MiPCT/MiHIN Clinical Data Summary Progress Briefing May, 2015

AGENDA A Look Back: The MiPCT ADT PO Partner Timeline A Look Forward: Adding Clinical Information Discussion and Next Steps

ADTs: From Alert to Care Delivery Alert appears in web-based member listing Care Manager acknowledges Repeat reminders to prompt activity Care Mgr Receives Electronic Alert Care Manager accesses EMR, discharge summary, or any available clinical information, (and if none, contacts patient if appropriate Care Manager communicates with facility discharge planning contacts or via call to patient Care Manager accesses available patient info. Medication reconciliation and TOC activities Identification of patient needs and initiation of follow-up care Bill (G/CPT) if applicable Initiate Near Real Time Transition of Care Activity ADTs: From Alert to Care Delivery

A Look Back: The MiPCT ADT PO Partner Timeline

A Brief History: The MiPCT/MiHIN ADT PO Partner Timeline Recap

MiPCT/MiHIN ADT Notification MiPCT Vendor (Crimson) Health Systems Health Provider Directory Primary Care Care Coordinator Patient Patient to Provider Attribution (ACRES) Care Manager Mapping POs 1) Patient goes to hospital which sends ADT message via substate to MiHIN 2) MiHIN checks MiPCT patient-provider attribution file (ACRES) and matches with ADTs received 3) MiHIN sends matched ADT to MiPCT Vendor (Crimson) 4) MiPCT Vendor (Crimson) matches MiPCT ADTs with PO-provided Care Manager mapping 5) MiPCT Vendor (Crimson) sends ADT to mapped Care Manager

Current Functionality 1) Web-based access to MiPCT member lists 2) Near real-time alerts when patients are hospitalized or discharged

ADT Progress –Alert Contents Beaumont HS Henry Ford HS Message Types All Patient ID / Medical Record (MR) X Patient Name Date of Birth Administrative Sex Address If Available Phone number – home Patient Account Number Patient Death Indicator If Applicable Primary Care Physician (ID, Name) Patient Class IP, ER OBS, IP, ER Assigned Patient Location (Room / Bed) Prior Patient Location N/A Attending Physician (ID, Name) IP Only Referring Physician (ID, Name) Consulting Physician (ID, Name) Admit Source Admitting Physician (ID, Name) Patient Type Discharge Disposition Admit Date Discharge Date Plan ID / Name Group Number Policy Number

Desired Functionality Web-based access to MiPCT member lists Near real-time alerts when patients are hospitalized or discharged Clinical information to facilitate prompt transitions of care

MiPCT PO ADT Users Group Discussion Findings - What Clinical Elements are Key to Successful Care Transitions? Facility (hospital) Length of stay(LOS) with admission and discharge dates Diagnosis code (number and text) Home health agency (name/location of sub-acute facility) if applicable Medications (discharge med list) Recommended follow up from hospital stat/critical labs), outpatient diagnostic testing needed, Specialist follow-up and timeframe(appt date and time if scheduled post discharge, Community referrals made Department/contact phone number of discharge facility to call for detail if needed

A Look Forward: Adding Clinical Information for patients in the MiPCT/MiHIN ADT Partner Project a. MiHIN i. Conformance Reporting ii. Medication Reconciliation b. MDHHS Integrated CareBridge Record

A Look Forward a. MiHIN i. Conformance Reporting ii. Medication Reconciliation

Conformance Reporting

Statewide ADT Notification Trusted Data Sharing Organization (TDSO) Trusted Data Sharing Organization (TDSO) Specialist Patient to Provider Attribution Health Provider Directory Patient Primary Care Care Coordinator 1) Patient goes to hospital which sends message to TDSO then to MiHIN 2) MiHIN checks patient-provider attribution and identifies providers 3) MiHIN retrieves contact and delivery preference for each provider from HPD 4) Notifications routed to providers based on electronic address and preferences Copyright 2015 Michigan Health Information Network Shared Services MiHIN HIE QO Day March 17, 2015

Copyright 2015 Michigan Health Information Network Shared Services ADT Message Quality ADT notification usage has brought attention to the known fact that all ADTs are not created equally ADTs are created with the HL7 specification as a guide, but each ADT source is unique to business needs that may require deviation from the HL7 specification ADT notification usage has increased the request for consistent quality of the message Is your organization getting the request to “Standardize” the ADT messages? Copyright 2015 Michigan Health Information Network Shared Services

Why Conformance Reporting? Reimbursement Driven Improve the quality of the ADT messages Helps users understand and use the message Copyright 2015 Michigan Health Information Network Shared Services

Quality Matters: Enforcing Conformance Hospitals must be ‘all green’ to receive full incentive payments Copyright 2015 Michigan Health Information Network Shared Services

Completeness Matters Too! Certain fields MUST be populated for recipients to utilize Copyright 2015 Michigan Health Information Network Shared Services

Decoding and Mapping Also Matter! Recipients need to understand how to interpret codes in key fields Copyright 2015 Michigan Health Information Network Shared Services

Medication Reconciliation

Payer Incentives for Statewide HIE 2014 2015 2016 Data flow Hospitals – Send ADT notifications to statewide service via MiHIN Providers – Send Patient-Provider Attribution (PPA), receive ADT alerts Integrate ADT, begin Medication Reconciliation Hospitals – Conformance with ADT spec, send Medications Providers – Integrate ADTs into workflow, receive Medications TBD Medications, potentially quality measures Hospital value-based contracts Physician Group Incentive Program (PGIP) Copyright 2015 Michigan Health Information Network Shared Services

Medication Reconciliation value proposition Approximately 1.5 million preventable adverse drug events (ADE’s) occur annually as a result of medication errors, at a cost of more than $3 billion per year. ADEs account for 2.5% of estimated emergency department visits for all unintentional injuries and 6.7% of those leading to hospitalization. Poor communication of medical information at transition points is responsible for: 50% of all medication errors 20% of all adverse drug events 66% of all medication errors resulting in death or major injury Copyright 2015 Michigan Health Information Network Shared Services

Submit-Receive Medication Reconciliation Upon Admission Hospital sends admission notification to care team Care team responds with known medications Upon Discharge Hospital sends discharge notification to care team Hospital sends discharge medication notification to care team Copyright 2015 Michigan Health Information Network Shared Services

Discharge Medication Reconciliation Data Flow MR Data Sharing Organization (DSO) Data Sharing Organization (DSO) Care Coordinator Patient to Provider Attribution Health Provider Directory Primary Care Specialist 1) Patient discharged, hospital sends message to DSO / MiHIN 2) MiHIN checks patient-provider attribution and identifies providers 3) MiHIN retrieves contact and delivery preference for each provider from HPD 4) Medication reconciliation routed to providers based on contact info, preferences Copyright 2015 Michigan Health Information Network Shared Services Copyright 2013 Michigan Health Information Network. All rights reserved. MiHIN Confidential--Proprietary--Restricted

A Look Forward a. MDHHS CareBridge Integrated Record

CareBridge Integrated Record Secure web-based portal where documents and messages can be posted and pushed Operated by ICO with access granted to enrollee and Integrated Care Team (ICT) Components History, issues list, lab results, medications, assessments IICSP (Individual Integrated Care and Supports Plan) Progress notes and status change

3. Discussion and Next Steps

QUESTIONS? On MiPCT ADT User Group: Diane Bechel Marriott (dbechel@umich.edu) 734 998 0390 On MiHIN Conformance Reporting or Medication Reconciliation Data Rick Wilkening, MiHIN Director, Business Development, wilkening@mihin.org Marty Woodruff, MiHIN Director, Production and Operations, woodruff@mihin.org