1. Health Information Technology for Post Acute Care (HITPAC): Minnesota Project Overview Candy Hanson Program Manager Julie Jacobs HIT Consultant June 13, 2013

2. Objectives Understand the purpose of the HITPAC project Identify benefits of the HITPAC project to Minnesota health care communities and its patient populations Learn about Minnesota’s adoption and use of electronic health records and health information exchange in its skilled nursing facilities

3. Stratis Health Independent, nonprofit, Minnesota-based organization founded in 1971 –Mission: Lead collaboration and innovation in health care quality and safety, and serve as a trusted expert in facilitating improvement for people and communities Working at the intersection of research, policy, and practice

4. The Six Goals of the CMS Quality Strategy Make care safer by reducing harm caused in the delivery of care Strengthen person and family engagement as partners in their care Promote effective communication and coordination of care Promote effective prevention and treatment of chronic disease Work with communities to promote healthy living Make care affordable 1 2 3 4 5 6

5. Our Key Collaborators… Aging Services of MinnesotaCare Providers of MinnesotaCHIC (Community Health Information Collaborative)Minnesota Alliance for Patient SafetyMinnesota Department of HealthLeadingAge /Center for Aging Services TechnologyMinnesota Hospital Association 8

6. Minnesota HITPAC is: Centers for Medicare & Medicaid Services' Special Innovation Project: Health Information Technology for Post-Acute Care Providers (HITPAC). Collaboration between 3 Fairview Hospitals and 10 skilled nursing facilities 5

7. Minnesota HITPAC Communities Community 1A Fairview Ridges Hospital Fairview Southdale Hospital Augustana Minneapolis BHC Innsbruck Ebenezer Ridges Martin Luther St. Gertrude's The Colony of Eden Prairie Community 1B Fairview Lakes Hospital Birchwood Health Care Ecumen North Branch GoldenLiving Rush City Margaret S. Parmly 5

8. TWO MAIN FOCUS AREAS: Transitions of Care Improving Medication Management Electronic Health Record/EHR towards Health Information Exchange/HIE

9. Improve quality and coordination of care through the effective use of health information technology (HIT) during care transitions Leverage standardized patient assessment content to facilitate health information exchange (HIE) with hospitals Reduce medical errors by improving the medication management process through the use of EHR functionality 6

10. Minnesota Environmental Scan Provides a broad brush stroke of the state of Minnesota skilled nursing facilities adoption and use of EHRs Describes EHR Functionality Informs about Health Information Exchange (HIE) possibilities Recommendations for moving forward Link to Minnesota Environmental Scan: http://intranet/c1/10sow/siphitpac/es/MN%20Environ mental%20Scan%20for%20HIT%20PAC%20%20- %20Final%2001_08_13%20(2).pdf http://intranet/c1/10sow/siphitpac/es/MN%20Environ mental%20Scan%20for%20HIT%20PAC%20%20- %20Final%2001_08_13%20(2).pdf

11. Minnesota EHR Adoption & Use 69% Minnesota nursing homes report adopting/using EHR 99% report using EHR to document activities such as MDS assessment 98% report using EHR to document resident demographics 96% report using EHR to document diagnosis or condition list Ref 2011 MDH Nursing home Survey Data

12. Minnesota Nursing Homes with EHRs Medication Management Activities 14% used EHRs for medication reconciliation 62% used alerts for medications 36% used an electronic medication activity record (e-Mar) 3% used e-Prescribing Ref: 2011 MDH Nursing Home Survey Data

13. Care Coordination Toolkit http://www.stratishealth.org/expertise/healthit/caretransitions http://www.stratishealth.org/expertise/healthit/caretransitions

14. Readiness Assessment Interviews

15. Education and Technical Assistance

16. Current and Future State Process Mapping

17. Findings: –Limited Long Term Post Acute Care (LTPAC) EHR functionality Interoperability CCD Medication Reconciliation and e-Prescribing Laws and rules that pre-date EHR use contribute to problematic work flows Hybrid health records (paper/electronic mix)

18. Findings: –LTPAC and Acute Care Facilities: Understanding the needs of each Inconsistent expectations of EHR users Potential points for improving medication administration in current medication reconciliation workflows Privacy and security practices in an electronic health record environment will continue to need attention View-only access to hospitals’ EHR does not solve interoperability issues

19. Next Steps: Early Recommendations –All EHR Vendors should design software that can both generate and consume a Continuity of Care Document (CCD) 225 Data points MDS, OASIS, Interact, other proprietary formats –Configuration and training related to Clinical Decision Support and e-Prescribing tools Medication Libraries Predictive text Electronically generated reports Work flow re-designs to advocate for Computer Physician Order Entry (CPOE) –Best practice around Medication Reconciliation Pharmacy consults EHR CDS

20. Next Steps (continued): Early recommendations -LTPAC facilities consider investing in a “super-user” environment -Financial assistance to help non-EHR LTPAC settings prepare for EHR adoption and use -Financial assistance made available to help LTPAC settings who have EHR in place assess adoption and use and workflow issues

21. Questions? For more information contact: Candy Hanson Program Manager Health Information Technology for Post Acute Care (HITPAC) Stratis Health chanson@stratishealth.org