Transcript What is 4Next

Partners Healthcare
Automating the Transition of Care
Cara Babachicos, CIO, Partners Continuing Care
Maureen Banks, President Partners SNF Division & Director 4Next
March 29, 2007
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Partners Overview:
Who We Are
Major Teaching
Hospitals
Community
Hospitals
Mental Health and
Non-Acute Care
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•
Brigham and Women’s/Faulkner Hospitals
Massachusetts General Hospital
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•
North Shore Medical Center
Newton-Wellesley Hospital
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•
McLean Hospital
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•
•
•
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Spaulding Rehabilitation Hospital
Shaughnessy Kaplan Rehabilitation Hospital
Rehabilitation Hospital of the Cape and Islands
Partners Home Care
Boston Center, North End, Clark House
Who We Are
Physician Practices
and Network
Physician
Organizations
Community
Health Centers
• Partners Community HealthCare, Inc.
• Massachusetts General Physicians Organization
• Brigham & Women’s Physicians Organization
• Brookside Community Health Center
• Charlestown HealthCare Center
• Chelsea HealthCare Center
• MGH Back Bay HealthCare Center
• North End Health Center
• Revere HealthCare Center
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• Southern Jamaica Plain Health Center
Our Employees
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
We have 53,000 employees, providing more jobs than any other non
government employer in Massachusetts

Of these:
– 18,000 are physicians, nurses and direct caregivers
– 13,000 are workers supporting the direct caregivers
– 5,000 are involved primarily in medical research
4NEXT Goals

Goal:
Software tool to help facilitate patient’s discharge and transition into
a non-acute setting
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Focus:
–
–
–
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ROI:
–
–
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Originally: Case Managers
Currently: Case Managers and Liaisons
Future: Case Managers, Liaisons and Staff Nurse
Originally: Shorten LOS in acute hospitals
Currently: Reduce risk of confidentiality breaches
Gold standard for referral
Contribute to National Patient Safety and JCAHO
4NEXT Goals
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
Web-based software product that easily finds appropriate “next” level
of care for our patients

Improve patient safety by communicating the critical, minimum level
of clinical information
–
HIPAA Compliant

Assemble patient information and communicate with multiple
providers simultaneously
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Provide a standard presentation across/from the Partners enterprise
4Next Business Flow
To provide timely web-based information to clinicians in order to facilitate
a smooth discharge and transition into a non-acute setting
Identifying appropriate non acute providers
Facilitating communication
Sharing clinical information
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
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Care
coordination
Prepare
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Match
Non acute
provider
4Next
Correspond
Discharge
Assess
Respond
Search and Sort (Phase I)

Database from CMS, JCAHO and Partners survey (within
New England)
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–
Over 39,611 active non-acute providers
Over 2,159 non-acute providers in New England
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55% have returned Partners more detailed survey of programs
and services
Surveys are on-line for providers to update
Currently used by all acute hospitals at Partners
Currently 10,000 hits per month
Search and Sort
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Transition of Care (TOC Phase II)
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Utilize Search & Sort to select
potential non-acute providers
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View, add and attach electronic and
paper clinical information
Statistics:
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Transmit on-line or fax to potential
providers simultaneously
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Document two-way real time
communication of the patient
referral

