Transcript Massache - (S&I) Framework

IMPACT - Connecting
Long Term and Post-Acute
Care Organizations to the
Healthcare System of the
Future
February 2013
Drs. Larry Garber and Terry O’Malley
Agenda
 Problems with care transitions
 What is Long Term and Post-Acute Care
(LTPAC)?
 IMPACT – addressing LTPAC needs
 ONC’s S&I Framework - Developing national
standards for transitions of care datasets
 LAND & SEE – software to facilitate
integrating LTPAC into electronic health
information exchanges (HIE)
2
Communication & Adverse Events
• Poor care coordination increases the chance
that a patient will suffer from a medication
error or other health care mistake by 140%
(Lu, et al., 2011)
• Communication failures between providers
contribute to nearly 70% of medical errors
and adverse events in health care
(Gandhi, et al., 2000)
• 150,000 preventable ADEs ($8 Billion
nationwide wasted) each year occur at the
time of admission due to inadequate
knowledge of outpatient medication history
(Stiell, et al., 2003)
3
Problems With ED Visits
• Physicians in the Emergency Department
(ED) lack important or critical patient
information 32% of the time
• 15% of ED admissions could be avoided
if the ED had outpatient information
(Stiell, et al., 2003)
4
Problems After Hospital Discharge
• 1.5 Million preventable adverse events
annually nationwide from discharge
treatment plans not followed (Forster, et al., 2003)
• When multiple physicians are treating a
patient following a hospital discharge, 78% of
the time information about the patient’s care
is missing (van Walraven, et al., 2008)
• 20% of Medicare patients are readmitted
within 30 days. Preventable readmissions
waste $26B nationwide annually
(McCarthy, et al., 2009)
5
Ambulatory Care is Just as Bad
• 68% of specialists receive no
information from the referring PCP
prior to referral visits
• 25% of PCPs do not receive timely
post-referral information from
specialists (Gandhi, et al., 2000)
6
Is Massachusetts Different?
• Preventable readmissions waste $577
Million in Massachusetts annually
• MA ranks 35th in the nation on
measures of quality relating to
coordination of care, such as
preventable hospitalizations for chronic
conditions and hospital readmissions
(McCarthy, et al., 2009)
7
National care transitions experts
overwhelmingly identified
“improving information flow and
exchange” as the most important
tool to improve care transitions
(ONC, 2011)
8
An Odd Twist of Fate
• 2008 – Economy crashed
• 2009 – ARRA passes, including the Health
Information Technology for Economic and
Clinical Health
– $27 Billion for hospital and MD practice EHRs
– Must use the EHR in a “Meaningful” way,
including improved communication with
others that have EHRs
• But Long Term and Post-Acute Care was
left out!
9
Yet Post-acute Care Costs are
Rising faster than acute care costs
Source: MedPAC, 2011
What is LTPAC?
11
Intensity of Care
High
The Spectrum of Care
Outpt.
Behav.
Health
CBS
Outpt.
Rehab
Adult
Day
Care
Psych
Hospital
Home PACE
Health
Acute
Care
Hospital
Hospice
Facility
Physician Office
Home
Hospice
Outpatient Testing/Pharmacy/DME
Living at Home
Low
Acuity of Illness
High
Adapted from Derr and Wolf, 2012
12
Traditional Long-Term and
Post-Acute Care (LTPAC)
Intensity of Care
High
Home PACE
Health
Hospice
Facility
Home
Hospice
Living at Home
Low
Acuity of Illness
High
Adapted from Derr and Wolf, 2012
13
Intensity of Care
High
IMPACT’s View of LTPAC
Outpt.
Behav.
Health
CBS
Outpt.
Rehab
Adult
Day
Care
Home PACE
Health
Hospice
Facility
Physician Office
Home
Hospice
Outpatient Testing/Pharmacy/DME
Living at Home
Low
Acuity of Illness
High
Adapted from Derr and Wolf, 2012
14
Intensity of Care
High
The Spectrum of Care
Outpt.
Behav.
