WNY Beacon Communities Enhancing Patient-Based Care and EHR Strategies HCA 626 Healthcare Information Systems Prepared By: Firas Jirjees, Billy McCall, & Jose Michel

Today’s Presentation ■ Introduction ■ Telecare ■ Beacon Community Cooperative Agreement Program ■ Community Impact ■ Health IT Adoption Programs ■ Western New York (WNY) Beacon Community ■ The Future of EHR

Introduction ■ EHR and meaningful use have proven highly effective in improving patient outcomes. ■ The ability to securely record patient data is vital for maintaining consistency, especially for patients who may not have a primary care provider and rely on emergency clinics. ■ Patients without easy access to a doctor still need to keep track of their medical history.

What is Telecare? ■ Recent developments in EHR allow doctors to check in with patients remotely. Patients log their data into interconnected EHR system. Data like blood pressure, blood glucose and weight can be securely stored in the EHR. ■ This “telecare” system is very promising, so doctors in the WNY Beacon Community tested its effectiveness on diabetes patients.

Beacon Community Cooperative Agreement Program ■ 17 communities throughout the United States ■ $250 million over three years from the Office of the National Coordinator for Health IT ■ Health Information Technology to improve health and wellness of their patients ■ Revolutionizing the delivery of healthcare –Health Information Technology –Meaningful Use of Electronic Health Records

Beacon Community Cooperative Agreement Program ■ Primary focus: – Improving health – Quality care – Decreasing cost ■ Developing infrastructure and exchange capabilities to increase quality and efficiency

Community Impact ■ Timely and accurate EHR data is available to providers enabling practice transformation ■ Increasing the accuracy of data exchange to measure community health outcomes ■ Empowering patients to ownership of their health and wellness

Health IT Adoption Programs ■ Western New York (WNY) community program ■ Primary objectives: –Close gaps in patient service –Advance health outcomes for patients with diabetes ■ Three strategic pillars for success: –Building and strengthening the health IT infrastructure –Improving health, quality of care, & reducing cost – Testing innovative approaches

Western New York (WNY) Beacon Community

WNY Beacon Design and Objectives ■ 8 Counties of Western New York –Over 1.5 million people –Mostly rural, except Buffalo –HEALTHeLINK, connectivity more than 40 organizations ■ Beacon Program Objectives –Build, link health IT –Improve health of populations –Test Innovative Strategies (Maloney, 2013; Rein, 2012)

WNY Beacon Objectives ■ Improve outcomes and safety of patients diabetes via meaningful use requirements through use of registries, electronic diabetes guidelines, and strengthening HIE--- Pillar 1 ■ Reducing ER visits, hospitalizations, less 30 day- readmission rates of high-risk patients with diabetes--- Pillar 2 ■ Testing innovative approaches, such as preventative telecare practices, patient portals, medication databases, management---Pillar 3 (WNY Beacon Community, 2012)

Results---Health Information Exchange ■ Facilitated connectivity to: –22 Hospitals equaling 95% of beds –336 Primary Care Physicians (healthIT.gov/wnyfactsheet, 2012) –85 practices –approximately 40, 000 diabetic patients (wnyhealthlink, 2013) ■ Develop EHR based registries diabetic patients, medication databases, reminders, alerts, & clinical decision support tools embedded EHR software

Results--- Outcomes and Measures ■ Number of practices that used registries for at least one year: –57 ■ Overall diabetics patients considered “uncontrolled” down 34% from 38% ■ Hospitalization of WNY Beacon diabetic patients down by 26% by end of program ■ Based on 2008 hospital charge data for high-risk diabetic patients ■ Estimated health savings 18 million/year (wnyhealthelink, 2013)

Results---Innovative Strategies ■ Telecare Telemonitoring Technologies ■ 144 patients enrolled: –In Home Devices –Home Health Nurses Triage daily for all patients –Virtual Health Record Access for Practice –Patient Education ■ Patients reported better understanding, lower BPs, glucose, weight ■ 100% of patient’s with baseline HbA1c > 9 are now < 9 (Maloney, 2013; wnyhealthlink, 2013)

Innovative Strategies, continued ■ Medication Management Program ■ Comprehensive Medication Review ED visit, Hospital, SNF Discharge ■ Increase medication database, use VHR 650% ■ Patient Portals ■ 57 practices implemented portals ■ First year, only 12% patients used portals, year three, up to 55% (healthIT.gov/wnyfactsheet, 2012; wny healthelink, 2013)

Reported Problems ■ Literature almost all positive, but some problems Med Management ■ Providers liked it ■ Easy to understand (5th grade) medication instructions ■ Available in 17 languages and large font for sight- impaired But… ■ Rx database was limited ■ Not accessible from the Electronic Medical Record – Required leaving the EMR to sign onto the Web ■ Duplicate workflow – ordered Rx’s in EMR, then retype in web (Maloney, 2013)

Other Lessons Learned ■ Work w/ Vendor(s) during implementation ■ Quality Assurance Plan developed & implemented ■ Clinical work with Technical at ALL TIMES ■ Make sure Patients have all supplies necessary (story) ■ Provider engagement – dropout rate when provider not engaged ■ Determine & confirm data evaluation measures and ■ methods-prior to program start (Maloney, 2013)

Conclusion ■ Since patient outcomes improved during the study (rates of re-hospitalization and blood glucose levels dropped) we can call the study a victory for meaningful use. ■ Telecare portals were effective in data collection, and patients used them with ease. ■ These findings indicate that greater access and trust in health care can be achieved.

The Future of EHR? ■ EHR and patient-based care are worth considerable future investment. ■ The ability for patients to log and access their health care remotely is empowering. ■ Doctors benefit when a patient can come to them with a complete, verified EHR record rather than a rough list of remembered visits or medications.

References ■ HealthIT.gov (n.d.) “About the Western New York Beacon Community.” Retrieved 07/27/2014 from implementers/western-new-york-beacon- community implementers/western-new-york-beacon- community ■ Maloney, N (2013) “Engaging Patients in Care Using Technology: Lessons Learned from the Beacon Community Program.” Government Health IT Conference. Retrieved 07/30/2014 from ns/2-2.pdf ns/2-2.pdf

References ■ Office of National Coordinator for Health Information Technology (last update 10/02/2012) “Western New York Beacon Community factsheet.” Retrieved 07/27/2014 from eet_westernny.pdf eet_westernny.pdf ■ Rein, A (2012) “The Beacon Community Program: Three Pillars of Pursuit.” Retrieved 07/30/2014 from _1.pdf _1.pdf ■ WNYHealthelink (2013) “The Western New York Beacon Community report.” (2013) Retrieved 07/27/2014 from