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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
KLAS Confidential Information. © 2017 KLAS Enterprises, LLC. All Rights Reserved. www.klasresearch.com
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