved consumer experience 2. Improved population health 3. Lower per capita healthcare costs The triple aim has become the focus of health and healthcare. It cannot be done without E-health, which will allow us to do all these things. It will give us tools to assess where we are, to improve the consumer experience and better understand our population health and get at understanding our per capita costs. In addition to the triple aim, we have a big driver of E-health, which is care coordination and care coordination includes the four rights. 1. The right people 2. With the right information 3. At the right time 4. For the right care E-health can help assure all four of those rights have it, that the right person gets it through health information exchange and that it s the right information using standards. That it s at the right time, so it s properly integrated into workflow and that it provides the right care, looking at clinical decision support. So in addition to the triple aim and care coordination, we ve had some policy levers that are pushing E-health in the state of Minnesota and beyond. Two of those policies are: 1. Minnesota 2011 E-prescribing mandate 2. The Minnesota 2015 inter-operable EHR mandate. Both are fairly self-explanatory. The 2011 E-prescribing mandate states that all prescribers, pharmacy s and pharmacy benefit managers need to be E-prescribing by 2011. The 2015 inter-operable EHR mandate says that all providers need to have an inter-operable EHR by January 1, 2015. Stratis Health 952 854-3306 www.stratishealth.org Page 2
The EHR mandate contains two components. Everyone has an EHR Everyone is doing health information exchange so they re achieving that interoperability. There s a third policy, although local public health in Minnesota is currently not eligible for the Federal Meaningful Use Incentive Program, is this program, which provides incentives to eligible professionals and hospitals as they take steps for achieving more Meaningful Use of their EHR. Next, I want to talk about achieving E-health, and we recognize this doesn t happen overnight, because even though there are many drivers, there are also many steps. So, the Minnesota E-health Initiative, which is a public/private collaborative, developed the Minnesota model for adopting inter-operable electronic health records. This model has three high level steps. 1. Adopt 2. Use 3. Exchange You ll hear about these three things repeatedly throughout the presentation. Adoption this means we assess, plan and select Use we implement it and focus on effective use and optimizing it Exchange we have a readiness for exchange and then we are inter-operability So, this framework which has been used for many years helps us to provide guidance for providers in each of those sections, as well as helping us to assess progress and barriers that providers see in these areas of E-health. Where are we in the adoption of EHRs? Minnesota leads the pack. Clinical labs, hospitals and local health departments have extremely high rates of EHR adoption. Then we have clinics around 87%, nursing homes are at 69% and chiropractic offices at 25%. So even though we see a lot of adoption, where we start to see a struggle is how we use our EHRs, because you can t just have an EHR, you must be able to use it. Some examples of how we measure effective use are for hospitals, clinics and nursing homes. If you look at hospitals using medication guides or alerts. Is the patient allergic to it and can it be taken with other medications? Clinics, an example of effective use, and one of my favorites, is using it as a tool to remind providers to help patients achieve preventative care services they need to get, such as: immunizations and mammograms. Finally, following clinical guidelines and making sure that providers have in front of them, the best practices needed to provide the best care for a patient in that situation. So, our adoption and use numbers are exciting and we re becoming very advanced at adoption and use, but is really powerful is when we look at the impact EHRs have on practice. In 2013, we assessed clinics and asked if they were seeing an impact of EHRs in their practice. We show that 67% of practices that they were alerted to potential medical errors. What I believe to be even more significant is that another two-thirds also saw they had enhanced patient care in their clinics. Stratis Health 952 854-3306 www.stratishealth.org Page 3
So, we expect to start seeing this and looking at this in our local health departments as well, and seeing the benefit and impact of using EHRs and any type of E-health. Next is our health information exchange. I will point out two trends we ve seen in health information exchange. First of all, exchange is happening, but it s happening with the partners that you re affiliated with. So, in health systems we see that partners are changing with partners in their health system. The other trend is that providers in a rural area are not as likely to be exchanging as in the more urban areas. However, exchange is happening and it is the last step in getting to inter-operability. I ve used the term inter-operability a few times and I want to take a moment here to step on my soapbox to talk about how there are components of inter-operability. 