Health
CBS
Outpt.
Rehab
Adult
Day
Care
Psych
Hospital
Home PACE
Health
Acute
Care
Hospital
Hospice
Facility
Physician Office
Home
Hospice
Outpatient Testing/Pharmacy/DME
Living at Home
Low
Acuity of Illness
High
Adapted from Derr and Wolf, 2012
15
How is LTPAC Different
Than Acute Care or Typical
Office-Base Care?
16
Type of LTPAC Patient
• Closer to end of life
• Greater number of health concerns, meds,
healthcare providers, and care settings
• Reduced cognitive capabilities
• Increased risk of adverse events
• Reduced mobility; increased risk of falls
• Increased transportation issues/costs
• Less financial and social support
• More legal issues
17
Type of LTPAC Organization
• Limited financial and human resources
• Fewer incentives for EHRs or HIE participation
– Less likely to have risk-sharing contracts
– Not part of HITECH/Meaningful Use
• Limited technological infrastructure:
– LAN/WIFI
– IT Security/Policies/Backup/Redundancy
– EHR, if present, likely to be ASP model
• Being asked to care for increasingly more
complex patients
MU’s Impact on LTPAC
• Meaningful Use defines the datasets that
Hospitals send when patients are
discharged
• ~40% of Medicare patients are
discharged to traditional LTPAC settings
(SNF, Home Health, Inpatient Rehab
Facility, etc…)
• These patients are the sickest population
and account for ~80% of Medicare costs
Sources: http://aspe.hhs.gov/health/reports/2011/pacexpanded/index.shtml#ch1
http://www.medpac.gov/documents/Jun11DataBookEntireReport.pdf
19
IMPACT Grant
February 2011 – HHS/ONC awarded
$1.7M HIE Challenge Grant to state of
Massachusetts (MTC/MeHI):
Improving Massachusetts Post-Acute
Care Transfers (IMPACT)
20
IMPACT Objectives & Strategies
• Facilitate developing a national standard
of data elements for transitions across the
continuum of care
• Develop software tools to
acquire/view/edit/send these data
elements (LAND & SEE)
• Integrate and validate tools into
Worcester County using Learning
Collaborative methodology
• Measure outcomes
21
Developing National
Standards to Support
LTPAC Needs
22
Datasets for Care Transitions
• Traditionally – What the sender thinks
is important to the receiver
• Future – Also take into account what
the receiver says they need
23
MA DPH Universal Transfer Form
• Started with DPH’s 3-pg Discharge Form
• Sought input from LTPAC “receivers”
• Reviewed existing forms and datasets:
– MDS
– OASIS
– IRF-PAI
– INTERACT
• Sought expert opinions
• Resulted in 7-page UTF
24
Massachusetts Paper UTF Pilot
25
14x14 Sender (left column) to Receiver (top)
= 196 possibly transition types
Transitions From (Senders)
Inpatient Acute Care Hospital
Emergency Department
Outpatient services
Behavioral Health Inpatient
Long Term Acute Care Hospital
Inpatient Rehab Facility
Skilled Nursing/Extended Care
Home Health Agency
Hospice
Ambulatory Care (PCP, PCMH)
Emergency Medical Services
Behavioral Health Community
Community Based Organizations
Patient/Family
26
Transitions to (Receivers)
In Patient
ED
Outpatient Behavioral
Acute Care
Services
Health
Hospitals
Inpatient
LTAC
IRF
SNF/ECF
HHA
Hospice
Amb Care
EMS
BH
CBOs
Patient/
Community
(PCP)
Services
Family
Prioritize Transitions by Volume, Clinical
Instability and Time-Value of Information
Transitions to (Receivers)
In Patient
ED
Out patient
