Medical Neighborhood Project
Implementation Team Meeting
April 30, 2015 8:30 – 11:30 AM Nationwide & Ohio Farm Bureau 4-H Center
Purpose Improve referral infrastructure across the medical neighborhood in Greater Columbus Today’s Objectives 1. Review purpose and history of the project 2. Clarity on scope and approach 3. Awareness on functionality of CliniSync referral tool
Coordinated by:
Medical Neighborhood Project
Implementation Team Meeting
Important Note Parking passes are required
Coordinated by:
Medical Neighborhood Project
Implementation Team Meeting
April 30, 2015 8:30 – 11:30 AM Nationwide & Ohio Farm Bureau 4-H Center
Purpose Improve referral infrastructure across the medical neighborhood in Greater Columbus Today’s Objectives 1. Review purpose and history of the project 2. Clarity on scope and approach 3. Awareness on functionality of CliniSync referral tool
Coordinated by:
Medical Neighborhood Project
Implementation Team Meeting
Today’s Agenda 8:30 – 8:35
Welcome
8:35 – 8:40
Framing
8:40 – 9:10
Review project purpose, history, clarity, and scope
9:10 – 10:20 Awareness on functionality of CliniSync referral tool 11:20 – 11:30 Closing
Coordinated by:
Our Strategic Areas of Focus
PATIENT-CENTERED MEDICAL NEIGHBORHOOD …improve care coordination between providers & social services
QUALITY TRANSPARENCY …improve the use of quality data
…exploring and catalyzing best practices to strengthen engagement between consumers, providers, and purchasers
PATIENT ENGAGEMENT …improve engagement between patients and providers
www.hcgc.org
COLLABORATIVE LEARNING …improve the application of learning in Greater Columbus
Implementation Team Meeting
Medical Neighborhood Project
WHY? Patient-Centered Medical Neighborhood
Patient-Centered Medical Home
www.hcgc.org
Medical Neighborhood Project
www.hcgc.org
Medical Neighborhood Model
Current View
Medical Neighborhood Project
Referral Process Between Community Organizations and Healthcare Providers Referral Type
Client Data
Client Data
Fax Email
Organization B
Phone Mail
Organization A Organization C
Organization E Client Data
Client Data Organization D
Client Data
Medical Neighborhood Project
Alignment with Other Initiatives
CPC Milestone VI: Care Coordination Across the Medical Neighborhood Demonstrate active engagement and care coordination across the medical neighborhood by creating and reporting a measurement to assess impact and guide improvement.
www.hcgc.org
Medical Neighborhood Project
www.hcgc.org
Alignment with Other Initiatives
Medical Neighborhood Project
www.hcgc.org
Alignment with Other Initiatives
Medical Neighborhood Project
Implementation Team Meeting
Review purpose and history of the project
www.hcgc.org
Medical Neighborhood Project
Implementation Team Meeting
Why are we doing this work? • In January 2014, UWCO and HCGC convened funded member agencies to determine the challenges organizations face when sending and receiving referrals, and identify the healthcare providers they most frequently exchange referrals with. Challenges Identified • Lack of standardization among types of referrals • Lack of shared-infrastructure for making referrals • Lack of clarity about services provided by other agencies
Common Healthcare Providers • Hospitals • FQHCs • Free Clinics
www.hcgc.org
Current View
Medical Neighborhood Project
Referral Process Between Community Organizations and Healthcare Providers Referral Type
Client Data
Client Data
Fax Email
Organization B
Phone Mail
Organization A Organization C
Organization E Client Data
Client Data Organization D
Client Data
Future View
Medical Neighborhood Project
Referral Process Between Community Organizations and Healthcare Providers Client Data
Client Data
Organization B
Organization A
Shared Referral Infrastructure
Organization C Client Data
Organization E Client Data
Organization D Client Data
Project Design Team
Medical Neighborhood Project
• AIDS Resource Center Ohio • The Breathing Association • Central Ohio Diabetes Association • Charitable Pharmacy of Central Ohio • Clintonville-Beechwold Community Resource Center • Columbus Neighborhood Health Center • Heart of Ohio Family Health Centers • LifeCare Alliance • Lower Lights Christian Health Center www.hcgc.org
• • • • •
Maryhaven The Medical Group of Ohio Mount Carmel Health System OhioHealth The Ohio State University Wexner Medical Center • Physicians CareConnection • United Way of Central Ohio • US Together, Inc.
