IMPACT - Connecting Long Term and Post-Acute Care Organizations to the Healthcare System of the Future February 2013 Drs. Larry Garber and Terry OMalley.

IMPACT - Connecting Long Term and Post-Acute Care Organizations to the Healthcare System of the

FutureFebruary 2013

Drs. Larry Garber and Terry O’Malley

Agenda

Problems with care transitions

What is Long Term and Post-Acute Care (LTPAC)?

IMPACT – addressing LTPAC needs

ONC’s S&I Framework - Developing national standards for transitions of care datasets

LAND & SEE – software to facilitate integrating LTPAC into electronic health information exchanges (HIE)

2

Communication & Adverse Events

• Poor care coordination increases the chance that a patient will suffer from a medication error or other health care mistake by 140% (Lu, et al., 2011)

• Communication failures between providers contribute to nearly 70% of medical errors and adverse events in health care (Gandhi, et al., 2000)

• 150,000 preventable ADEs ($8 Billion nationwide wasted) each year occur at the time of admission due to inadequate knowledge of outpatient medication history (Stiell, et al., 2003)

3

Problems With ED Visits

• Physicians in the Emergency Department (ED) lack important or critical patient information 32% of the time

• 15% of ED admissions could be avoided if the ED had outpatient information (Stiell, et al., 2003)

4

Problems After Hospital Discharge

• 1.5 Million preventable adverse events annually nationwide from discharge treatment plans not followed (Forster, et al., 2003)

• When multiple physicians are treating a patient following a hospital discharge, 78% of the time information about the patient’s care is missing (van Walraven, et al., 2008)

• 20% of Medicare patients are readmitted within 30 days. Preventable readmissions waste $26B nationwide annually (McCarthy, et al., 2009)

5

Ambulatory Care is Just as Bad

• 68% of specialists receive no information from the referring PCP prior to referral visits

• 25% of PCPs do not receive timely post-referral information from specialists (Gandhi, et al., 2000)

6

Is Massachusetts Different?

• Preventable readmissions waste $577 Million in Massachusetts annually

• MA ranks 35th in the nation on measures of quality relating to coordination of care, such as preventable hospitalizations for chronic conditions and hospital readmissions (McCarthy, et al., 2009)

7

National care transitions experts overwhelmingly identified

“improving information flow and exchange” as the most important tool to improve care transitions

(ONC, 2011)

8

An Odd Twist of Fate

• 2008 – Economy crashed• 2009 – ARRA passes, including the Health

Information Technology for Economic and Clinical Health – $27 Billion for hospital and MD practice EHRs– Must use the EHR in a “Meaningful” way, including

improved communication with others that have EHRs

• But Long Term and Post-Acute Care was left out!

9

Yet Post-acute Care Costs are

Source: MedPAC, 2011

Rising faster than acute care costs

What is LTPAC?

11

Physician Office

12

Living at Home

CBSOutpt. Rehab

Home Health

Adult Day Care

PACE

Assist

Living

Nursing

Home

SNF

LTACH

IRF

Acute Care

Hospital

Emergency Department

Urgent

Care

Psych Hospital

Hospice Facility

Home Hospice

Outpt. Behav. Health

Acuity of Illness

Inte

nsi

ty o

f C

are

Adapted from Derr and Wolf, 2012

Low

High

High

The Spectrum of Care

Outpatient Testing/Pharmacy/DME

13

Living at Home

Home Health

PACE

Assist

Living

Nursing

Home

SNF

LTACH

IRF

Hospice Facility

Home Hospice

Acuity of Illness

Inte

nsi

ty o

f C

are

Adapted from Derr and Wolf, 2012

Low

High

High

Traditional Long-Term and Post-Acute Care (LTPAC)