Transitions From (Senders)
Services
In patient
ED
Out patient services
LTAC
IRF
SNF/ECF
HHA
Hospice
Ambulatory Care (PCP)
CBOs
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=M
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = M
TV = H
V=H
CI = M
TV = H
IRF
SNF/ECF
HHA
Hospice
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = M
TV = H
V=M
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = H
TV = H
V=H
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=L
CI = M
TV = M
V=H
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=H
CI = M
TV = H
V=L
CI = L
TV = L
V=L
CI = L
TV = M
V=M
CI = M
TV = M
V=H
CI = L
TV = H
V=M
CI = M
TV = H
V=L
CI = L
TV = H
V=M
CI = M
TV = H
V=L
CI = M
TV = H
V=M
CI = M
TV = M
V=M
CI = L
TV = L
V=L
CI = L
TV = M
V=L
CI = L
TV = H
V=L
CI = H
TV = H
V=M
CI = H
TV = M
V=L
CI = M
TV = M
V=M
CI = M
TV = M
V=L
CI = M
TV = H
Black circles = highest priority
Green circles = high priority
Patient/Family
27
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=H
CI = H
TV = H
V=L
CI = H
TV = H
V=M
CI = H
TV = H
LTAC
27
Amb Care
(PCP)
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=H
CI = L
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=H
CI = L
TV = M
V=H
CI = L
TV = L
V=L
CI = M
TV = L
V=L
CI = L
TV = M
CBOs
V=H
CI = L
TV = H
V=M
CI = L
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = L
V=M
CI = L
TV = L
V=M
CI = L
TV = M
Patient/
Family
V=H
CI = M
TV = H
V=H
CI = M
TV = H
V=H
CI = L
TV = L
V=H
CI = M
TV = H
V=H
CI = L
TV = H
V=H
CI = L
TV = H
V=H
CI = L
TV = L
V=L
CI = M
TV = M
V=L
CI = L
TV = L
“Receiver” Data Element Survey
•
•
•
•
1135 Transition surveys completed
Largest survey of Receivers’ needs
46 Organizations completing evaluation
12 Different types of user roles
28
11 Types of Organizations
29
12 User Roles
30
Findings from Survey
• Identified for each transition which
data elements are required, optional,
or not needed
• Each of the data elements is valuable
to at least one type of Receiver
• Many data elements are not valuable
in certain care transition
31
A single paper form can’t represent this
variability in data needs
Transitions to (Receivers)
In Patient
ED
Out patient
Transitions From (Senders)
Services
LTAC
IRF
SNF/ECF
HHA
Hospice
In patient
ED
Out patient services
LTAC
IRF
SNF?ECF
HHA
Hospice
Ambulatory Care (PCP)
Black circles = highest priority
Green circles = high priority
CBOs
Patient/Family
32
32
Amb Care
(PCP)
CBOs
Patient/
Family
Five Transition Datasets
1. Report from Outpatient testing,
treatment, or procedure
2. Referral to Outpatient testing, treatment,
or procedure (including for transport)
3. Shared Care Encounter Summary
(Office Visit, Consultation Summary,
Return from the ED to the referring facility)
4. Consultation Request Clinical Summary
(Referral to a consultant or the ED)
5. Permanent or long-term Transfer of Care
to a different facility or care team or Home
Health Agency
33
Five Transition Datasets
Shared Care Encounter Summary:
• Office Visit to PHR
• Consultant to PCP
• ED to PCP, SNF, etc…
Consultation Request:
• PCP to Consultant
• PCP, SNF, etc… to ED
Transfer of Care:
• Hospital to SNF, PCP, HHA, etc…
• SNF, PCP, etc… to HHA
• PCP to new PCP
34
Five Transition Datasets
Transitions to (Receivers)
In Patient
ED
Out patient
Transitions From (Senders)
