1. Turning Best Practice into Common Practice Connecting Michigan for Health Lansing, MI June 8, Ewa Matuszewski

2. Daily Census Report One fax from each health plan
No consistency of when information received
Significant delay in sharing admission and discharge information
No information ED visits, DME, Home Health
Limited information on skilled nursing facility and post acute care facility admissions, discharges and transfers

3. Ideal State: A Communication Tool
Provide patient information in real-time “quo vadis”
Patient information
Demographics
Insurance
PO affiliation
PCP attribution
Care manager’s contact information
Patient specific instructions such as re-directing and “note sharing”
These messages are. MiHIN then matches the message to the patient’s Active Care Relationship Service (ACRS) file.

4. Information About ADTs Spreads
“The ADT service is an important piece of improving patient care because provides primary care doctors and their care teams a single access point to timely information regardless of health plan affiliation, where the admission or ED visit occurred.”
Incentives to engage provided by BCBSM
Tom Simmer, MD BCBSM Value Partnership

5. Researching ADTs…
American corporation that provides residential and small business electronic security, fire protection and other related alarm monitoring services, hours a day, 365 days a year
Androgen Deprivation Therapy
Average Daily Traffic Count
Associates Degree for Transfer
Advanced Dvorak Technique
Admissions, Discharges, Transfers

6. Standards Available
There are 51 different types of ADT messages that are used for various trigger events
ADT-A01 – patient admit
ADT-A02 – patient transfer
ADT-A03 – patient discharge
ADT-A04 – patient registration
ADT-A05 – patient pre-admission
ADT-A08 – patient information update
ADT-A11 – cancel patient admit
ADT-A12 – cancel patient transfer
ADT-A13 – cancel patient discharge

7. What and Who We Didn’t Know
In 2014 researched vendors engaged in ADT activity
MiHIN and Qualified Organizations (QO)
ACRS
Entered into an agreement with PatientPing
Tool was officially launched November 2014

8. Ideal System
A healthcare provider would always receive real-time information
when a patient was admitted to a hospital, skilled nursing facility or post acute care facility
when a patient was seen in the ED
when a patient was receiving home care services or durable medical supplies

9. Real-Time Notifications Are Important
Make the system more efficient
Help avoid unnecessary procedures, readmissions, and ED use
Monitor patients that are treated in facilities with which the healthcare professional has no relationship
Reinforce a team-based approach to health care

10. Biggest Challenges Normalizing the data: health systems
Translating data into a format that can be used
Revising workflow to support usability of alerts
Training alert recipients on appropriate routing and follow-up
Evaluating and reporting results for real time improvement

11. Patient Roster CCD available for encounter
CCD available for previous encounters

12. Where Is the Patient
High utilizer flag – 3 ER events in past 60 days 3
High utilizer flag – 5 ER events in past 60 days 5 3

13. On Admission: High Utilizer
High utilizer alert shown on admission

14. CCD List
Set of CCDs available for patient

15. CCD View

16. Alert Frequency
Healthcare professionals can be overwhelmed by receiving too many alerts
ADT-based alerts may be one of many types of alerts in a clinical system: room change, diagnostic testing
End users: Create ADT-based alerts on an appropriate delivery schedule and take into account other alerting workflows

17. How Did We Get Started…
Started small
Education and training

18. Staffing for Success Physician Organization
Medical Management Team: blend of medical assistants, RNs and a medical officer of the day
Clinician of the Day: all care managers are assigned a day to monitor the ADT feed and send “census” report to practice units without an assigned care manager
RN: offsite clinician who reviews PO daily census; tracks crucial information such as lengths of stay, place of stay; communicates outlier information to the medical officer of the day or the PCP; and interacts with SNFs, Home Care Agencies, DME

19. What’s In It For Me? Transition of Care Billing
99495 (Moderate Complexity)
Average reimbursement: $142.96
99496 (High Complexity)
Average reimbursement: $231.11

20. Live Demonstration