Physician Office

14

Living at Home

CBSOutpt. Rehab

Home Health

Adult Day Care

PACE

Assist

Living

Nursing

Home

SNF

LTACH

IRF

Urgent

CareHospice Facility

Home Hospice

Outpt. Behav. Health

Acuity of Illness

Inte

nsi

ty o

f C

are

Adapted from Derr and Wolf, 2012

Low

High

High

IMPACT’s View of LTPAC

Outpatient Testing/Pharmacy/DME

Physician Office

15

Living at Home

CBSOutpt. Rehab

Home Health

Adult Day Care

PACE

Assist

Living

Nursing

Home

SNF

LTACH

IRF

Acute Care

Hospital

Emergency Department

Urgent

Care

Psych Hospital

Hospice Facility

Home Hospice

Outpt. Behav. Health

Acuity of Illness

Inte

nsi

ty o

f C

are

Adapted from Derr and Wolf, 2012

Low

High

High

The Spectrum of Care

Outpatient Testing/Pharmacy/DME

How is LTPAC Different Than Acute Care or Typical

Office-Base Care?

16

Type of LTPAC Patient

• Closer to end of life• Greater number of health concerns, meds,

healthcare providers, and care settings• Reduced cognitive capabilities• Increased risk of adverse events• Reduced mobility; increased risk of falls• Increased transportation issues/costs• Less financial and social support• More legal issues

17

Type of LTPAC Organization

• Limited financial and human resources

• Fewer incentives for EHRs or HIE participation – Less likely to have risk-sharing contracts

– Not part of HITECH/Meaningful Use

• Limited technological infrastructure:– LAN/WIFI

– IT Security/Policies/Backup/Redundancy

– EHR, if present, likely to be ASP model

• Being asked to care for increasingly more complex patients

MU’s Impact on LTPAC• Meaningful Use defines the datasets that

Hospitals send when patients are discharged

• ~40% of Medicare patients are discharged to traditional LTPAC settings (SNF, Home Health, Inpatient Rehab Facility, etc…)

• These patients are the sickest population and account for ~80% of Medicare costs

Sources: http://aspe.hhs.gov/health/reports/2011/pacexpanded/index.shtml#ch1

http://www.medpac.gov/documents/Jun11DataBookEntireReport.pdf 19

IMPACT Grant

February 2011 – HHS/ONC awarded $1.7M HIE Challenge Grant to state of Massachusetts (MTC/MeHI):

Improving Massachusetts Post-Acute

Care Transfers (IMPACT)

20

IMPACT Objectives & Strategies

• Facilitate developing a national standard of data elements for transitions across the continuum of care

• Develop software tools to acquire/view/edit/send these data elements (LAND & SEE)

• Integrate and validate tools into Worcester County using Learning Collaborative methodology

• Measure outcomes21

Developing National Standards to Support

LTPAC Needs

22

Datasets for Care Transitions

• Traditionally – What the sender thinks is important to the receiver

• Future – Also take into account what the receiver says they need

23

MA DPH Universal Transfer Form

• Started with DPH’s 3-pg Discharge Form

• Sought input from LTPAC “receivers”

• Reviewed existing forms and datasets:– MDS

– OASIS

– IRF-PAI

– INTERACT

• Sought expert opinions

• Resulted in 7-page UTF24

Massachusetts Paper UTF Pilot

25

26

14x14 Sender (left column) to Receiver (top) = 196 possibly transition types

Transitions to (Receivers)In Patient ED Outpatient Behavioral LTAC IRF SNF/ECF HHA Hospice Amb Care EMS BH CBOs Patient/

Acute Care Services Health CommunityTransitions From (Senders) Hospitals Inpatient (PCP) Services Family

Inpatient Acute Care Hospital

Emergency Department

Outpatient services

Behavioral Health Inpatient

Long Term Acute Care Hospital

Inpatient Rehab Facility

Skilled Nursing/Extended Care

Home Health Agency

Hospice

Ambulatory Care (PCP, PCMH)

Emergency Medical Services

Behavioral Health Community

Community Based Organizations

Patient/Family

27

Transitions to (Receivers)In Patient ED Out patient LTAC IRF SNF/ECF HHA Hospice Amb Care CBOs Patient/