Services
LTAC
IRF
SNF/ECF
HHA
Hospice
Amb Care
(PCP)
5
3
In patient
ED
1
Out patient services
5
LTAC
IRF
5
SNF?ECF
HHA
Hospice
Ambulatory Care (PCP)
CBOs
Patient/Family
35
5 4 2
CBOs
Patient/
Family
Additional Contributor Input
•State (Massachusetts)
–
–
–
–
–
–
MA Universal Transfer Form workgroup
Boston’s Hebrew Senior Life eTransfer Form
IMPACT learning collaborative participants
MA Coalition for the Prevention of Medical Errors
MA Wound Care Committee
Home Care Alliance of MA (HCA)
–
–
–
–
–
–
–
–
–
–
–
–
–
–
NY’s eMOLST
Multi-State/Multi-Vendor EHR/HIE Interoperability Workgroup
Substance Abuse, Mental Health Services Agency (SAMHSA)
Administration for Community Living (ACL)
Aging Disability Resource Centers (ADRC)
National Council for Community Behavioral Healthcare
National Association for Homecare and Hospice (NAHC)
Transfer of Care & CCD/CDA Consolidation Initiatives (ONC’s S&I Framework)
Longitudinal Coordination of Care Work Group (ONC S&I Framework)
ONC Beacon Communities and LTPAC Workgroups
Assistant Secretary for Planning and Evaluation (ASPE)/Geisinger MDS HIE
Centers for Medicare & Medicaid Services (CMS)(MDS/OASIS/IRF-PAI/CARE)
INTERACT (Interventions to Reduce Acute Care Transfers)
Transfer Forms from Ohio, Rhode Island, New York, and New Jersey
•National
Two Care Plan Datasets
Transfer of Care
Consultation Request
Care Plan
Shared Care
Encounter
Summary
Home Health
Plan of Care
(CMS-485)
37
Situation-specific Data Elements
Variable Base on Situations:
A. Setting
B. Diagnoses
C. Medications
D. Treatments
E. Procedures
A.
B.
C.
D.
E.
38
Care Plan Permeates Datasets
39
How do they compare to CCD?
• 175 element CCD
• 325 element IMPACT for
basic LTPAC needs
• 480+ elements for
Longitudinal
Coordination
of Care
Testing the
IMPACT Dataset
41
Pilot Sites to Test the Datasets
• 9/2011 – Applications sent to 34 organizations
• Selection Criteria:
– High volume of patient transfers with other pilot sites
– Experience with Transitions of Care tools/initiatives
• 16 Winning Pilot Sites:
– St Vincent Hospital and UMass Memorial Healthcare
– Reliant Medical Group (formerly known as Fallon
Clinic) and Family Health Center of Worcester
(FQHC)
– 2 Home Health agencies (VNA Care Network &
Overlook VNA)
– 1 Long Term Acute Care Hospital (Kindred Parkview)
– 1 Inpatient Rehab Facility (Fairlawn)
– 8 Skilled Nursing and Extended Care Facilities
42
Nursing Facility Pilot Sites
•
•
•
•
•
•
•
•
Beaumont Rehabilitation of Westborough
Christopher House of Worcester
Holy Trinity Nursing & Rehab
Jewish Healthcare Center
LifeCare Center of Auburn (+EMR)
Millbury Healthcare Center
Notre Dame LTC
Radius Healthcare Center Worcester
43
IMPACT Learning Collaborative:
Testing the Care Transitions
Datasets
16 organization, 40 participants,
6 meetings over 2 months, and
several hundred patient transfers…
44
Learning Collaborative Surveys
• Surveys directly on envelopes carrying
IMPACT packet, filled out by sender as
well as receiver.
• Online survey at completion of pilot
45
Analyzing data elements helped
46
Senders found the data
47
Receivers got most of their needs
48
Home Care needed even more!
49
Comment from Pilot Site Survey
“While we knew what ED's and
hospitals required, we didn't realize
Home Health Agencies needed much
more than what we typically sent.”