Medical Neighborhood Project
2015 Project Overview
WHAT: Spread best practices to improve coordination of care between providers and social services in Greater Columbus. HOW: Implement cloud-based, shared referral infrastructure among local healthcare providers, social service agencies, and other healthcare stakeholders.
2015 Objectives • Convene interested social service agencies and healthcare providers to plan for implementation of initial phase of project. • At least ten social service agencies and five local healthcare providers participating in project implementing CliniSync to send and receive referrals. • Collect project measures, document lessons learned, and share learning with public-private partners
www.hcgc.org
Project Implementation Team
Medical Neighborhood Project • • • • • • • • • • • • • • • • • • • • • •
Aetna AIDS Resource Center Ohio American Cancer Society The Breathing Association Central Ohio Area Agency on Aging Central Ohio Diabetes Association Central Ohio Primary Care Charitable Pharmacy of Central Ohio Clintonville-Beechwold Community Resource Center Columbus Neighborhood Health Center Columbus Public Health Community Refugee & Immigration Services CompDrug, Inc. Concord Counseling Services Ethiopian Tewahedo Social Services Faith Mission Gladden Community House Godman Guild Association HandsOn Central Ohio Helping Hands Health and Wellness Center Horn of Africa Voluntary Youth Committee LifeCare Alliance
www.hcgc.org
• • • • • • • • • • • • • • • • • • • • •
Lower Lights Christian Health Center The Medical Group of Ohio Mid-Ohio Foodbank Mount Carmel Health Partners Mount Carmel Health System Mount Carmel Medical Group National Church Residences Nationwide Children’s Hospital Primary Care Network Ohio Asian America Health Coalition Ohio Association of Community Health Centers Ohio Department of Health Ohio Office of Human Services Innovations The Ohio State University Wexner Medical Center OhioHealth Group Physicians CareConnection Prevent Blindness Ohio Southeast, Inc. Syntero UHCAN Ohio United Way of Central Ohio YMCA of Central Ohio
Medical Neighborhood Project
Implementation Team Meeting
Review project scope and approach
www.hcgc.org
Project Milestones
Medical Neighborhood Project Q3 2015
Q2 2015
Q4 2015
Q1 2016 and Beyond
Wave 1 • 15 – 25 Participation Commitments
• Organizations Using Referral Tool
• CliniSync Referral Tool Implementation and Training
• Begin Reporting Monthly Project Measures • Identify Orgs to Participate in Next Wave
• Report Project Value Measures
• Participants Share Learning with Community
Wave 2 Wave 3 As needed
www.hcgc.org
• Ongoing Project Participation, Reporting, and Shared Learning
Current View
Medical Neighborhood Project
Referral Process Between Community Organizations and Healthcare Providers Referral Type
Client Data
Client Data
Fax Email
Organization B
Phone Mail
Organization A Organization C
Organization E Client Data
Client Data Organization D
Client Data
Medical Neighborhood Project
Project Measures
• Learning from other regions • Michigan • Maine, New Hampshire, Connecticut, New York, Virginia, Georgia • Participation, System Use, Value
• A good place to start!
www.hcgc.org
Medical Neighborhood Project
Project Measures
• Participation Measures (Collected Monthly) • # of organizations in CliniSync network • # of services available on CliniSync network • # of patients in CliniSync network • System Use Measures (Collected Monthly) • # of referrals sent within CliniSync • Total # of referrals made by an organization inside and outside of CliniSync • Value Measures (Collected Quarterly) • Value of CliniSync to the organization • Estimated time saved by CliniSync • Estimated # of new organizational relationships from the Medical Neighborhood Project www.hcgc.org
Medical Neighborhood Project
Implementation Team Meeting
What questions of clarity are you sitting with regarding the Medical Neighborhood Project?