Transitions From (Senders) Services (PCP) FamilyV = H V = H V = H V = H V = H V = H V = H V = H

In patient CI = H CI = H CI = M CI = M CI = L CI = M CI = L CI = MTV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = HV = H V = H V = H V = H V = M V = H V = M V = H

ED CI = H CI = H CI = H CI = M CI = M CI = L CI = L CI = MTV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = HV = H V = H V = H V = H V = L V = H V = H

Out patient services CI = H CI = M CI = M CI = M CI = L CI = L CI = LTV = H TV = H TV = H TV = H TV = H TV = H TV = L

V = H V = H V = H V = M V = H V = H V = M V = H V = H V = HLTAC CI = H CI = H CI = H CI = M CI = M CI = M CI = M CI = M CI = M CI = M

TV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = HV = H V = H V = H V = L V = H V = H V = L V = H V = H V = H

IRF CI = H CI = H CI = M CI = H CI = L CI = L CI = M CI = L CI = L CI = LTV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = H TV = HV = H V = H V = H V = M V = L V = L V = H V = M V = H V = H V = H

SNF/ECF CI = H CI = H CI = M CI = H CI = M CI = M CI = M CI = M CI = L CI = M CI = LTV = H TV = H TV = H TV = M TV = M TV = M TV = H TV = M TV = M TV = H TV = HV = H V = H V = L V = M V = H V = H V = H

HHA CI = H CI = H CI = L CI = L CI = L CI = L CI = LTV = H TV = H TV = L TV = L TV = L TV = L TV = LV = L V = M V = M V = L V = L V = L V = M V = L

Hospice CI = H CI = H CI = M CI = L CI = L CI = M CI = L CI = MTV = H TV = H TV = M TV = M TV = M TV = L TV = L TV = MV = M V = H V = L V = M V = L V = L V = M V = L

Ambulatory Care (PCP) CI = H CI = H CI = M CI = M CI = L CI = L CI = L CI = LTV = H TV = H TV = H TV = M TV = H TV = M TV = M TV = L

CBOs

Patient/Family

Prioritize Transitions by Volume, Clinical Instability and Time-Value of Information

Black circles = highest priority Green circles = high priority

27

“Receiver” Data Element Survey

28

• 1135 Transition surveys completed

• Largest survey of Receivers’ needs

• 46 Organizations completing evaluation

• 12 Different types of user roles

11 Types of Organizations

29

12 User Roles

30

Findings from Survey

• Identified for each transition which data elements are required, optional, or not needed

• Each of the data elements is valuable to at least one type of Receiver

• Many data elements are not valuable in certain care transition

31

32

Transitions to (Receivers)

In Patient ED Out patient LTAC IRF SNF/ECF HHA Hospice Amb Care CBOs Patient/Transitions From (Senders) Services (PCP) Family

In patient

ED

Out patient services

LTAC

IRF

SNF?ECF

HHA

Hospice

Ambulatory Care (PCP)

CBOs

Patient/Family

Black circles = highest priorityGreen circles = high priority

A single paper form can’t represent this variability in data needs

32

1. Report from Outpatient testing, treatment, or procedure

2. Referral to Outpatient testing, treatment, or procedure (including for transport)

3. Shared Care Encounter Summary (Office Visit, Consultation Summary, Return from the ED to the referring facility)

4. Consultation Request Clinical Summary (Referral to a consultant or the ED)

5. Permanent or long-term Transfer of Care to a different facility or care team or Home Health Agency

33

Five Transition Datasets

34

Shared Care Encounter Summary:•Office Visit to PHR•Consultant to PCP•ED to PCP, SNF, etc…

Consultation Request:•PCP to Consultant•PCP, SNF, etc… to ED

Transfer of Care:•Hospital to SNF, PCP, HHA, etc…•SNF, PCP, etc… to HHA•PCP to new PCP

Five Transition Datasets

Transitions to (Receivers)

In Patient ED Out patient LTAC IRF SNF/ECF HHA Hospice Amb Care CBOs Patient/Transitions From (Senders) Services (PCP) Family

