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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
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