February 6, 2018

Physician Community Webinar Series

Building Patient-Centered Data Exchange into the EHR

Welcome to the Physician Community Webinar Series Sponsored by the HIMSS Physician Community

• A complimentary virtual event.

• Covers a wide range of topics on Medical Informatics,

HIEs (Health Information Exchange), Standards and

Interoperability, eMeasures and Quality Initiatives, and

how it affects, impacts and involves physicians.

• For more information, visit www.himss.org/physician or

contact Yvonne Patrick at ypatrick@himss.org.

Welcome to the Physician Community Webinar Series Sponsored by the HIMSS Physician Community

• Please insert all questions in the Q & A box located on

the bottom right of your screen.

• A copy of the recording and slide set will be available for

download within 5 business days on the Physician

Community Webinar Series Archive Page

www.himss.org/physician

Mark Roche, MD, MS, Avanti iHealth, Washington DC

(HIMSS Physician and I&HIE committee member)

Mark is a physician with fellowship training in Bioinformatics (NIH) and

Masters degree in Medical Informatics (Northwestern Univ.). He

currently aids private and public sector in EHR integration and

adoption of emerging technologies. He previously led national EHR

initiatives at the ONC for Health-IT and in Canada. He (co)-authored

US interoperability roadmap, several standards (C-CDA) and

electronic clinical quality measures (eCQMs).

Moderator:

Speakers:

Jitin Asnaani, Executive Director, CommonWell Health

Alliance

is on a mission to make nationwide health data exchange a reality. Jitin is

helping CommonWell build a scalable infrastructure that enables health

data to follow the patient regardless of where care occurs. Jitin has led

national interoperability initiatives through his previous work at

athenahealth and at the ONC for Health IT, and is a co-founder of the S&I

Framework and Argonaut Project.

Speakers:

Arthur M. Lauretano, MD, MS, FACS, Chief Medical

Officer, Circle Health, Lowell, Massachusetts

Dr. Lauretano is an assistant professor of Otolaryngology at Boston

University School of Medicine and an instructor in Otolaryngology at

Harvard Medical School. He has a Masters in Clinical Informatics and

holds board certifications in Otolaryngology and Clinical Informatics.

Learning Objectives

• Articulate the barriers that hinder scalable, nationwide,

vendor-neutral interoperability today

• Gain insights on how physicians are gaining immediate

access to relevant patient information to improve patient

care

• Understand how better coordinated care can reduce

tests, time and costs, as well as improve outcomes

Barriers that hinder scalable, nationwide, vendor-neutral interoperability today

The average person sees more than 18 providers in their lifetime

And each provider has their own EHR(s) and other clinical data sources

Patients believe that their physicians have access to all their health data

But we all know the reality: Health data information is still very siloed

• Competing priorities:

• Within the government

• Across the health IT vendor community

• At the Provider Organization level

• At the Physician level

• Few standards for data sharing, both in

terms of how and what is being shared

• Most data sharing agreements are

either at a regional or local level or a

provider-to-provider single connection

So what is standing in the way of nationwide health data exchange?

“I really just wanted to

see the lab results from

her last visit, not have to

sift through her last eight

years of visits…”

Current interoperability approaches simply don’t scale

CommunityHospital

IDN

Pharmacy

Lab

Post-Acute

Specialist

PCP

Clinic

• In this example alone,

28 distinct point-to-point

interfaces

• Organizations are

forced to create

contract-by-contract

interoperability between

local IT systems

• Regional “networks”

achieve only regional

results

Ask patients to

remember their

clinical historyRequest a fax+

Care Coordination is too dependent on the patient and on archaic technology

How physicians are gaining immediate access to relevant patient information nationwide

Ask patients to

remember their

clinical history

Know where

patient has

beenRequest a fax

Get the data

within the

workflow

++

We are solving a hard problem

We created a person-centered network…

CommonWell Services

1. Enroll individuals in the network

2. Find their records

3. Match and Link their records

4. Broker queries and responses

5. Notify when patients have

encounters

6. Serve other interoperability

purposes in support of

caregivers

• No Clinical Data Repository

So that individuals and caregivers benefit from person-centered exchange

All this happens while ensuring:• No clinical data shown without opportunity to Link.

• Linked locations have access to data on future visits.

• Providers see the documents natively in their EHR.

Primary Care

Hospital (Surgery)

Lab

Physical Therapy

NO MATCH

MATCH

MATCH

MATCH

Specialist

OB-GYN

12

3

CommonWell is live across the nation

Acute Ambulatory

Patient AccessHome

Health

Critical

Access Rehab/LTC

8,000+ provider sites | 23M+ enrolled people

73M+ patient records

Going above and beyond – for the patient, for the provider

CommonWell is working with Carequality

Sequoia Project and CommonWell

to explore collaboration

opportunities in the future

CommonWell to implement

Carequality Directed Query

specification

Basic version of CommonWell

Record Locator Service (RLS) to

be available to Carequality

Implementers

1

2

3

CollaborationCollective Success

Together, members and participants

from both organizations represent:

90%of acute EHR market

60%of ambulatory EHR market

Source: KLAS and SK&A, a Cegedim Company 2016 Hospital EMR Market Share, May 2016. © 2016 KLAS Enterprises, LLC. All rights reserved. www.KLASresearch.com

“Physician Office Usage of EHR Software” SK&A. February 2017.”