-Skilled Nursing Facility
50
Advancing Interoperable HIE
Identify need
for electronic
HIE
Ballot Needed
Standards
Regular/On-going
communication with CMS,
ONC, HIT Policy and
Standards Committee
regarding need for and status
of standards
Fill gaps in standards:
Work with ONC S&I,
HL7, other Standards
Development
Organizations (SDOs)
51
Identify gaps in
HIE standards
New World of Standards Development
National Coordinator
for Health IT (ONC)
Office of the Deputy
National Coordinator
for Programs & Policy
Office of the Deputy
National Coordinator
for Operations
Office of Policy &
Planning
HIT Policy
Committee Defines
“Meaningful Use”
of EHRs
Office of Science &
Technology (formerly
known as the Office of
Standards and
Interoperability (S&I))
S&I Framework
convenes public
and private experts,
and proposes
HIT/HIE standards
Office of Provider
Adoption Support
Office of State &
Community Programs
52
Office of the Chief
Privacy Officer
IMPACT
Office of Economic
Analysis &
Modeling
HL7 ballots
standards
Office of the Chief
Scientist
Secretary of HHS
makes standards
part of “Meaningful
Use” and EHR
Certification
S&I’s Longitudinal Coordination of Care WG
Longitudinal
Coordination of
Care Workgroup
LTPAC Care
Transition SubWorkgroup
Patient Assessment
Summary SubWorkgroup
•
Identifying the key
business and technical
challenges that inhibit
long-term care data
exchanges
•
Establishing the
standards for the
exchange of Patient
Assessment Summary
(PAS) documents
•
Defining data elements
for LTPAC information
exchange using a single
standard for LTPAC
transfer summaries
•
Providing consultation to
transformation tool being
developed by Geisinger
to transform the noninteroperable MDSv3
and OASIS-C into an
interoperable clinical
document (CCD+)
http://wiki.siframework.org/Longitudinal+Coordination+of+Care
53
• Providing subject matter expertise and
coordination of SWGs
• Developing systems view to identify
interoperability gaps and prioritize activities
Longitudinal Care
Plan SubWorkgroup
•
Near-Term: Developing
an implementation guide
to standardize the
exchange of the Home
Health Plan of Care
(former CMS 485 form)
•
Long-Term: Identify and
develop key functional
requirements and data
sets that would support
a longitudinal care plan
Original S&I ToC Use Case
Scenario 1 - Provider to provider:
User Story 1 - Hospital/ED to PCP
• Discharge Instructions
• Discharge Summary
User Story 2 - Closed Loop Referral
• Consult Request
• Consult Summary
Scenario 2 - Provider to patient:
User Story 1 - Discharge Instructions and Discharge
Summary to patient’s PHR
User Story 2 - Closed Loop Referral where copies of
Consult Request and Consult Summary are sent to
patient’s PHR
54
Relationship to S&I ToC Scenarios
Type 3 Dataset:
• Scenario 1 & 2/User Story 2
Consult Summary
Type 4 Dataset:
• Scenario 1 & 2/User
Story 2 Consult Request
Type 5 Dataset:
• Scenario 1 & 2/User Story 1
55
LTPAC “Poster Child” Scenarios
Type 3 Dataset:
• Scenario 1 & 2/User Story 2
Consult Summary
• ED to SNF
• Anticoagulation
• CHF
Type 4 Dataset:
• Scenario 1 & 2/User
Story 2 Consult Request
• SNF to ED
Type 5 Dataset:
• Scenario 1 & 2/User Story 1
• Hospital to Home Health Agency
• HHA  PCP (HH POC Subset)
S&I Care Plan Use Case
Scenario 1 - Complete handoff of care from the
sending care team to a receiving care team
(Hospital to SNF)
Scenario 2 - Between care team members
during shared care :
User Story 1 – Between PCP and Home Health
Agency for HH Plan of Care (CMS-485)
User Story 2 – Between PCP and outside Physical
Therapist
Scenario 3 – Between providers and patient
57
Timeline for Standards Development
• October 2012
MA HIway go-live in 10 large sites with CCD
and LAND
• February 2013
Preliminary Implementation Guide completed
• May 2013
Pilot electronic Transfer of Care Datasets
between 16 central Massachusetts
organizations using MA HIway, LAND & SEE
• July 2013
Finish Implementation Guides using the
S&I Framework and Lantana, incorporating
pilot feedback
• November 2013 HL7 Balloted/Reconciled/Published
Implementation Guides in Consolidated CDA
58
Getting Connected:
LAND & SEE
59
