Electronic Referral Management Powered by DirectKansas City Safety Net Providers

Debbie Joyce, Truman Medical CentersLisa Millerd, Samuel U. Rodgers Health Center

Hannah Luetke-Stahlman, MetroCARE of Greater Kansas CityDerek Zaun, Cerner Corporation

Health Care is too Important to Stay the Same

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Powered by Direct - What is Direct?

The Direct Project specifies a simple, secure, scalable, standards-based

transportation mechanism that enables participants to send

encrypted health information directly to known, trusted recipients over the

Internet.

b.wells@direct.aclinic.org h.elthie@direct.ahospital.org

Industry standard, developed in partnership with the federal government, ensuring universal interoperability and security.Direct is a transport protocol for health information exchange that leverages secure email and a trust fabric.Secure email is S/MIME using x.509 digital certificates. (“https:\\”)MIME is standard email messages.Email messages can include structured or unstructured attachments, i.e. CCD, CCR, PDF, JPG, HL7 lab resultshttp://wiki.directproject.org/

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

What is Direct - Simplified

Think of Direct as Electricity or Phone Lines• Phone lines needed before your phone works• Electricity needed for your toaster/radio to work

Simply a secure transportation vehicle• Allows separate organizations to securely and reliably exchange

sensitive information• No custom or expensive interfaces required• Given an address, just like an email address (drbob

@direct.ahospital.org)

Uses for Direct?• It’s not just email• Start with any workflow that involves fax/phone/paper• Ad Hoc communication, Referrals, Results Delivery, HIE

Contribution• No limit to uses, be creative

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

KC Safety Net Providers - Powered by Direct

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Representing KC Safety Net - Who are we?

Truman Medical Centers• An academic health center providing

accessible, state-of-the-art quality healthcare to our community regardless of the ability to pay.

MetroCARE of Greater Kansas City• A charitable non-profit for the residents of

Jackson, Clay and Platte Counties. Connect low-income, uninsured patients to over 850 volunteer physicians in 45 specialties in their private offices.

Samuel U. Rodgers Health Center• A Federally Qualified Health Center providing

quality, compassionate and affordable healthcare for all. Proudly offering translation services in over 30 languages.

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Why Automate Patient Referrals between Providers?

Why electronic referral management?

• Improve the accuracy and timeliness of secure information exchange across disparate providers to reduce the costs and improve the patient experience and health outcome.

• Because our loved ones and ourselves will likely be a patient one day

• Patient stories

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Key Learning Objectives for today

1. Challenges• Understand the challenges of electronically referring

patients between different providers

2. Benefits• Describe problems of traditional fax/phone/paper

methods• Benefits gained by using E-Referrals powered by

Direct

3. Current and Future• Explain how disparate facilities are currently

connecting with Cerner Direct Referrals and the future outlook as Direct adoption expands

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Challenges of E-Referrals between Providers• Patient Privacy – HIPAA

• Secure transfer of PHI is required

• Costs• Connecting disparate systems• Vendor enhancement/upgrade fees• Staff implementation/training costs

• Organizational Differences• Different EMR systems• Different policies and agendas• Requires collaboration and teamwork

approach

SOLUTION must be EMR agnostic, LOW-COST and EASY to use & implement!!

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Problems with traditional phone/fax/paper methods

Inaccurate/Missing data• Data written down wrong over phone or mistyped during

data entry• Fax failed or pages missing on transmission• Paper lost in transit

Was it delivered and who is working on it?• No delivery confirmation with fax delivery• Uncertainty on delivery leads to resubmission/duplicate• Unsure who to contact or if it is being worked on

Manual methods take longer• Manual data entry• Missing information requires phone call

Costs• Fax/Printer maintenance/toner• Paper costs

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Benefits realized thru E-Referrals powered by Direct

HIPAA CompliantSimple• Easy, cost effective implementation• Need only a modern browserEfficient• Communication is greatly improved• Improved turnaround time on appointments• Eliminates time spent on manual paper and fax processes• Easily send results/visit summary (“Close the loop”)• Eliminates use of spreadsheets for tracking referralsImprove Referral Relationships• Delivery is confirmed by receiver and contact person is known• Improves customer service with referring organization • Maintain/increase revenue by increased referrals Patient Care• Improves quality of care and experience for the patient• Accurate and timely information

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Look at the Numbers – RAND Study on E-Referrals 2007-2008

Data Sources:Implementation of an Electronic Referral System for Outpatient Specialty Care

http://www.rand.org/content/dam/rand/pubs/reprints/2012/RAND_RP1433.pdf

• 71.9% of PCPs believed that e-Referral improved overall clinical care

• 89% reported improved tracking of referrals over paper-based

• 73% believed it improved pre-visit work-ups

• Inability of specialist to discern reason for the referral dropped significantly when using e-referral. Only 9.5% of e-referrals were unclear as compared to 38% of paper referrals.

• Use of e-Referrals led to lower rates of follow-up visits for specialty surgical visits (rate of follow-up visits deemed avoidable were lowered by 44.7%)

• Led to decreased wait times for new appointments, presumably by decreases in inappropriate referrals.

RAND Study on E-Referrals 2007-2008

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Current Implementation – Cerner Direct Referrals Portal

Results received at referring provider. Referral loop has been closed and referral is now complete.

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

Future Implementation – Portal + Direct embedded in EMR

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

KC Safety Net Providers - Powered by Direct

© 2012 Cerner Corporation. All rights reserved. This document contains Cerner confidential and/or proprietary information which may not be reproduced or transmitted without the express written consent of Cerner.

What will the next year bring for Direct?

Direct-enabled web portals will play a key part as interim and long-term solutions for interoperability360 Exchange Industry Work Group is helping to shape interoperability standards for referrals and care coordination using Direct secure messagingVendors will develop new Direct-enabled solutions and embed Direct into existing solutions to improve efficiencies in various workflowsTrust between Direct HISP vendors will be more prevalent and make Direct secure messaging ubiquitous

“Increased use of Direct should go a long way toward replacing the slow and inefficient way most providers currently share information via phone, fax, and mail—ultimately improving patient care and outcomes.”

Farzad Mostashari, MD, ScM, ONC National Coordinator for Health Information

TechnologyThe Office of the National Coordinator

for Health Information Technology

Questions?

Debbie Joyce - Truman Medical Centers - debra.joyce@tmcmed.org

Lisa Millerd - Samuel U. Rodgers Health Center - lmillerd@rodgershealth.org

Hannah Luetke-Stahlman - MetroCARE of Greater KC -

hannah@metromedkc.org

Derek Zaun - Cerner Corporation - derek.zaun@cerner.com

Electronic Referral Management powered by Direct