Diane Thorson Otter Tail County Public Health Director, and Wade Jyrkas, Lake Region Healthcare, CIS Director

Lessons Learned

Partners & their EHR Lake Region Healthcare Clinic-Allscripts Lake Region Healthcare Hospital-McKesson Paragon Lakeland Mental Health Center-Bradoc LB Homes-Point Click Care Lakeland Hospice and Homecare-Brightree PioneerCare-Point Click Care Productive Alternatives-no EHR paper only Otter Tail County Human Services-SSIS Otter Tail County Public Health-PH-Doc State Operated Services Behavioral Health-Netsmart Avatar

MDH Certified HDI s Relay Health (Lake Region Healthcare) DIRECT secure email CONNECT query Personal Health Record CHIC-HIE Bridge Inpriva-DIRECT secure email (all partners) Orion-CONNECT query (OTCPH)

Readiness Assessment 1. EHR functionality Can your EHR create a Continuity of Care Document Has your EHR embedded DIRECT email within their product 2. What is your current workflow to process incoming or outgoing referral information? How could the workflow change to process incoming or outgoing referral information? 3. Identify the most common Use Case Who provides the most referrals to your agency? Where to you send the most referrals from your agency? What information is needed on a referral How can the information be captured from within an EHR to populate other documents such as a CCD, a discharge summary, or other client specific report

Readiness Assessment 1. EHR functionality Can your EHR create a Continuity of Care Document

Readiness Assessment EHR functionality Has your EHR embedded DIRECT email within their product Or Separate address for DIRECT email processing How is the DIRECT email processed within the EHR Drag and drop into an area of the EHR Parse data into the EHR Copy and Paste data into the HER Can you create a PDF of the CCD to send to agencies that do not have an EHR in order to be able to read the document?

Readiness Assessment Workflow What is your current workflow to process incoming or outgoing referral information? How could the workflow change to process incoming or outgoing referral information?

Work Flow Example-Paper Process

Paper Process Continued

Work Flow-Electronic Process

Detox/Mental Health Crisis Unit & Lake Region Healthcare Productive Alternatives does not use an EHR, so DIRECT Messaging from within an EHR is not an option or in the foreseeable future. Specific use cases as the next step: Discussion identified the following use cases: LRHC Emergency Dept patient discharged to PAI Detox LRHC Emergency Dept patient discharged to PAI Crisis Stabilization Unit (CSU) PAI CSU client goes to LRHC Emergency Dept or Bridgeway (LRHC psych beds) Bridgeway patient discharge to PAI CSU Other PAI client interaction with PAI may involve primary care physician questions, recommendations, guidance from PCP, etc

Readiness Assessment Identify the most common Use Case Who provides the most referrals to your agency? Where to you send the most referrals from your agency? What information is needed on a referral How can the information be captured from within an EHR to populate other documents such as a CCD, a discharge summary, or other client specific report

Human Services & Lake Region Healthcare OTC Human Services does not use an EHR, so DIRECT Messaging from within an EHR is not an option or in the foreseeable future for OTC Human Services. Deb noted that DHS is exploring EHRs, but probably no sooner than 3-5 years. Specific use case as the next step: Discussion concluded that that immediate use case Getting the Human Services case manager/care coordinators recorded in LRHC s McKesson system. This is part of demographics, which also feed the Allscripts system in the clinic, and would be used for discharge planning & communication, but would not initially be electronic. This item is on the Human Service SIM dashboard Increase community awareness of clients who have external care coordinators. Notification from LRHC of admits and ED visits. Can the current LRHC ADT feeds to RelayHealth be used for this? Wade said this would be outside of the scope of the current SIM grant, so consider this as part of desired future state.

Mental Health & Lake Region Healthcare Current version of LMHC s Bradoc EHR uses EMR Direct as its HISP (Health Information Service Provider) for built-in DIRECT messaging for CCDs. EMR Direct is not MN-certified, and MDH has confirmed that SIM rant funds cannot be used for a non-certified HIE vendor. Need to be on the latest version to test sending/received CCDs. Specific use cases as the next step. Start with one use case below Discharge from LRHC inpatient of an LMHC client: What forms or information is being sent from LRHC? Is all of it useful? Is information needed that is not being sent? (Discharge instructions can be included in CCD/C-CDA). What triggers sending information to LMHC? What about LRHC discharges that result in referrals for new clients to LMHC?

Long Term Care & Lake Region Healthcare PointClickCare uses Medicity as its HISP (Health Information Service Provider); Harriet and Joe had a call 5/5/15 with Medicity to learn more, and Joe sent followup emails to Medicity and PCC. Medicity is not MNcertified, and MDH has confirmed that SIM grant funds cannot be used for a non-certified HIE vendor. This will also be an issue for Lakeland Mental Health Center, where the Bradoc EHR uses EMR Direct as its HISP, but EMR Direct is not MN-certified. Specific use cases as the next step. Start with first two use cases below what forms or information is being sent? Is all of it useful? Is information needed that is not being sent? Address clinic use cases after these first two: Discharge from LRHC inpatient to Long Term Care Long Term Care resident to LRHC Emergency Dept or inpatient admission

Public Health & Lake Region Healthcare 1. Using Relay Health DIRECT to Communicate with Inpriva DIRECT 2. We have set a goal for discontinuing all faxing of postpartum referrals to OTC starting on July 1, 2015. This provides time for training of staff on the procedure and implementation. In place of Faxing, a CDA document will be fine tuned to include all the fields currently part of the paper form and delivered using DIRECT mail into PH-Doc. These data elements will also be located in one portion of the CDA to make it easier to locate. If there are fields on the existing old form that OTC may think are unnecessary or outdated at this time or new data elements to add, LRHC needs to know that as she builds the new format.

How will it be exchanged? 1. Snail mail 2. Print copy and fax or efax from the EHR-tracking # s if faxes 3. Secure DIRECT email as an attachment-tracking # s of emails 4. Query Option-using CONNECT protocols- Not yet available in our area 5. Patient copies from their Patient Portal and takes to the referral agency

Engage & Activate Individuals & Caregivers Patient Portal Copied records from Mayo Clinic to provide to local provider for follow-up care Telehealth- computer monitoring of BP, WT, and O2 levels Family members note BP readings are high Obtain printout of readings past 30 days for patient to provide to clinician Clinician appointment scheduled with medications changed Faxed Clinician printouts at follow-up visit 30 days later (No HIE option available through that clinic setting)

Engage & Activate Health Providers Providers have access to comprehensive medication histories Sure Scripts interoperability with Electronic Health Record Medications prescribed at specialty hospital in November Medications noted at primary care clinic at follow-up visit in December Providers have ability to communicate/share information within their own organization Comprehensive medication list available at the main clinic, satellite clinic, emergency room, and cancer center

Extend Care Coordination into the Community Providers have access to identified social as well as medical needs One patient referred to Community Paramedic Service Already noted fewer ER visits Will compare costs 6 mos before and 6 mos after start of this community service.

Monitor cohorts & Attributed Populations IHP project 4000+persons Cross referenced IHP population with Clinic/Hospital EHR Looked at variables to identify population for Community Care Coordination BMI>30, A1C between 5.5-6.5, Blood pressure, Tobacco Use, # clinic visits, #ER visits, #hospital admits Behavioral Health as a co-morbidity Narrowed population to approximately 130 persons to offer Community Care Coordination

Privacy and Security

Notice of Privacy Practices

Release of Information

Data Use Agreement Business Use Agreement between Partner organizations being explored. Sample Data use Agreements being explored.

Diane Thorson Wade Jyrkas dthorson@co.ottertail.mn.us wajyrkas@lrhc.org