LAND & SEE
• Sites with EHR or electronic assessment tool
use these applications to enter data elements
– LAND (“Local” Adaptor for Network
Distribution) acts as a data courier to gather,
transform, and securely transfer data if no
support for Direct SMTP/SMIME or IHE XDR
• Non-EHR users complete all of the data fields
and routing using a web browser
to access their “Surrogate EHR
Environment” (SEE)
60
Surrogate EHR Environment (SEE)
• Acts as destination for routed CCD+ documents
• Software hosted by trusted authority, accessed via
web browser
• SEE is accessed via the HIE’s web mailbox
• Non-EHR users able to use SEE to view, edit, send
CDA documents via HIE or Direct to next facility
• Can select document type (e.g. Transfer of Care or
INTERACT SBAR) to display section flags indicating
their optionality
• Can reconcile 2 documents to create a third
• SEE users able to locally print copies of the
documents or subsets of the documents
61
Using SEE for LTPAC Workflows
• SNF patient getting sicker
– Subset of Transfer of Care dataset that is in SBAR
(INTERACT) is flagged for completion by nurse online
– Can re-use data received from hospital
– Can re-use clinical assessment data (function,
cognition, wound) from last MDS
– Completed SBAR printed for chart
• Patient transfer to Emergency Department
– Can re-use hospital, MDS, OASIS or SBAR data
– Multiple users (nurse, social worker, clerk, etc…) can
work on different sections online at same time
– Completed ToC dataset sent electronically to ED
– Subset can be printed for ambulance team
62
LTPAC Communication Today – Paper!
Home Health
Non-standard EHR
OASIS
PCP
Hospital
Billing Program
MDS
Nursing Facility
63
LTPAC Communication with LAND & SEE
LAND & SEE
fill in gaps
Home Health
SEE
Non-standard EHR
OASIS
CCD+
OASIS
LAND
CCD+
Hospital
SEE
CCD+
MDS
Nursing Facility
64
LAND
Billing Program
MDS
CCD+
PCP
The Future with LTPAC EHR Standards
Home Health
EHR
OASIS
CCD+
CCD+
CCD+
Hospital
EHR
MDS
CCD+
Nursing Facility
65
PCP
Advantages of LAND & SEE
• Most role-based authentication uses EHR, using
work that local organizations have already done
• Most users (docs & nurses) only work out of 1
system
• Data re-used whenever possible
• No blended central clinical data repository
• Case/discharge managers or nurses can control
when and where to route documents because
they’re the ones that know when and where!
• Non-EHR users get same HIE transport
functionality as EHR users
• Relatively low-cost to deploy and support
• Easily scalable and replicable
66
Standard Configurations of LAND
Necessary to support some advanced
characteristics of IMPACT:
• MDS XML documents from Nursing
Facilities
• OASIS XML documents from Home
Health agencies
• Expanded data set beyond what is in a
standard CCD
67
Outbound LAND configurations
• Merge a standard CCD and a second XML
document that contains additional data
elements into a “Transfer of Care” CDA
document
• Transform data element transmitted via an
HL7 2.x Results interface from an EHR into
a “Transfer of Care” CDA document
• Transform an MDS XML file into a CCD*
• Transform an OASIS XML file into a CCD*
*Exploring the use of Pennsylvania’s “KeyHIE Transform”
(AKA “The Gobbler”) as cheaper alternative
68
Inbound LAND configurations
• Transform a “Transfer of Care” CDA document
into a free-text document
• Transform a “Transfer of Care” CDA document
into a free-text document and transmit it to an
EHR via an HL7 2.x Transcription interface
• Transform a “Transfer of Care” CDA document
into discrete data elements and transmit them
to an EHR via an HL7 2.x Results interface
• Transform a “Transfer of Care” CDA document
into a standard CCD and a second XML
document that contains additional data
elements
69
Next Steps for Pilot Sites
 Update gap analysis using expanded dataset
 Catalog which data elements are captured (and by whom using what
vocabulary) electronically, on paper, or not at all with current standard
process
 Of those captured electronically (including CCD, MDS & OASIS), identify
process (technology & workflow) to make these available to LAND (for
Phase 2).