1. Technical 2. Semantic 3. Process Technical is how it got to me. Semantics, is could I read it when I got it. What is in a language I could understand? Process, was it available to me in a way I could use it at the time when I needed it? Again, when you think about care coordination it s the right people, right time and right information, in order to make the right healthcare decisions. It fits in, so we ll keep stressing the fact that it s not just the technical solution, but we need to make sure we re using standards so everyone can understand it and continue to identify best practices so it works into our process. Now I ll touch on some of the resources that are available at the Minnesota Department of Health. We have five guides that are available. 1. Addressing the barriers to EHR adoption 2. Recommended standards 3. E-prescribing 4. Effective use of EHRs 5. Health information exchange These are all useful, but it s also a lot of pages, so if I was to recommend just one, it would be the health information exchange guide, for two reasons. It gets at the use cases and scenarios on why it s important for us to achieve health information exchange and what it takes to achieve HIE. That way you can see the golden egg of what we re doing. It s the shortest one, so if you re going to focus your time, focus on the number five guide to HIE. Some other resources we have is the guidance for understanding the Minnesota 2015 inter-operable EHR mandates. I also highly recommend this resource and that you take a few minutes to sit down and read through the mandates. Focus on how you and your agency can continue to build how you use E-health, through having an EHR and an inter-operable EHR. Finally, other resources we have available, which Phil will talk about is the E-health HIT toolkits. We recognize that these resources won t meet all your needs, so I strongly encourage you to reach out to MDH staff and Stratis if you have other needs that we can help you with. Stratis Health 952 854-3306 www.stratishealth.org Page 4
Finally, I want to push the three ways that you can become involved in E-health and continue to grow your knowledge. This is how work is going to be done in all of our professions. As a healthcare professional and members of your CHBs in your local health departments. You can continue to collaborate with other organizations in healthcare settings, which local public health has been doing for years. Many of your local health departments were doing it through the HIE e-connectivity grants that were released two years ago and continue to participate in E-health training education committees and work groups. Use, adapt and share E-health tools. We want your feedback on all our resources. You can join and participate in the Minnesota E-health initiative. You can subscribe to our updates, which come out once a week. You can participate in E-health initiative work groups. We have a very strong voice of local public health on our work group center E-health initiative, where they have one spot saved for local public health representation. We had a committee meeting and we had two or three people from local public health there. It s very important that your voices are heard, so we can continue taking into consideration your experiences and needs. Also, your associations, local public health association and even some of your regional groups can continue to achieve our move towards consensus. Many of you have done this by working together to identify your requirements, looking at what policies you need or to create or offer training. I m going to stress this exponentially about watching for and responding to the requests for proposals (RFP) to be released this winter/spring regarding the Minnesota Accountable Health Model (MAH). This is often referred to as SIM because it s funded by Federal SIM dollars. You can find out more about MAH and SIM at the website MN.gov.sim. The three RFPs are: 1. One will be from the office of Health Information Technology as a grant program, looking at how communities can come together to use E-health for accountable care and to participate in the MAH model. 2. We ll be looking at developing E-health roadmaps for four settings that we feel have a need for resources and identified strategies to move towards E-health to participate in accountable care. Long-term and post acute care Local public health Social services Behavioral health All four of those are closely related and often share similar clientele in what local public health does. Watch for that RFP. 3. The third RFP will be looking at some of our privacy and security needs around health information exchange. Stratis Health 952 854-3306 www.stratishealth.org Page 5
Please sign up to receive the alerts, so we can have a strong local public health voice in response to the RFPs. Finally, as a patient, please be engaged in E-health, whether it s using your patient portal or being reminded on your smart phone or mobile device to medicate at the end of the day. Start getting comfortable with E-health, because this is where we re going in our work. If you have any questions, please email the Office of Health Information Technology at mn.ehealth@state.mn.us or visit the website. Please sign up for updates SIM. I think this is a great opportunity for local public health to become engaged when we start thinking about care coordination. We have a few minutes for questions if there are any, otherwise, you know where you can find me either by email or online. At this time there are no questions. This first video is by Pat Adams on the toolkits and E-health for local public health. This material was prepared by Stratis Health, the Quality Improvement Organization for Minnesota, under a contract with the Minnesota Department of Health. Stratis Health 952 854-3306 www.stratishealth.org Page 6