POLST Registry Vendor Webinar October 8, 2014 10:00 11:00am
Agenda Introduction to Project Team Project Background What Is POLST? Technical Requirements RFI and Technology Vendor Process Key Dates Q&A
Introduction to Project Team California HealthCare Foundation The California HealthCare Foundation works as a catalyst to fulfill the promise of better health care for all Californians. We support ideas and innovations that improve quality, increase efficiency, and lower the costs of care. Kate O Malley, Senior Program Officer Katie Rodriguez, Program Officer Coalition for Compassionate Care of California The Coalition for Compassionate Care of California (CCCC) promotes high quality, compassionate care for all Californians who are seriously ill or approaching the end of life. CCCC is a statewide collaborative of organizations and individuals representing healthcare providers, assisted living facilities, nursing homes, hospices, consumers, state agencies and others. Judy Thomas, Executive Director BluePath Health BluePath Health is a full service, California based health care consulting firm. We partner with government agencies, public health think tanks, health IT companies, providers and payers to develop forward thinking policies and strategies that improve patient care and community health. Our diverse and far reaching industry network provides clients with the connections they need to plan for and adapt to regulatory change, technical innovation and new markets. Timi Leslie, CEO Matt Meyanathan, Consultant John Weir, Technical Consultant BluePath Health Inc.; Client Proprietary and Business Confidential 3
Project Background The California HealthCare Foundation (CHCF) began its investment in POLST program development in 2007 that has state and national impact: Coalition for Compassionate Care of California (CCCC) formed in 2007 as an independent non profit organization that works to facilitate uniform adoption of POLST through a network of 24 local coalitions Statewide POLST Taskforce formed in 2008 California has representation and participates in the National POLST Taskforce efforts In 2013, the CCCC POLST Train the Trainer program reached over 900 participants trained in having the POLST goals of care conversation and how to teach others. A 2012 survey of 286 responding hospitals found that 84% of staff have been educated on POLST. 82% of Skilled Nursing Facility staff has received POLST education and 54% of nursing home residents have a POLST. Phase 1 activities follow the recommendations identified in the Statewide POLST registry feasibility study conducted and completed by BluePath Health in May 2014. Phase 1 major activities include: Conducting a request for information (RFI) process to identify the best fit technology and operations solution and confirm budget assumptions, Working with candidate pilot communities to identify the community that can best fulfill the objectives of the pilot and will commit to sustain the program post pilot phase, and Engaging with state leadership to ensure any pilot development process fits within overall state efforts and has input/guidance from state leadership staff. Phase 1 will inform next steps including initiation of a pilot phase BluePath Health Inc.; Client Proprietary and Business Confidential 4
POLST is patient centered. A POLST registry enables patient wishes to be followed 70% of Californians say they would prefer to die at home. However, in 2009, 42% of deaths in California occurred in a hospital, 32% at home, and 1 18% in a nursing home. POLST improves provider understanding of patient wishes and will change the course of treatment to 2,3,4 better match those wishes. Advance care planning is aligned with the triple aim: better quality, better care, and improved per 5 capita costs. POLST reduces hospitalizations and improves care 6 transitions in California. 1. The Final Chapter, California HealthCare Foundation, April 2012. 2. T. A. Schmidt, et al The Physician Orders for Life Sustaining Treatment Program: Oregon Emergency Medical Technicians Practical Experiences and Attitudes, Journal of the American Geriatrics Society, 2004. 3. S. E. Hickman, et al, A Comparison of Methods to Communicate Treatment Preferences in Nursing Facilities: Traditional Practices Versus the Physician Orders for Life Sustaining Treatment Program, Journal of the American Geriatrics Society, 2010. 4. Erik K. Fromme, et al, POLST Registry Do Not Resuscitate Orders and Other Patient Treatment Preferences, Journal of the American Medical Association, 2012. 5. The Dartmouth Atlas of Health Care, Care of Chronic Illness in the Last Two Years of Life, 2010. 6. http://www.sutterhealth.org/about/news/2012/sutter Health launches innovativeadvanced care program.html. BluePath Health Inc.; Client Proprietary and Business Confidential 5
The POLST form is a tool available among other end of life planning resources POLST Form Durable Power of Attorney for Health Care or living wills Advance Health Care Directive Pre Hospital DNR Form Medallion (Requires completed DNR or POLST form) Physician s Order / Prescription Scope DNR Order Other Interventions Contact Details Choose Health Care Agent Choose Health Care Agent Type of Care DNR Order DNR Order Other Interventions (if POLST) Contact Details (if POLST) DNR Order Patient Type Serious Illness Anyone 18 & Over Anyone 18 & Over Near end of life Near end of life Near end of life Originating Organization EMSA Lawyer Lawyer CMA kit EMSA / CMA Patient Advocates MedicAlert Physician Accessibility Physical proximity or EMR Physical proximity or EMR Physical proximity or EMR Physical proximity or EMR 24/7 with patient Physical proximity or EMR Recognized by EMS? Yes Generally No Dependent on local EMS agency Yes Yes Dependent on local EMS agency BluePath Health Inc.; Client Proprietary and Business Confidential 6