 Identify workflow to review new documents in SEE
 Notification by email or text message, and to whom?
 View online vs. print? Who does it and where?
 Can any of the data elements received be electronically filed
discretely for re-use using LAND?
 Identify workflow to update and send SEE document with current info
when discharging to Home Health or ED transfer
 How can standard and non-standard data elements be collected and
added online using SEE to the documents being sent?
 How will copies be printed for patient and ambulance?
 Additional computers, printers, or chairs required?
IMPACT Timeline for Next Steps
Dates
Activity
9/2012 –
3/2013
Integrate pilot sites into state HIE using LAND & SEE
4/2013 –
5/2013
Pilot site Go-lives with state HIE using LAND & SEE
2/2013 –
9/2013
Ballot updated datasets in S&I Framework and HL7
6/2013 –
7/2013
Make SEE available under Open Source License
4/2013 –
9/2013
Evaluate hospital (re)admissions & total cost of care
71
Sharing LAND & SEE
• LAND
– Orion Health’s Rhapsody Integration Engine
http://www.orionhealth.com/solutions/packages/rhapsody
– We’ll make some standard configurations available
• SEE
– Written in JAVA
– Baseline functionality software and source code
that can connect to Orion’s HISP mailbox via API
available for free starting ~July 2013 (Apache
Version 2.0 vs. MIT open source license)
– Innovators can develop and charge for
enhancements, for example:
• Integration with other vendors’ HISP mailboxes
• Automated CDA document reconciliation
72
Disseminating the Seeds
IMPACT Advisory Committee
Massachusetts Care Transitions Forum
Massachusetts QIO (MassPRO)
Another Galaxy
Worcester Galaxy
Another Galaxy
Pilot Sites
Core
Project
Team
Pilot Sites
Pilot Sites
Another Galaxy
Core
IMPACT
Team
73
Core
Project
Team
Pilot Sites
Core
Project
Team
Another Galaxy
Another Galaxy
Pilot Sites
Pilot Sites
Core
Project
Team
Core
Project
Team
Questions?
[email protected]
[email protected]
Bibliography
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•
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•
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Forster AJ, Murff HJ, Peterson JF, Gandhi TK, Bates DW. The Incidence and Severity of
Adverse Events Affecting Patients after Discharge from the Hospital. Annals of Internal
Medicine 138: 161-167. 2003.
Gandhi, Tejal K., Sitting, Dean F., Franklin, Michael, Sussman, Andrew J., Fairchild, David G.,
and David W. Bates. “Communication Breakdown in the Outpatient Referral Process.” Society
of General Internal Medicine (September 2000): 226- 231. doi:10.1046/j.15251497.2000.91119.x. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/.
Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007
Dec;40(6 Suppl):S40-5. Epub 2007 Sep 7.
Lu, C. Y. and E. Roughead. “Determinants of Patient-Reported Medication Errors: A
Comparison Among Seven Countries.” International Journal of Clinical Practice (April 6, 2011):
65: 733–740. doi: 10.1111/j.1742-1241.2011.02671.x.
http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2011.02671.x/pdf.
Overhage JM, McDonald CJ, et al. A randomized, controlled trial of clinical information shared
from another institution. Annals of Emergency Medicine 39[1], 14-23. 2002.
Stiell A, Forster AJ, Stiell IG, van Walraven C. Prevalence of information gaps in the emergency
department and the effect on patient outcomes. CMAJ. 2003 Nov 11;169(10):1023-8.
Van Walraven, C., Seth, R., Austin, P. & Laupacis, A., 2002. Effect of discharge summary
availability during post-discharge visits on hospital readmission. J Gen Intern Med, Volume 17,
pp. 186-92.
Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The Value of
Healthcare Information Exchange and Interoperability. Hlth Aff (Millwood) 2005 Jan-Jun;Suppl
Web Exclusives:W5-10-W5-18.