Real-World Experience With Secure Messaging

Presented by: WEDI Healthcare Secure Messaging SWG

Session Objective

The communication of PHI:– between clinical sites– between providers and consumers– between providers and payers– between providers and HIEs, and – between consumers and payers

is most often an inefficient and manual process that adds unnecessary time and cost to the nation’s healthcare system.

Secure Healthcare Messaging via Direct has the ability to provide an efficient and safe method of moving data.

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Learning Objectives

This session will share:

real world experience with Direct secure messaging within healthcare to assist audience members to:

1. Better understand the availability of and how Direct secure messaging is being used within healthcare.

2. Be able to identify current and future use case scenarios that could enhance patient care and wellness through the use of secure messaging.

3. Understand the objectives of and know how to sign up and become a part of the WEDI Secure Messaging Workgroup.

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Doreen Espinoza, Vice President of Regulatory Affairs and Privacy Officer, Utah Health Information NetworkCase Study: Payer to Provider –Provider exchange of supporting medical documentation via Direct.

Ryan Bramble, Director of Integration – CRISP - Ryan.Bramble@Crisphealth.orgCase Study: Provider Notifications and Secure Data Exchange via Direct Messaging

Cindy Throop, MSW, Center for the Advancement of Health IT, RTI InternationalCase Study: Behavioral Health data exchange using secure messaging

Panelist

Doreen Espinoza, Vice President of Regulatory Affairs and Privacy Officer, Utah Health

Information Network

Case Study: Payer to Provider –Provider exchange of supporting medical documentation

via Direct.

Real-World Experience With Secure Messaging

USE Case I

Utah Medicaid has an “Emergency Only” program which requires all services to have additional documentation for payment:

Participants: University of Utah and Utah Medicaid

Payload: Delivery of Clinical data to support an Emergency Only claim

Results

• Number of Exchanges ~1400 per year• Dollar amount represented

– $800,000 to $900 average at $7500 • What is impact to the provider

– Tracking, timeliness (30 to 14 days), open line of communication

– Dropped AR 23% for this program in the last quarter

Use Case II

Long Term Care entities must prior authorize all stays for Medicaid clients.

Participants: Long Term Care Entities and Medicaid

Payload: Long Term Care Prior Authorization and additional documents

Results

• Number of Exchanges 4953+– Prior Auth and medical record 4.9 million records

• Dollar amount represented– 180-120 per day charge with a yearly cost of

401 million dollars• What is the impact to the payer

– Savings of postage, copy costs, time for processing

– Streamlining and quality of data

Impact to Provider

• Reduction of processing time from 90 days to 15

• Reduction of time for preparing the forms and sending the appropriate medical records

• Improved communication with Payer• Cost savings associated with time spent

gathering information and office supplies including envelops and stamps

Ryan Bramble, Director of Integration – CRISP - Ryan.Bramble@Crisphealth.org

Case Study: Provider Notifications and Secure Data Exchange

via Direct Messaging

Real-World Experience With Secure Messaging

• CRISP currently receives information pertaining to ER visits and admissions in real-time:

– All Maryland hospitals– Most D.C. hospitals– All Delaware hospitals (in partnership with DHIN)– Over 40 Long Term Care Sites

• CRISP has the ability to communicate this information, in the form of real time alerts sent via DIRECT to PCPs, care coordinators, and others responsible for patient care.

• There are currently over 2,000,000 patients subscribed to by provider organization with in ENS resulting in over 3,000 notifications per day most of which are sent via DIRECT.

Encounter Notification Service (ENS)

• Primary Care Providers• Hospitals (for readmission tracking)• Accountable Care Organizations (ACOs)• Care Coordination organizations• Health Enterprise Zones (HEZs)• Behavioral Health• Primary Care Medical Home (PCMH)• Commercial Payers • Medicaid Managed Care Organizations• Medicare Coordination of Care

What is the Market?

How does it work?

A patient goes to the hospital

Hospital Registration

At registration the hospital asks the patient for basic information (name, DOB, etc.) and the reason for the visit.

The registrar enters that information into an Electronic Medical Record.

When the registrar is completed entering that information, and pushes ‘save’, a copy of that information is immediately sent to CRISP

How does it work?

When enrolling in CRISP ENS, the organization must supply CRISP with a list of patients they wish to be alerted on or set up a ADT feed to CRISP.

A provider can subscribe to any patient they have a treatment or care coordination relationship with, and that they have seen at least once in the previous 18 months.

CRISP chose to have providers choose the patient’s to follow instead of relying on PCP information captured at patient registration.

Provider selected patient attribution is more timely and reliable than other sources.

How does it work?