In patient

ED

Out patient services

LTAC

IRF

SNF?ECF

HHA

Hospice

Ambulatory Care (PCP)

CBOs

Patient/Family35

3

5

5

5

51

Five Transition Datasets

Additional Contributor Input•State (Massachusetts)– MA Universal Transfer Form workgroup– Boston’s Hebrew Senior Life eTransfer Form– IMPACT learning collaborative participants– MA Coalition for the Prevention of Medical Errors – MA Wound Care Committee– Home Care Alliance of MA (HCA)

•National– NY’s eMOLST– Multi-State/Multi-Vendor EHR/HIE Interoperability Workgroup– Substance Abuse, Mental Health Services Agency (SAMHSA)– Administration for Community Living (ACL)– Aging Disability Resource Centers (ADRC)– National Council for Community Behavioral Healthcare– National Association for Homecare and Hospice (NAHC)– Transfer of Care & CCD/CDA Consolidation Initiatives (ONC’s S&I Framework) – Longitudinal Coordination of Care Work Group (ONC S&I Framework)– ONC Beacon Communities and LTPAC Workgroups– Assistant Secretary for Planning and Evaluation (ASPE)/Geisinger MDS HIE– Centers for Medicare & Medicaid Services (CMS)(MDS/OASIS/IRF-PAI/CARE)– INTERACT (Interventions to Reduce Acute Care Transfers)– Transfer Forms from Ohio, Rhode Island, New York, and New Jersey

37

Two Care Plan Datasets

A.

B.

C.

D.

E.

38

Situation-specific Data Elements

Variable Base on Situations:A.SettingB.DiagnosesC.MedicationsD.TreatmentsE.Procedures

39

Care Plan Permeates Datasets

How do they compare to CCD?• 175 element CCD

• 325 element IMPACT forbasic LTPAC needs

• 480+ elements forLongitudinalCoordination of Care

Testing the

IMPACT Dataset

41

Pilot Sites to Test the Datasets• 9/2011 – Applications sent to 34 organizations• Selection Criteria:

– High volume of patient transfers with other pilot sites– Experience with Transitions of Care tools/initiatives

• 16 Winning Pilot Sites:– St Vincent Hospital and UMass Memorial Healthcare– Reliant Medical Group (formerly known as Fallon

Clinic) and Family Health Center of Worcester (FQHC)

– 2 Home Health agencies (VNA Care Network & Overlook VNA)

– 1 Long Term Acute Care Hospital (Kindred Parkview)– 1 Inpatient Rehab Facility (Fairlawn)– 8 Skilled Nursing and Extended Care Facilities

42

Nursing Facility Pilot Sites• Beaumont Rehabilitation of Westborough• Christopher House of Worcester• Holy Trinity Nursing & Rehab• Jewish Healthcare Center • LifeCare Center of Auburn (+EMR)• Millbury Healthcare Center• Notre Dame LTC• Radius Healthcare Center Worcester

43

44

IMPACT Learning Collaborative:Testing the Care Transitions

Datasets

16 organization, 40 participants, 6 meetings over 2 months, and

several hundred patient transfers…

Learning Collaborative Surveys

• Surveys directly on envelopes carrying IMPACT packet, filled out by sender as well as receiver.

• Online survey at completion of pilot45

Analyzing data elements helped

46

Senders found the data

47

Receivers got most of their needs

48

Home Care needed even more!

49

Comment from Pilot Site Survey

50

“While we knew what ED's and hospitals required, we didn't realize

Home Health Agencies needed much more than what we typically sent.”