• Implies that consistency of interoperability across networks and IT solutions is critical

• Lays out the minimum requirements for trusted data exchange across networks

• Encourages national networks to work together and create common access methods across networks

• Extends expectations for data queries to new data, new use cases and new participants across the health and care industry

Trusted Exchange Framework and Common Agreement (TEFCA)

From a Clinician’s Perspective

Dr. Arthur Lauretano

CMO, Circle Health

• Lowell is the 4th largest city in the Commonwealth of Massachusetts

• Lowell General merged with Saints Medical Center in 2012 to form 2nd largest community hospital in the State

• 8th largest hospital in the state

• HIMSS Stage 6 on the EMR Adoption Model

• Received Magnet Recognition for quality patient care

Who We Are

About Circle Health

3,500+

associates2 hospitals & 18

ambulatory clinics

280,000 + annual annual outpatient

visits

396 Beds2,269 annual

births660 physicians

• Circle Health / Lowell General Hospital

• Tufts Medical Center

• Melrose / Wakefield Hospital

• Lawrence Memorial Hospital

About Wellforce

Circle Health EHRs / EMRs

Currently, 12 EMR/EHR Systems:

• eClinicalWorks

• Cerner

• ComChart

• SpringCharts

• HDox

• SuiteMed

• SRS Freedom

• athenahealth

• Allscripts

• ICS

• Epic

• AdvancedMD

• Desire to find specific data

• Push technology yielding too much data

• Delay in receiving information, including faxed information

The challenges our clinicians faced every day

Truly patient-centered care

Timely access to information

Specificity of information

Simplicity of use

Easy, quick implementation

Consolidated view of the patient

records

Immediately electronically available

Refined to the necessary information

Built right into your current software

and workflow

In less than 6 months, rolled out to

5,400+ facilities

Today’s reality with CommonWell

• CommonWell doesn’t store any of the clinical data

• Enrollment/Consent Process is simple when

incorporated into standard check-in process

• Patients actually get what they believe already exists –

provider access to all of their records

Dispelling the myths

How better coordinated care can reduce time, tests and costs, as well as improve outcomes

For those patients whose records are not yet connected

to CommonWell:

Reduce time

30% of the time asking office staff to track down

missing patient information

Clinical Scenario: Thyroid Nodule

• Patient sees specialist for thyroid nodule identified on ultrasound;

referred from an outside system

• If the ultrasound result is not easily accessible, we would often

repeat it in our own system, possibly at a different date, requiring

additional visits and copays

• Delay in treatment, increased patient anxiety, decreased patient

satisfaction

Reduce tests

Clinical Scenario: Pediatric Cancer Scare

• A recent 12 year-old-patient came to

me because her MRI report was

interpreted to the parents as showing

an “abnormal shadow” – PCPs office

staff led family to believe this was

possibly cancer

• Access to PCP note with MRI report –

“Dental artifact from patient’s braces”

• Obviated need for CT (cost and

radiation exposure) and resolved

patient and family anxiety

Reduce costs (and increased peace of mind)

Clinical Scenario: Chest pain patient in the Emergency Room

• 55-year-old male with chest pain, new to the facility

– CommonWell access to PCP notes:

• Smoker, high cholesterol, father died at 52 - MI

• 55-year-old male with chest pain, new to the facility

– CommonWell access to PCP notes:

• Has been seen multiple times in the last two weeks, pulled a muscle, but wanted to be assessed for CAD

– Cardiology workup, including stress test, was negative

Improve processes and outcomes

• Now can access records from providers across the nation, not just locally

• Electronic access, available immediately if/once linked

• Can just pull the note that you want, rather than culling through 30+pages of notes

• Better quality of care with reduced costs (appropriate tests, not duplicate tests) – Better Healthcare Value

• Better Patient Experience

• Contribution to the Triple/Quadruple Aim

Benefits of CommonWell

• It is critical to have access to a patient’s information

regardless of where prior care has occurred

– Regional solutions are limiting

– Point-to-Point connections are not scalable

– Nationwide connectivity is required with our

increasingly mobile population

Takeaways

• Effective interoperability solutions need to allow:

– Timely access to information

– Specificity of information

– Simplicity of use

Takeaways

• With patient-centric health information at the touch of

your finger, providers can achieve better coordinated

care:

– Reducing tests, time and costs

– Improving outcomes

Takeaways

Q&APlease insert all questions in the Q & A box located on

the bottom right of your screen.

Physician Community Website

Please visit www.himss.org/physician for more information on:

– Physician community activities

– How to get involved and membership

– Educational sessions

– Networking

– eNewsletters

– Physician Community Blog

– Physician Community Member Profiles

– New to Medical Informatics Workgroup

Save the DateUpcoming Physician Webinar

February 27, 2018 | 12:00pm – 1:00pm CT

Leveraging Standards to Address Patient Safety

Issues

For more information on the Physician Webinar Series, please

visit:

http://www.himss.org/physician-community-webinar-series

Save the Date!

www.himssconference.org

SAVE the Date: HIMSS18 EVENTS

• AMDIS/HIMSS Physician Executive

Symposium: Shifting from Computer Care to

Patient Care

Monday, March 5, 2018 | 8:00am - 4:30pm PT

Credit Designation

The Postgraduate Institute for Medicine designates this live activity for a

maximum of 6.0 AMA PRA Category 1 Credit(s)™. Physicians should

claim only the credit commensurate with the extent of their participation in

the activity.

• CMIO Roundtable

Tuesday, March 6, 2018 | 4:00pm - 5:00pm PT

For more information, visit: http://www.himssconference.org/