Notification can be sent at customizable times, options include:• Real-time secure DIRECT message within 15 minutes of event• Daily Excel Summary sent via secure DIRECT message once or twice a

day

There are also several ways to receive the alerts• Through CRISP’s web-based DIRECT service (www.crispdirect.org)• Via HISP to HISP trust into the provider’s DIRECT platform of choice• HL7, SFTP, other secure protocols

SOURCE_MRN FNAME MNAME LNAME GENDER DOB ADDR1 ADDR2 CITY STATE ZIP958 Mario Speedwagon M 02/03/1875 1234 Main Street Baltimore MD 21212959 Petey Cruiser M 02/03/1876 1235 Main Street Westminster MD 21075960 Anna Sthesia F 02/03/1877 1236 Main Street Towson MD 21204961 Paul Molive M 02/03/1878 1237 Main Street Frederick MD 20177962 Anna Mull F 02/03/1879 1238 Main Street Salisbury MD 22136963 Gail Forcewind F 02/03/1880 1239 Main Street Baltimore MD 21212964 Paige Turner F 02/03/1881 1240 Main Street Westminster MD 21075965 Bob Frapples M 02/03/1882 1241 Main Street Towson MD 21204966 Walter Melon M 02/03/1883 1242 Main Street Frederick MD 20177967 Nick Bocker M 02/03/1884 1243 Main Street Salisbury MD 22136968 Barb Ackue F 02/03/1885 1244 Main Street Baltimore MD 21212969 Buck Kinnear M 02/03/1886 1245 Main Street Westminster MD 21075970 Greta Life F 02/03/1887 1246 Main Street Towson MD 21204971 Ira Membrit M 02/03/1888 1247 Main Street Frederick MD 20177972 Shonda Leer F 02/03/1889 1248 Main Street Salisbury MD 22136973 Brock Lee M 02/03/1890 1249 Main Street Baltimore MD 21212974 Maya Didas F 02/03/1891 1250 Main Street Westminster MD 21075975 Rick O'Shea M 02/03/1892 1251 Main Street Towson MD 21204976 Pete Sariya M 02/03/1893 1252 Main Street Frederick MD 20177977 Monty Carlo M 02/03/1894 1253 Main Street Salisbury MD 22136978 Sal Monella M 02/03/1895 1254 Main Street Baltimore MD 21212979 Sue Vaneer F 02/03/1896 1255 Main Street Westminster MD 21075980 Cliff Hanger M 02/03/1897 1256 Main Street Towson MD 21204981 Barb Dwyer F 02/03/1898 1257 Main Street Frederick MD 20177982 Mickey Mouse M 02/03/1899 1258 Main Street Salisbury MD 22136983 Terry Aki M 02/03/1900 1259 Main Street Baltimore MD 21212984 Cory Ander M 02/03/1901 1260 Main Street Westminster MD 21075985 Robin Banks F 02/03/1902 1261 Main Street Towson MD 21204986 Jimmy Changa M 02/03/1903 1262 Main Street Frederick MD 20177987 Daffy Duck M 02/03/1904 1263 Main Street Salisbury MD 22136988 Daisy Duck F 02/03/1905 1264 Main Street Baltimore MD 21212989 Fred Flinstone M 02/03/1906 1265 Main Street Westminster MD 21075990 Barney Rubble M 02/03/1907 1266 Main Street Towson MD 21204991 Wilma Flinstone F 02/03/1908 1267 Main Street Frederick MD 20177992 Don Stairs M 02/03/1909 1268 Main Street Salisbury MD 22136

Note – This is a snapshot, not the full spreadsheet.

What does it look like?

How can it help PCPs?

Case Study: Readmission rates at Johns Hopkins Community Physicians since implementing ENS to schedule 7-day follow up appointments

Code Required elementsReimbursement in facility setting (approximate)

Reimbursement in non-facility setting

(approximate)

99495

• Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge

• Medical decision making of at least moderate complexity during the service period

• Face-to-face visit, within 14 calendar days of discharge$135 $164

99496

• Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge

• Medical decision making of high complexity during the service period• Face-to-face visit, within 7 calendar days of discharge

$198 $231

ENS is a critical tool for providers to capture new payments, which are estimated to total $600M in 2013

Reimbursements began Jan 1, 2013 CMS estimates that providers will provider the post-discharge TCM service for 5.7 million

discharges in 2013, and AMA RUC estimates that 2 million of these codes will be billed each year

How can it help PCPs?

How can it help Payors and MCOs?

Case Study: Cigna HealthSpring implemented ENS and DIRECT to receive secure hospital notifications. They use ENS to help get in contact with their members post-hospitalization.

• 28% reach rate prior to ENS Report• 47% member reach rate using ENS

Report• 41% Increase in reach rate

• Hospitals can “auto-subscribe” to receive 30 day readmission alerts for all of their hospital discharges.