www.hcgc.org
Medical Neighborhood Project
Implementation Team Meeting
Awareness on Functionality of CliniSync Referral Tool
www.hcgc.org
CliniSync Update Dan Paoletti CEO, Ohio Health Information Partnership
26
Module 1 Project Participation 27
Requirements for Participation • Sign CliniSync Participation Agreement • Attend Kick-Off (web-based) • Participate in Training (onsite) • Participate in Touch Point calls
CliniSync Participation Agreement • Includes Business Associate Agreement (BAA) • Same BAA signed by all CliniSync participants
• Pricing • No cost to use the Community Health Record • Patient Referrals
Kick-Off for Group • Sample Agenda • Purpose and scope • Consent policy & guidance • Security • Demonstration • Support • Training overview
Duration: 60 minutes (web-based)
Site Specific Training • Sample Agenda • Review workflow • Demonstration • Maintenance of questions and preferences
• Working sent and received referrals • Review training materials • Assist staff with login • Support
Duration: 60 – 90 minutes (on-site)
Site Specific Training, continued • Who should be involved? • Think about who manages referrals today • Referral coordinators
• Intake staff
• Think about who trains staff today • Train-the-trainer approach
Touch Point Calls for Group • Discuss experiences • Communicate workflow strategies • Share lessons learned Duration: 15 - 30 minutes weekly
Q&A 34
Module 2 Organization’s Profile 35
Community Health Record
Community Results Delivery Health Record Continuity of Care Record Clinical Results Inbox Patient Referrals Web Direct
Integrated EHR Delivery of results and reports Locally Hosted PDF Delivery
Provider DIRECTory
Notify
HIE Data Publishing
Use yours or our Direct-enabled secure email to exchange with other providers
Automated delivery of event notifications as they happen throughout the network
Registration Data
CliniSyncPLUS
Discrete Notes
Practice Transformation
Join our statewide list of >13,000 providers
CCDAs Public Health
36
Consulting
Provisioned Access/Roles • Community Health Record • Expressed consent role • Patient referrals module • Ability to search for and add patients • Continuity of care record (addition to providerbased practices)
Your Organization Customized • Inbound Preferences • Questionnaire Management • Options
Preview 39
Q&A 40
Inbound Preferences • Referral Documents and Instructions
Example: Map or New Patient Packet
Questionnaire Management • Duplicating paper form and mandating answers
Options • Favorites, staff permissions and email notifications
Module 3 Sending a Referral 44
Sending A Referral • Search for patient • Select patient • Click create referral • Choose referring provider • Choose referral destination • Enter reason • Answer questions
• Attach record/result if necessary • Review • Click refer
Adding A Patient • Search for patient • No patient found • Click add patient (consent gathered) • Enter patient demographics • Submit • Patient has been added to the Community Health Record patient index • Create referral as normal from added patient
Monitoring Sent Referrals • Click Referrals at top right of screen • Sent Referrals tab opens • View list of referrals • Click on referral from Sent list to see detail • Communicate with referring practice within sent referral
Preview 48
Q&A 49
Module 4 Received Referrals 53
Working Received Referrals • Click Referrals at top right of screen • Click Received Referrals tab • Use filters as needed • Click on referral to see detail • Adjust status as needed • Sending practice/facility will see status change and any scheduling detail entered
• Check for new messages • Acknowledge and reply to sending practice/facility about the referral
Preview 55
Q&A 56
Closing 59
CliniSync Community Health Record Services
60
What is the Community Health Record?
Community Results Delivery Health Record Continuity of Care Record Clinical Results Inbox Patient Referrals Web Direct
Integrated EHR Delivery of results and reports Locally Hosted PDF Delivery
Provider DIRECTory
Notify
HIE Data Publishing
Use yours or our Direct-enabled secure email to exchange with other providers
Automated delivery of event notifications as they happen throughout the network
Registration Data
CliniSyncPLUS
Discrete Notes
Practice Transformation
Join our statewide list of >13,000 providers
CCDAs Public Health
61
Consulting
What can I do in the Community Health Record? CONTINUITY OF CARE •Access a patient’s treatment history, hospital encounters, problem list, allergies, lab results, radiology and other transcribed reports exchanged through CliniSync.
PATIENT REFERRALS •Initiate and coordinate patients’ referrals with other CliniSync providers using customizable templates.
•Check patient demographic and insurance information captured by other providers.
RESULTS INBOX •Receive and manage your patients’ results and reports via your own inbox.
•View, print or download encounter-specific or full continuity of care summaries for your records.
WEB DIRECT •Send and receive secure emails with attachments to more than 13,000 providers in our statewide DIRECTory.
•Coming soon: Query Ohio’s Automated Rx Reporting System (OARRS) as required by law. 62
Medical Neighborhood Project
Next Steps
• Reflections and learning will be included in meeting record • Individual organizations invited to participate over the next few weeks • Starting with healthcare providers
• Medical Neighborhood Learning Group
Thank you for your participation! www.hcgc.org