POLST Form (front) BluePath Health Inc.; Client Proprietary and Business Confidential 7 (back)
POLST Project Phases Phases Feasibility Study Phase 1 Potential Pilot Timing January May 2014 August December 2014 Q1 2015 Profiled State Registries and Capture Lessons Learned Conducted Stakeholder Analysis Conducted Options Analysis Conducting a request for information (RFI) process to identify the best fit technology and operations solution and confirm budget assumptions, Establish pilot communities Collaborate with technology vendor to create a prototype Create implementation plan Key Activities Developed Recommendations and Next Steps Working with candidate pilot communities to identify the community that can best fulfill the objectives of the pilot and will commit to sustain the program post pilot phase, and Engaging with state leadership to ensure any pilot development process fits within overall state efforts and has input/guidance from state leadership staff BluePath Health Inc.; Client Proprietary and Business Confidential 8
Phase 1 Informs the Potential Pilot Phase Develop and test product features e.g. Integration with EHR (Web and Direct messaging) Tablet input and access Integrate into current provider and nursing home workflow Determine role of EMS and integration strategy Develop financing model and gain commitment from public/private stakeholders Confirm budget assumptions Educate state leadership and regulators Pilot Selection Criteria 1 Commitment of provider community 2 Coalition resources present in the community 3 Stakeholder demographics in the community 4 EHR Integration 5 Named champion with accountability BluePath Health Inc.; Client Proprietary and Business Confidential 9
Ideal POLST Pilot Community Population Greater than 500,000 Geographical Area Providers Emergency Medical Services Payers ~750 sq. mi. Approximately: (3) Large medical groups (4) Hospitals (19) Skilled nursing facilities (9) Hospice Approximately: (11) Fire substations (1) 911 Responder (9) Medical Transport Local Payers or ACOs engaged that are able to contribute to sustainability planning BluePath Health Inc.; Client Proprietary and Business Confidential 10
Introduction to Other State POLST Models Description Oregon New York West Virginia Utah Oregon operates a POLST form repository receiving forms via mail, fax, HIE, and SFTP Upload (pilot phase) EMS, ED s, and Hospital Acute Care have 24/7 access via call center. Long term care facilities, hospitals, clinics, health systems, hospice, and other users access POLST forms through the Registry back office (M F, 8am 4pm). Hybrid form completion system with repository functionality. emolst forms and associated materials with separate self submit advance directive registry. Providers complete emolst with automatic submission to repository. Individuals submit advance directives through RHIO patient portal. Providers using RHIO, as well as those using electronic medical records with emolst linkage. Form repository: Advance directives, POST forms, surrogate selection checklists, combined medical power of attorney and living wills, and miscellaneous related documents. Providers access through WV Health Information Network. e Directive Registry available to all participating providers. Hybrid form completion system with repository functionality: POLST Forms only. Health care systems, providers access content through aweb based interface. High POLST Registry State Landscape Oregon California Target POLST Adoption West Virginia New York Low Utah Less Advanced Registry Technology Advanced Source: Interviews BluePath Health Inc.; Client Proprietary and Business Confidential 11
Functional Requirements The POLST Paradigm Task Force Registry committee has developed the following technical high level technical requirements to assist states in registry development. Form Entry and Update 1. A searchable database to maintain forms. 2. A mechanism to assure that a large percentage of existing forms is entered into the registry. 3. Timely entry of the forms into the registry. 4. A mechanism to assure accurate entry into the registry. 5. Unique identifier. 6. A mechanism to update the form for a person in the registry when the person voids a present form and completes a new one. 7. A mechanism to identify a deceased person s forms, archive them, and remove them from the searchable portion of the registry. Quality Assurance and Research 1. A quality assurance program that assures that the key components are monitored. 2. Ability to produce de identified reports about forms in the registry. Initial and Ongoing Education about Use of the Registry 1. EMS/ED/Acute Care hospital professionals (users). 2. A mechanism to provide all health care professionals who counsel, complete and sign POLST Paradigm forms (senders) about entry into the Registry. Access to the Forms 1. 24/7 access to the information in the registry by health care professionals such as EMS and acute care hospitals who need them at the time of a crisis. 2. Non urgent access for other health care professionals who are members of the patient s care team. 3. A mechanism that protects the information from unauthorized access. 4. A mechanism that assures correct match of the patient and the form so that the wrong information is not provided. 5. Mechanism for patients, signers and others, as needed, to access information about forms in the registry. Legal Considerations 1. Assurance that the form is HIPAA compliant. 2. A mechanism to assure data security. 3. Definition of who is authorized to enter forms. 4. Review of specific state requirements. 5. Consideration of medical legal concerns for risk management. Source: National POLST Paradigm Task Force, Registry Subcommittee BluePath Health Inc.; Client Proprietary and Business Confidential 13