• Hospitals interested need to just identify a recipient for these alerts. CRISP will use the existing hospital to CRISP ADT feeds to automatically add discharged patients to a list which we will “watch” for readmissions

• If a patient is readmitted within 30 days, the recipient will receive an alert to their DIRECT account informing them the patient has been readmitted and provide information from the hospital where the readmission occurred.

• If a patient presents in your ED and they are a readmission from another hospital we will alert your ED in real time with a secure DIRECT message

How can it help hospitals?

• Automatic push of CCD documents from hospitals to ENS recipients post discharge– Currently in pilot with 4 hospitals and 10 practices– CCD is sent to CRISP via DIRECT then pushed to providers based on patient

subscriptions in ENS.– CCD is sent in both XML (machine readable) and PDF (human readable)

forms– Recent (September 2014) CMS FAQ permits use of CRISP ENS for a hospital’s

numerator calculation for Meaningful Use Stage 2’s Transitions of Care Measure. (https://questions.cms.gov/faq.php?faqId=10660)

• Use of analytics to send a risk score to ENS recipients for each patient currently hospitalized

What’s Next?

Cindy Throop, MSW, Center for the Advancement of Health IT

Case Study: Behavioral Health Data Exchange Using Direct Secure Messaging

Real-World Experience With Secure Messaging

Behavioral Health Data Exchange Using Direct

CINDY TROOP INSERT SLIDES

Why Use Direct?

• Traditional query-based approach to HIE was not getting the expected traction given the financial investments provided

• Experiment to see if Direct is a potential solution for the exchange of behavioral health data

Expected Efficiencies

NO behavioral health data exchange

SOME behavioral health data exchange

REGULAR behavioral health data exchange

• Improve understanding of policies (42 CFR Part 2 and relevant state policies)

• Establish technical capacity to exchange data in compliance with 42 CFR Part 2

Impact to Patient Care

• Behavioral health data exchange is an important step towards primary care-behavioral health integration

• Exchanging information is a prerequisite to providing coordinated, patient-centered care

• Direct enables granular patient consent; current query-based HIE cannot currently handle that

No Boundaries

WA

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TX

OK

KSCO

UTNV

CA

ID

MT ND

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NE

MN

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MS ALLA

FL

GA

TN

WI

IL INOH

MI

KY

NJ

NY

CTRIMA

NHME

WYPA

VAWV

DEMD

VT

NC

SC

AK

HI

interconnected health care ecosystem – the possibilities are endless

Healthcare Secure Messaging SWG

Educational References•15 things to know about DIRECT messaging•Secure Messaging Terminology Glossary•Real World Experiences with Secure Messaging – case studies

Visit: http://www.wedi.org/workgroups/security-privacy/healthcare-secure-messaging

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Join today! New WEDI SWG

Healthcare Secure Messaging Sub Workgroup Joining a workgroup is easy –

Sign in at www.wedi.org on the WEDI web site. Select My Profile Subscribe to the listserv that corresponds with each workgroup that you’d like to join ORContact Sam Holvey at 202-618-8803 or sholvey@wedi.org.

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Panelist Contact Information

Doreen Espinoza, Vice President of Regulatory Affairs and Privacy Officer, Utah Health Information NetworkEmail: despinoza@uhin.org

Ryan Bramble, Director of Integration – CRISPEmail: ryan.bramble@crisphealth.org

Cindy Throop, MSW, Center for the Advancement of Health IT, RTI InternationalEmail: cthroop@rti.org

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Questions

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Appendix

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What is CRISP?

CRISP is a non-profit health information exchange, or HIE, organization serving Maryland and the District of Columbia.

Health Information Exchange allows clinical information to move electronically among disparate health information systems. The goal of HIE is to deliver the right health information to the right place at the right time—providing safer, more timely, efficient, effective, equitable, patient-centered care.

CRISP’s Mission: To advance the health and wellness of our patients by deploying health information technology solutions adopted through cooperation and collaboration.

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1. Query Portal

– Traditional HIE Query services allowing providers to access patient information at the time of treatment

2. Maryland Prescription Drug Monitoring Program (PDMP)

– Access to all controlled dangerous substances dispensed in Maryland

3. Encounter Notification Service (ENS)

– Real time alerts and CCD documents via DIRECT when a patient is admitted, transferred, or discharged

What does CRISP offer to Providers?

RTI International

History and Mission

Independent, not-for-profit research and development organization

Founded in 1958 through a partnership between business leaders, state government, and area universities

Mission: to improve the human condition by turning knowledge into practice

One of the world’s leading research institutes

180 acre campus22 buildings895,000 ft2 in RTP

RTI’s Center for the Advancement of Health IT provides research and technical services to advance the effective use of health IT and health information exchange to improve the efficiency and effectiveness of health care delivery at home and abroad.