Track history
12,000 referrals in
2005
18,719 FY 2006
80% user growth
– Now over 700
users
Over 10,000 website
hits/month
Transition of Care
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Medication List
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High Performance Medicine
7 Essential Data
Elements
Status
Pre-admission
medications
Complete
Allergies
Complete
Physician
Contact
Procedures
Diagnoses
Follow up Plan
Anticoagulation
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Complete
Complete
Case Prep Time
Large Acute Facilities
35.00
30.00
29.69
26.27 26.16
minutes
25.00
20.00
17.72
15.00
24.85
27.76
26.76 27.29
23.26
20.22 21.06
19.07 18.45
27.74
26.46
25.77
25.29 25.74
25.31 25.8825.86
26.93
25.07
24.96
22.72
22.35
23.74
21.70
20.54
19.21
23.51
22.82 22.64
21.90
20.93
20.73 21.44
20.09
18.87
15.15
10.00
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42.59 41.51 40.59
37.11
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12.52 12.90 11.96 11.42
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49.81
36.70
5
Hours
Accept Time
Large Acute Facilities
5.62
4.67
Accept time: Cases going to
Homecare
3.00
2.50
Hours
2.00
1.80
1.78
1.50
1.21
1.00
0.50
1.04
1.24
1.08
1.03
0.86 0.81 0.89
0.72 0.68
0.60
0.58
0.86
0.79
0.65 0.58 0.68 0.70 0.74
0.62
0.58
0.53
0.50
0.41 0.47
0.40
0.39 0.51
0.38 0.44 0.47
0.36 0.43
0.36 0.39 0.44
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Today’s Challenges
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4NEXT necessitates changes in Care Coordination and Nursing
work processes for greatest efficiency
Requires new work process vs. retrofit; may have HR
considerations
Shifts existing relationships with outside facilities with
unknown impact
Best Practice Mandate
Push vs Pull
Ease Creates New Challenges
Non-Acute Referral
Before 4Next TOC
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Non-Acute Referrals
with 4Next TOC
Inbound
Electronic Data
Faxing
Outbound Faxing
Online Two-Way Communication
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Future Scope: 4NexTrac
Partners Patients
Partners Continuing Care Entities
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Patients Outside Partners
Other Non-Acute Facilities
4NexTrac – Non-Acute Referral Tracking and Management Module within
4NEXT that will capture 100% of Non-Acute Referrals from Partners
institutions and other sources to provide a better understanding of referral and
admission trends.
Dashboard to Prioritize Work
For Home Care
New Features
Columns
Case List
Date Selection
Patient Info
1 Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Update Filter
City,
State
From
Medicare A
HomeMedford, MA
MGH
Medicaid
ServiceWaltham, MA
BWH
HMO Blue
HomeBoston, MA
BIDMC
Harvard
Vangaurd
HomeWatertown, MA
NWH
HMO Blue
ServiceBedford, MA
SLM
9/15/2006
RN, RESP
AUTH, CLN
Blue Cross MA
HomeBrookline, MA
MD
Office
9/15/2006
PT, OT
CLN
SOC/
ROC
Services
Progress
9/15/2006
RN
INS
9/15/2006
RN, HHA
ROC 9/15/
2006
ROC 9/15/
2006
Start
Start
Start
Start
Start
Start
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Filters
Insurance
RN, PT, OT,
HHA
Status
INS, CLN,
ORD, AUTH
RN, MEAL, PT
of
of
of
of
of
of
Care
Care
Care
Care
Care
Care
Date
Date
Date
Date
Date
Date
is
is
is
is
is
is
Past Due
Today
Tomorrow
2 days from Now
3 days from Now
4 or more days from Now
Dashboard to Prioritize Work
For Facilities
Spaulding Rehabilitation
Hospital
New Features
Columns
Case List
Date Selection
Patient Info
1 Claus, Santa (M)
DOB: 1/1/1950
Claus, Santa (M)
DOB: 1/1/1950
Update Filter
Filters
Insurance
From
Disch
Date
Medicare A
MGH
Act.
9/15/2006
CHF
BWH
Est.
9/15/2006
STROKE
Multi-Trauma
Medicaid
Claus, Santa (M)
DOB: 1/1/1950
HMO Blue
BIDMC
Est 9/15/
2006
Claus, Santa (M)
DOB: 1/1/1950
Harvard Vangaurd
NWH
Est 9/15/
2006
Claus, Santa (M)
DOB: 1/1/1950
HMO Blue
SLM
9/15/2006
Claus, Santa (M)
DOB: 1/1/1950
Blue Cross MA
MD
Office
9/15/2006
Program
Progress
INS
Status
INS, CLN, ORD,
AUTH
AUTH, CLN
AIDS
CLN
Expected/Actual Discharge Date is Past Due
Expected/Actual Discharge Date is Today
Expected Discharge Date is Tomorrow
Expected Discharge Date is 2 days from now
Expected Discharge Date is 3 days from now
Expected Discharge Date is 4 or more days from now
Screening/Resee Date is Today
Screening/Resee Date is Past Due
Screening/Resee Date is Tomorrow
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Manage Referral
Used by
Intake and
Admitting to
insure
everyone
knows what’s
been done
Transaction History
Manage referral
Facesheet
Allergies
Precautions
Laboratory
Operative notes
Insurance Verified
Yes
No
Orders received
Yes
No
Cinically Cleared
Yes
No
Managed Care Auth
Complete
Yes
No
Yes
No
Patient on Medhold/
Delay
Last Updated: MGupta @ 12/18/06 @ 2:30pm
N/A
Discharge Info
Print options
Site Notes
SAVE
CANCEL
SEND to REG/ADT
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Enter
Review
Referral Referral
Manage
Referral
Interface
Data
Reporting
Statistics
New Function- Interface
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Opportunities
Lab
Schedule Patient
Rad
Admit Patient
Ca
se
M
gm
Web services to 4Next
from Acute data repo’s
Online
Comm via
Fax
server
t
4Next
(add on CM
functionality?)
Source
Admission
Interface
Mobile
Users
of TOC
Mobile workers
entering referrals into
4NexTrac
ACUTE PROCESS
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NON-ACUTE PROCESS
4Next Architecture
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Patient’s Data in 4Next
Online presentation for
Intranet user (Acute)
Manually
entered data
Online presentation for
Internet user (Non-Acute)
Clinical Services
Data (CDR, EMPI,
Meditech, PEAR)
4Next
stored data
Data faxed into 4Next
via Inbound Fax solution
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4Next
Application
Windows presentation for
data operations
Outbound fax to deliver
patients data to facilities
Print service to
local/network printer
(Adobe PDF)
Infrastructure Diagram
Inbound Fax
Intranet
Outbound Fax
Printer
Fax serv er
(FaxCore)
PHS4NFSWEB1
PHS Workstation
Other users
PHS Workstation
4Next user
.
Internet
Printer
Non PHS User
PHSweb87
Printer
clinical services
4Next
SQL
PHSSQL171
SQLServ er2000
OE
Non PHS User
Firewall
XML Service
Access to Internet
via ISP
S
TP
HT
EMPI
Printer
CDR
Common Clinical Applications
Non PHS User
PHSWEB79
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Architecture
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How will the future look?
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