Promoting Expansion and Innovationin a Mature HIE Network

Care Everywhere Governing Council

Epic Care Everywhere Governing Council• Matthew Eisenberg, MD, FAAP

• Stanford Health Care

• Kevin Isbell, MSHA• Kaiser Permanente

• David Kaelber, MD, PhD, MPH• MetroHealth System

• Andrew Kling• Geisinger Health System

• Steven Lane, MD, MPH, FAAFP• Sutter Health

• Timothy Larson, MD• Mayo Clinic

• Katherine Lusk, MHSM, RHIA• Children’s Health System of Texas

• Dean Miner, MD• Duke University Health System

• James D. Murray, MS, CPHIMS• CVS Health / MinuteClinic

• Marie Ruddy• Nemours Children’s Health System

• Andy Zechnich, MD, MPH• Providence Health & Services

Agenda• The Care Everywhere Network

– Measuring success and opportunities– Promoting best practices

• Not just Epic to Epic exchange• Innovation • Secondary use of CCD data

The Care Everywhere Network

90% of U.S. Populationlives within 30 minutes of a facility using Care Everywhere

As of September 2016

The Care Everywhere Network• 100% of U.S. EpicCare sites are live

• Over 1,200 hospitals and 33,000 clinics covering 186M patients

• Simple “Rules of the Road”

• Participant governed

• Standards-basedhttps://open.epic.com/Clinical/EHRtoEHR

• Regional user group collaboration

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Global Network

Singapore (Future)

Finland (Future)

Lebanon (Future)

Canada (Live)Netherlands (Live)

United States (Live)

Australia (Live)

U.A.E. (2017 Q1)

England (2017 Q1)

Saudi Arabia (Future)

Denmark (Future)

Measuring Success and Opportunities

28% 24% 63% 45%

Patient Record Exchanges per Month

0M

5M

10M

15M

20M

25M

30M

35M

40M

45M

2012 2013 2014 2015 2016 2017

Measuring ImpactBenefits of viewing external data

faster via Care Everywhereper hour of faster access

ED Length of Stay 52.9 min

Est. ED Charges $1,187

Likelihood of:CTMRIX-RayAdmission

2.5 p.p. 1.6 p.p. 2.4 p.p. 2.4 p.p.

Promoting Best Practices

Best Practices

Simplify patient consent

Automatically query for records

Incorporate discrete data into the local record

From: Health information exchange policies of 11 diverse health systems and the associated impact on volume of exchange

J Am Med Inform Assoc. 2016;24(1):113-122. doi:10.1093/jamia/ocw063

Patient Records Exchanged Before/After Consent Requirement Changes

Opt-In/Opt-Out Policies by State - 2013

Opt In Opt Out

Opt-In/Opt-Out Policies by State - 2017

Opt In Opt Out

Discrete Data Reconciliation

Outside information added to the local chart in 2016

Not Just Epic-to-Epic

eHealth Exchange

As of February 2017

Hospitals Using Epic Connected to Government Agencies

0

100

200

300

400

500

2012 2013 2014 2015 2016 2017

Department of Defense

VeteransAffairs

Social Security Administrationhttps://www.ssa.gov/disabilityssi/hit/

A standardized, national-level interoperability frameworkto link all data sharing networks

RLS

How Record Location Services Work1. Patient arrives at clinic

2. Record Locator Service searches the country for the patient’s record

3. A summary is returned and documents are automatically retrieved from other Carequality participants

How Record Location Services Work1. Patient arrives at clinic

2. Record Locator Service searches the country for the patient’s record

3. A summary is returned and documents are automatically retrieved from other Carequality participants

Innovation

A complete patient record? Happy TogetherDiscrete Element C-CDA Other Sources

(e.g. Claims)

Problems

Allergies

Medications

Medication Dispenses

Immunizations

Results

Encounters

Health Maintenance

Questionnaires and assessments

History (social, surgical, family)

Vitals

Procedures

Diagnoses

Risk scores

mage ExchangeI

FHIR Based Provider Directory

Secondary Uses of CCD Data

Using the CCD Med List to Populate MedAction Plan• Customized medication patient instructions• CCDs automatically sent to MedAction Plan portal• Workflow enabled Stanford’s Diabetes Education to become ADA-accredited

CCD Sent to MedAction Plan

Formats intoMed Templates

Provider updates meds in Epic

Verify CCD in MedAction Plan

Clinic Staff prints out schedule for patient

Sending CCDs to VA Third Party Administrators (TPAs)

Use case: When the VA refers a patient externally, the external organization needs to show medical necessity to be paid by TriWest (VA insurer)

Current State With New Development

• External organization manually gathers required encounter information and creates a PDF

• End user faxes or scans/uploads PDF to TriWest

• When payor is TriWest, system automatically sends a direct message to VA upon encounter close

• CCD only contains encounter-level information, as required by HIPAA

Questions?

As of September 2016