-Skilled Nursing Facility

Advancing Interoperable HIE

51

Regular/On-going communication with CMS,

ONC, HIT Policy and Standards Committee

regarding need for and status of standards

Office of the Chief Scientist

Office of the Chief Scientist

National Coordinator for Health IT (ONC)

Office of the Deputy National Coordinator

for Operations

Office of the Deputy National Coordinator

for Operations

Office of the Chief Privacy Officer

Office of the Chief Privacy Officer

Office of Economic Analysis & Modeling

Office of the Deputy National Coordinator for Programs & Policy

Office of the Deputy National Coordinator for Programs & Policy

Office of Policy & Planning

Office of Policy & Planning

Office of Science & Technology (formerly known as the Office of

Standards and Interoperability (S&I))

Office of Science & Technology (formerly known as the Office of

Standards and Interoperability (S&I))

Office of Provider Adoption Support

Office of State & Community Programs

52

S&I Framework convenes public

and private experts, and proposes

HIT/HIE standards

HL7 ballots standards

Secretary of HHS makes standards

part of “Meaningful Use” and EHR Certification

IMPACT

HIT Policy Committee Defines “Meaningful Use”

of EHRs

New World of Standards Development

Longitudinal Coordination of Care Workgroup

Longitudinal Coordination of Care Workgroup

Patient Assessment Summary Sub-

Workgroup

Patient Assessment Summary Sub-

Workgroup

LTPAC Care Transition Sub-

Workgroup

LTPAC Care Transition Sub-

Workgroup

Longitudinal Care Plan Sub-

Workgroup

Longitudinal Care Plan Sub-

Workgroup

• Providing subject matter expertise and coordination of SWGs

• Developing systems view to identify interoperability gaps and prioritize activities

• Establishing the standards for the exchange of Patient Assessment Summary (PAS) documents

• Providing consultation to transformation tool being developed by Geisinger to transform the non-interoperable MDSv3 and OASIS-C into an interoperable clinical document (CCD+)

• Identifying the key business and technical challenges that inhibit long-term care data exchanges

• Defining data elements for LTPAC information exchange using a single standard for LTPAC transfer summaries

• Near-Term: Developing an implementation guide to standardize the exchange of the Home Health Plan of Care (former CMS 485 form)

• Long-Term: Identify and develop key functional requirements and data sets that would support a longitudinal care plan

S&I’s Longitudinal Coordination of Care WG

53http://wiki.siframework.org/Longitudinal+Coordination+of+Care

Original S&I ToC Use Case

Scenario 1 - Provider to provider: User Story 1 - Hospital/ED to PCP

• Discharge Instructions• Discharge Summary

User Story 2 - Closed Loop Referral • Consult Request• Consult Summary

Scenario 2 - Provider to patient:User Story 1 - Discharge Instructions and Discharge Summary to patient’s PHRUser Story 2 - Closed Loop Referral where copies of Consult Request and Consult Summary are sent to patient’s PHR

54

55

Relationship to S&I ToC Scenarios

Type 3 Dataset:•Scenario 1 & 2/User Story 2 Consult Summary

Type 5 Dataset:•Scenario 1 & 2/User Story 1

Type 4 Dataset:•Scenario 1 & 2/User Story 2 Consult Request

56

LTPAC “Poster Child” Scenarios

Type 3 Dataset:•Scenario 1 & 2/User Story 2 Consult Summary•ED to SNF

Type 4 Dataset:•Scenario 1 & 2/User Story 2 Consult Request•SNF to ED

Type 5 Dataset:•Scenario 1 & 2/User Story 1•Hospital to Home Health Agency•HHA PCP (HH POC Subset)

• Anticoagulation• CHF

S&I Care Plan Use Case

Scenario 1 - Complete handoff of care from the sending care team to a receiving care team (Hospital to SNF)

Scenario 2 - Between care team members during shared care :

User Story 1 – Between PCP and Home Health Agency for HH Plan of Care (CMS-485)

User Story 2 – Between PCP and outside Physical Therapist

Scenario 3 – Between providers and patient57

Timeline for Standards Development• October 2012 MA HIway go-live in 10 large sites with CCD

and LAND

• February 2013 Preliminary Implementation Guide completed

• May 2013 Pilot electronic Transfer of Care Datasets between 16 central Massachusetts organizations using MA HIway, LAND & SEE

