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Multimodal Delivery of Patient Events to Providers

Session #242, February 23, 2017

Vish Anantraman, Chief Information Architect, Northwell Health

Erik Kins, Chief Innovation Officer, Allscripts

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Speaker Introduction

Vish Anantraman, MD, MSChief Information Architect

Northwell Health

• Vish Anantraman received his medical degree from St. John's Medical College in 2000 and a masters in Medical Informatics from the Massachusetts Institute of Technology in 2002. Vish is a system architect for multiple electronic health systems. He leads the vision and development of the Care Management application for population health management. He is also responsible for marketing and product management of complex clinical information technology products.

• Prior to this role, Vish served as the Director of CIS Integration and Analytics for Northwell Health and managed the integration of three EHR implementations in addition to developing a strategy for continuum of care and datawarehousing across the three venues in 13 hospitals.

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Conflict of InterestVish Anantraman, MD, MS

Has no real or apparent conflicts of interest to report.

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Speaker Introduction

Erik KinsChief Innovation Officer

Allscripts• Erik Kins is Allscripts Chief Innovation Officer and oversees

the development and expansion of Allscripts Open Application Programming Interface (API) and other healthcare IT industry integration initiatives, such as SMART and FHIR.

• Erik leads a team that fosters a vibrant developer community known as the Allscripts Developer Program. Erik strives to drive innovation by assessing new technology, and encouraging adoption of emerging trends into Allscripts core products. Erik is also a professional actor and musician.

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Speaker Introduction

Tina JorosVice President, General Manager - Open

Allscripts• Tina is responsible for managing the day to day operations of the

Allscripts Developer Program, from signing new partners via our Developer Portal to marketing the applications and integration built by developers directly to Allscripts clients through the Allscripts Application Store.

• Prior to her role in the Open Business Unit, she held positions on the Business Development and Culture & Talent teams. She also served as Associate General Counsel for Allscripts, with responsibilities for third party contracting and partner management, client contracts, privacy and security issues and other legal matters. Before joining Allscripts, she worked for private law firms handling employment law matters and SEC litigation. Tina holds a Doctor of Jurisprudence degree as well as a Bachelor of Science in Business degree from Indiana University – Bloomington.

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Conflict of InterestErik Kins, BA, International Business, International Relations

Tina Joros, BS, JD

Employee of Allscripts Healthcare

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Agenda

• Complex Healthcare Environments – Northwell

Health

• Information Gaps in Patient Event Notifications

• Beyond Simple Notifications

• Open Platforms and APIs Necessary for Future

Enhancements

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Learning Objectives• Illustrate the complex environment health systems must navigate to

coordinate care among providers using different EHRs

• Demonstrate the value of API calls that allow providers to save discrete data directly into the EHR

• Discuss the future of healthcare information technology and care coordination with widespread adoption of APIs for data exchange and interoperability.

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APIs facilitate provider and patient satisfaction, patient engagement goals

APIs that are well documented, secure, flexible and supported by the vendor or organization providing them are critical to achieving an interoperable healthcare ecosystem of connected applications and devices.

APIs are an effective conduit for facilitating patient status notifications to improve communication with providers and engaging patients, as well as communicating with agencies for population health.

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21 Hospitals

4 Nursing Facilities

450+ Practice Locations

61,000+ Employees

13,600+ Affiliated Physicians

Hofstra Northwell School of Medicine

CareConnect Insurance Company

Feinstein Institute

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Healthcare Transformation Journey

ShareCapture

Understand

Act

Strategic Informatics Platform

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Data Integration

Comprehensive Health Record

Patient Registries

Northwell’s Strategic Informatics Platform

Event Detection Engine

Clinical Decision Support

Data Transmission / Notification

NSLIJ

Systems

JV or Affiliate

Systems

Payer Enrollment &

Claims

NSLIJ

Systems

JV or Affiliate

Systems

Direct Notification

to ProvidersApps

Aggregate data from multiple NSLIJ

sources, partners and affiliates, and

payers

Track patients in registries based on

clinical programs and/or payer-based

programs (e.g. specific risk contracts)

Identify events occurring to patients

such as visits or new clinical changes

Apply business and clinical rules to all

data known about the patient

Push clinical information to providers

assuming care for the patient; send

relevant notifications to clinicians or

case managers around unexpected

encounters or clinical status change

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Event Notifications – A Key Value Based Payment Models

• Improving Care Coordination

– Timely notification to care managers

• Improving Patient Satisfaction

– Notifications to PCPs as part of Patient Centered Medical Home

• Improving Patient Safety

– Delivery of asynchronous clinical decision support across continuum of care

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Simple Events Complex Events