Pilot and Statewide Requirements for epolst System Functionality Pilot Secure web based completion of POLST forms by qualified providers, including digital signature for provider and patient Secure web based access to POLST forms by qualified providers and registry staff Administration of user accounts and access control for qualified providers and registry staff on a small scale Manual data entry of faxed/scanned POLST forms by registry staff Integration with major EHR products to enable unstructured submission of scanned POLST forms that are collected/stored via EHRs for subsequent manual data entry Analysis/reporting on the contents and use patterns of POLST registry (ad hoc methods) Statewide Roll Out Secure web based completion of POLST forms by qualified providers, including digital signature of provider and patient Secure web based access to POLST forms by qualified providers and registry staff Administration of user accounts and access control for qualified providers and registry staff on a large scale Manual data entry of faxed/sent POLST forms by registry staff Integration with major EHR products to enable: Unstructured submission of scanned POLST forms that are collected/stored via EHRs for subsequent manual data entry Structured submission of POLST forms that are collected/stored via EHRs for automated data entry Streamlined access from EHR to POLST forms stored in registry Culling of POLST forms for deceased patients by automated cross referencing to CA death registry Analysis/reporting on the contents and use patterns of POLST registry (user friendly tools) BluePath Health Inc.; Client Proprietary and Business Confidential 14
Stakeholder workflow analysis indicates different levels of required registry user access User Workflow POLST Transfer Skilled Nursing Facilities Receive patients with POLSTs Can generate POLSTs during admission process Sign POLSTs (Medical Director) Follow POLST orders Helps to transport POLST form with patients POLST Initiator POLST Signer Requires POLST Access X X X X EMS / Fire Service / Ambulance Read & follow POLST Orders when available Adhere to local EMS districts POLST policies Transport POLST patients Helps to transport POLST form with patients X X Hospital ED Receive patients with POLSTs Follow POLST orders Helps to transport POLST form with patients X X Hospice Acute Care Assisted and Residential Living Receive patients with POLSTs Can generate POLSTs during admission process Sign POLSTs (Medical Director) Follow POLST orders Helps to transport POLST with patients Receive patients with POLSTs Can generate & sign POLSTs during admission process Follow POLST Orders Helps to transport POLST with patients Educate patients on location of their POLST form Helps to transport POLST form with patients X X X X X X X X X Primary Care Physician Receive patients with POLSTs Generate POLSTs Sign POLSTs X X X BluePath Health Inc.; Client Proprietary and Business Confidential 15
Registry Capacity: Estimated volume of POLST registrants and forms (yearly) 231,764 125,000 30% Total deaths in CA, 2009 Estimated quantity of POLST appropriate patients at any given time (see below table) Estimate of POLST patients that revise form within a year 165,000 POLST forms to registry assuming full penetration of appropriate patient group Notes: Registrants are expected to be in registry for 1 year Full penetration not expected in year one, but will gradually grow POLST Appropriate Patients: Applicable Deaths by Care Setting, Age, Disease, 2009 Care Setting % Die In NH 18% NH Qty 41,718 % Die in Hospice 2% Hospice Qty 4,635 % Die in Home 32% Home Qty 74,164 Total 120,517 Age 75 84 57,669 Age 85 and over 72,825 Total 130,494 Disease Heart Disease 58,801 Cancer 55,753 Cerebrovascular Disease 13,410 Chronic Respiratory Disease 12,905 Alzheimer 9,882 Diabetes 6,961 Influenza / Pneumonia 6,350 Chronic Liver Disease 4,256 Total 168,318 % Planned 75% Applicable Total 126,239 Source: California Department of Public Health, Death Records; Final Chapter: Californians Attitude Towards Death and Dying, CHCF BluePath Health Inc.; Client Proprietary and Business Confidential 16
RFI Timeline Activity Request for Information released October 2, 2014 Date Informational webinar (including Q&A session) 10:00 11:00 AM Pacific, October 8, 2014 Follow up questions from webinar due October 10, 2014 Questions & Answers posted October 22, 2014 RFI Responses due October 31, 2014 BluePath Health Inc.; Client Proprietary and Business Confidential 17
Resources Organizations: Coalition for Compassionate Care of California http://coalitionccc.org California HealthCare Foundation http://www.chcf.org Reports: Final Chapter: Californians' Attitudes and Experiences with Death and Dying http://www.chcf.org/publications/2012/02/final chapter death dying 2014 POLST Form http://www.chcf.org/~/media/media%20library%20files/pdf/p/pdf%20polstform2014engca.pdf BluePath Health Inc.; Client Proprietary and Business Confidential 18
Q&A Taking questions from the group If you have any follow up questions, please email Glenda Pacha at gpacha@chcf.org BluePath Health Inc.; Client Proprietary and Business Confidential 19
FAQ Is there a set budget for the project? No, the budget has not been determined. The RFI and LOI process will be key inputs into helping to determine the project budget. What timeframe would this need to be developed? A sandbox prototype is expected to be developed in 2 3 months with a first release into a production environment within the first 6 months of the project. We anticipate that the pilot will be running on production level software for at least 12 months the total timespan estimated for the pilot is 18 months. When will the state introduce legislation to implement a state wide POLST registry? Not known at this time. BluePath Health Inc.; Client Proprietary and Business Confidential 20