• July 2013 Finish Implementation Guides using the S&I Framework and Lantana, incorporating pilot feedback

• November 2013 HL7 Balloted/Reconciled/Published Implementation Guides in Consolidated CDA

58

Getting Connected:LAND & SEE

59

LAND & SEE• Sites with EHR or electronic assessment tool

use these applications to enter data elements–LAND (“Local” Adaptor for Network

Distribution) acts as a data courier to gather, transform, and securely transfer data if no support for Direct SMTP/SMIME or IHE XDR

• Non-EHR users complete all of the data fields and routing using a web browser

to access their “Surrogate EHR Environment” (SEE)

60

Surrogate EHR Environment (SEE)

• Acts as destination for routed CCD+ documents• Software hosted by trusted authority, accessed via

web browser• SEE is accessed via the HIE’s web mailbox• Non-EHR users able to use SEE to view, edit, send

CDA documents via HIE or Direct to next facility• Can select document type (e.g. Transfer of Care or

INTERACT SBAR) to display section flags indicating their optionality

• Can reconcile 2 documents to create a third• SEE users able to locally print copies of the

documents or subsets of the documents

61

Using SEE for LTPAC Workflows• SNF patient getting sicker

– Subset of Transfer of Care dataset that is in SBAR (INTERACT) is flagged for completion by nurse online

– Can re-use data received from hospital– Can re-use clinical assessment data (function,

cognition, wound) from last MDS– Completed SBAR printed for chart

• Patient transfer to Emergency Department– Can re-use hospital, MDS, OASIS or SBAR data– Multiple users (nurse, social worker, clerk, etc…) can

work on different sections online at same time– Completed ToC dataset sent electronically to ED– Subset can be printed for ambulance team

62

63

Hospital

Home Health

PCP

Non-standard EHR OASIS

Nursing Facility

Billing Program MDS

LTPAC Communication Today – Paper!

64

Hospital

Home Health

PCP

SEE CCD+

OASIS

Non-standard EHR OASIS

LAND

SEE CCD+

MDS

Billing Program MDS

LAND

CCD+

CCD+

LAND & SEEfill in gaps

LTPAC Communication with LAND & SEE

Nursing Facility

The Future with LTPAC EHR Standards

65

Hospital

Home Health

PCP

CCD+

CCD+

EHR MDS

CCD+

EHR OASIS

CCD+

Nursing Facility

Advantages of LAND & SEE• Most role-based authentication uses EHR, using

work that local organizations have already done• Most users (docs & nurses) only work out of 1

system• Data re-used whenever possible• No blended central clinical data repository• Case/discharge managers or nurses can control

when and where to route documents because they’re the ones that know when and where!

• Non-EHR users get same HIE transport functionality as EHR users

• Relatively low-cost to deploy and support• Easily scalable and replicable66

Standard Configurations of LAND

Necessary to support some advanced characteristics of IMPACT:

•MDS XML documents from Nursing Facilities

•OASIS XML documents from Home Health agencies

•Expanded data set beyond what is in a standard CCD

67

Outbound LAND configurations • Merge a standard CCD and a second XML

document that contains additional data elements into a “Transfer of Care” CDA document

• Transform data element transmitted via an HL7 2.x Results interface from an EHR into a “Transfer of Care” CDA document

• Transform an MDS XML file into a CCD* • Transform an OASIS XML file into a CCD*

*Exploring the use of Pennsylvania’s “KeyHIE Transform” (AKA “The Gobbler”) as cheaper alternative

68

Inbound LAND configurations

• Transform a “Transfer of Care” CDA document into a free-text document

• Transform a “Transfer of Care” CDA document into a free-text document and transmit it to an EHR via an HL7 2.x Transcription interface

• Transform a “Transfer of Care” CDA document into discrete data elements and transmit them to an EHR via an HL7 2.x Results interface

• Transform a “Transfer of Care” CDA document into a standard CCD and a second XML document that contains additional data elements

69

Next Steps for Pilot Sites Update gap analysis using expanded dataset

Catalog which data elements are captured (and by whom using what vocabulary) electronically, on paper, or not at all with current standard process

Of those captured electronically (including CCD, MDS & OASIS), identify process (technology & workflow) to make these available to LAND (for Phase 2).