• Admission to ED notifications

• Admission to inpatient notifications

• Admission to non-system facilities

• Discharge from ED

• Discharge from inpatient

• Potential readmission of patient in risk cohort (ED registration)

• Real time high risk of readmission calculation and notification (Discharge)

• Tests resulted after patient discharge

• Missed appointment

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Care Management Notifications• Notification of high risk patients in CMS Bundled payments, NY State

Health Home, CareConnect (full risk), NY State managed Medicaid (full

risk – HealthFirst)

• Goals

– Initiate care management services

– Prevent avoidable ED to inpatient admissions

– Ensure timely follow up post discharge patients

• Mode of delivery

– Simple emails sophisticated information embedded in

notifications

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Email notification - enhanced data

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Regulatory / Patient Satisfaction• Notify primary care provider when patient admitted to inpatient facility

Patient centered medical home

• Notify hospitalists of known patients from faculty practice Increases patient

retention

• House calls program – notice of patient hospitalization reduces

unnecessary doctor visits

• Mode of delivery – Directly into EMRs / emails

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Task Generation Directly to EMR

• Multiple API calls

Determine if admitted patient has relationship with provider –GetPatientAppointments, GetPatientsClinicalData

Task provider – SaveTask,

• Delivers data in the provider workflow , improving utilization

• Trackability for compliance and reporting

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2016 Email Notification Statistics

Total – 189,763

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Beyond Simple Notifications

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Notification Driven Workflow Apps

• Need to follow up on notification events

• Delivering notifications that may after the typical EHR workflow

especially Transition of Care Workflows

– Post Discharge Real time risk stratification and tracking of patients

– Post Discharge Follow up of patients post surgery

– Detection and delivery of clinical decision support across transitions of

care – e.g. Acute Kidney Injury alerts

– Tracking and acting on Tests Resulted After Discharge

• Notification delivered into mini-Apps that extend EMR functionality

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Challenge #1 – Use LACE score to target post discharge followup of High risk patients

• “L” stands for the length of stay of the index admission.

• “A” stands for the acuity of the admission. Specifically, if the patient is admitted

through the Emergency Department vs. an elective admission.

• “C” stands for co-morbidities, incorporating the Charlson Co-Morbidity Index.

• “E” stands for the number of Emergency Department visits within the last 6

months.

• A score of 0 – 4 = Low; 5 – 9 = Moderate; and a score of ≥ 10 = High risk of

readmission.

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The Solution

Patient

Discharge

Discharge Message

(HL7 Engine)Event Screener

(Rules Engine)

Data request (API

based from HIE)LACE Calculation

(Rules Engine)

LACE Program Enrollment

(HIE Program Registry)

Application View

(BPM technology)

Agent places

a call

Interaction

recorded

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LACE App – Main Screen

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Future Appointments – Feedback loop from HIE

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Patient Safety Delivered as a SMART on FHIR APIs

• Early identification of Acute

Kidney Injury

• Leverages historic creatinine

levels using getLabs API

• Uses FHIR APIs to deliver

“asynchronous” alerts

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Open Platforms and

APIs Necessary for Future Enhancements

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API Evolution

Clinical/Financial Rest of the World

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Why providers do not use externally provided electronic patient data

https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-interoperability-

2015.php

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When treating patients, physicians use externally provided electronic patient data:

https://dashboard.healthit.gov/evaluations/data-briefs/non-federal-acute-care-hospital-interoperability-

2015.php

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Types of support needed to effectively utilize APIs

Documentation

Sample Code

Sandboxes

Workshops

Live Resources

FAQs

Online Environment

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Value of selecting supported APIs• Ability to collaborate with EHR Vendor to ensure optimal usage

• Lower cost than other integration options

• Accessible and easier to use, especially when code samples and format allows for various programming languages to be used

• When built by the EHR Vendor, they are specific to the solution and need less customization

• Ability to request enhancements to improve APIs, which results in less customization for each client

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Industry Action Items• Evaluate using APIs for internal projects

• Dedicate technical resources to learn API and attend learning workshops and events

• Demand support from organizations providing APIs

– Complete documentation

– Opportunity to learn/prototype anytime online

– Sandboxes

– Workshops

– Real live people to teach you to use the API and help get questions answered

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APIs facilitate provider and patient satisfaction, patient engagement goals

APIs that are well documented, secure, flexible and supported by the vendor or organization providing them are critical to achieving an interoperable healthcare ecosystem of connected applications and devices.

APIs are an effective conduit for facilitating patient status notifications to improve communication with providers and engaging patients, as well as communicating with agencies for population health.

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Questions

• Tina Joros

• Tina.Joros@allscripts.com

• Follow on Twitter @AllscriptsADP

• developer.allscripts.com

• Vish Anantraman

• Vanantraman@northwell.edu