Identify workflow to review new documents in SEE Notification by email or text message, and to whom? View online vs. print? Who does it and where?

Can any of the data elements received be electronically filed discretely for re-use using LAND?

Identify workflow to update and send SEE document with current info when discharging to Home Health or ED transfer How can standard and non-standard data elements be collected and

added online using SEE to the documents being sent? How will copies be printed for patient and ambulance?

Additional computers, printers, or chairs required?

IMPACT Timeline for Next Steps

71

Dates Activity

9/2012 – 3/2013 Integrate pilot sites into state HIE using LAND & SEE

4/2013 – 5/2013 Pilot site Go-lives with state HIE using LAND & SEE

2/2013 – 9/2013 Ballot updated datasets in S&I Framework and HL7

6/2013 – 7/2013 Make SEE available under Open Source License

4/2013 – 9/2013 Evaluate hospital (re)admissions & total cost of care

Sharing LAND & SEE• LAND

– Orion Health’s Rhapsody Integration Enginehttp://www.orionhealth.com/solutions/packages/rhapsody– We’ll make some standard configurations available

• SEE– Written in JAVA– Baseline functionality software and source code

that can connect to Orion’s HISP mailbox via API available for free starting ~July 2013 (Apache Version 2.0 vs. MIT open source license)

– Innovators can develop and charge for enhancements, for example:• Integration with other vendors’ HISP mailboxes• Automated CDA document reconciliation72

Disseminating the Seeds

IMPACT Advisory CommitteeMassachusetts Care Transitions Forum

Massachusetts QIO (MassPRO)

Worcester GalaxyWorcester Galaxy

Pilot Sites

Core IMPACT

Team

Another Galaxy

Pilot Sites

Core ProjectTeam

Another Galaxy

Pilot Sites

Core Project Team

Another Galaxy

Pilot Sites

Core Project Team

Another Galaxy

Pilot Sites

Core Project Team

Another Galaxy

Pilot Sites

Core Project Team

73

[email protected]@ReliantMedicalGroup.org

Questions?

Bibliography

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• Gandhi, Tejal K., Sitting, Dean F., Franklin, Michael, Sussman, Andrew J., Fairchild, David G., and David W. Bates. “Communication Breakdown in the Outpatient Referral Process.” Society of General Internal Medicine (September 2000): 226- 231. doi:10.1046/j.1525-1497.2000.91119.x. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/.

• Kaelber DC, Bates DW. Health information exchange and patient safety. J Biomed Inform. 2007 Dec;40(6 Suppl):S40-5. Epub 2007 Sep 7.

• Lu, C. Y. and E. Roughead. “Determinants of Patient-Reported Medication Errors: A Comparison Among Seven Countries.” International Journal of Clinical Practice (April 6, 2011): 65: 733–740. doi: 10.1111/j.1742-1241.2011.02671.x. http://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2011.02671.x/pdf.

• Overhage JM, McDonald CJ, et al. A randomized, controlled trial of clinical information shared from another institution. Annals of Emergency Medicine 39[1], 14-23. 2002.

• Stiell A, Forster AJ, Stiell IG, van Walraven C. Prevalence of information gaps in the emergency department and the effect on patient outcomes. CMAJ. 2003 Nov 11;169(10):1023-8.

• Van Walraven, C., Seth, R., Austin, P. & Laupacis, A., 2002. Effect of discharge summary availability during post-discharge visits on hospital readmission. J Gen Intern Med, Volume 17, pp. 186-92.

• Walker J, Pan E, Johnston D, Adler-Milstein J, Bates DW, Middleton B. The Value of Healthcare Information Exchange and Interoperability. Hlth Aff (Millwood) 2005 Jan-Jun;Suppl Web Exclusives:W5-10-W5-18.