Netsmart CareThreads
Netsmart CareThreads

Episode · 1 year ago

1: #carecoordination Be the Change … or the Change Will Be Forced on You w/ Dr. Joe Parks

ABOUT THIS EPISODE

The Office of the National Coordinator (ONC) has published a final version of the 21st Century Cures Act regarding interoperability in information blocking. It includes parameters of compliance for health information technology. The ONC is also looking for provider transparency to stimulate innovation in healthcare and thus establish and enable interoperability in a much bigger fashion.  

The result? Unprecedented access to data. 

In this episode of NetSmart, AJ Peterson, vice president and general manager of NetSmart Technologies, talks with Dr. Joe Parks, medical director for The National Council for Behavioral Health and distinguished research professor of science at Missouri Institute of Mental Health with the University of Missouri, St. Louis. 

What AJ and Joe discussed:  

  • How providers will manage the higher volume of data to make it meaningful 
  • The risks of patients gaining greater access to data 
  • How access to data supports the acceleration of reimbursement models 
  • How the standard of practice will change as a result of interoperability initiatives and greater access to data 

If you want to hear more episodes like this one, look for the Netsmart CareThreads podcast on Apple Podcasts, Google Podcasts, Spotify or Stitcher.

Welcomed in that smart care, threads, apodcast fore human services and postocute leaders across the healthcarecontinuum come together to discuss industry trends, challenges andopportunities. Listen is we uncover real stories about how to innovate andimpreve the quality of care to the communities we serve? Let's get intothe show. Welcome to Tha podcast. My name is AJPeterson on Vice Presidentin general manager, net Mark Technologies, thetopic, today's episode is be the change or the change will be forced on you, soevolving interoperability, landscape and how providers should be thinkingabout how to play off ense in this new age of healthcare, data exchange andaccess. I'm pleased to be here with octor Joe Parks, medical director ofthe National Cancil for behavioral health and we're going to have adiscussion regarding the interoperability rules from theopfnational coordinator and how providers should be prepared and startthinking about playing in this new world of open access to data. So youknow some of the concepts that were thinking about or aroundstandardization versus innovation or privacy and security versusinteroperability, which is really an interesting balancing act that we aredoing as relate to interropt and data sharing. So we think about the hopes ofjuggling these kind of main priorities, such as patient access to healthinformation, while still protecting their privacy. The office, an nationalcoordinator or the O NC has published a final version of the twenty firstcentury, cursact regarding introperability and informationblocking and they've, taken it to the extent of the health it certificationprogram, which has been updated as...

...recently as May of this year. So whatthis rule is really doing? Is it implementing new provisions of theTwenty First Century Cursac, which in really includes parameters ofcompliance for health information technology that developers itdevelopers under the ONC it certification program? So the MC isreally also looking at or provider, transparency to stimulate innovationand health care by really trying to minimize the developments costs as wellas Tieline, and friction to establish an enable inropperability in a muchbigger fashion than it was before. So one of the other areas- I think it'simportant to point out specifically this conversation- is that they reallyare looking the own sea to reduce the burden on providers and health systemsand organizations by making the information that health careinformation from the physician's chart. INSIDEOF TE trying to help recordavailable to other providers, as well as to patients in consumers in Liht, sothe ONC rule is really are primarily based on chare decision making betweenpatients and providers that is ultimately promoting better and moreappropriate patient center care. So with that set ind kind of the backdrapwanted to bring in Dr Joe Parks to talk a little bit about you know. As thisnow kind of UNPRECEDENCEA access to data is going to be made available. Youknow what are providers needing to be prepared for or what should they startbe considering, or should they really know about the interoperability ruleyeah? So thank Yo Aj, and I think this is a great opportunity, because I thinkthis is going to be the biggest change...

...in how health information ha gets donesince HIPPA got rolled out these twenty years ago. This is really huge, andit's going to it's already passed. It's a done deal there's no one doing it andit takes effect in less than twenty four months. The cures act. It takeseffect twenty four months after the carasact, and that was just last spring.So what's going to happen here is there's going to be there's a going tobe a requirement that any payer of healthcare in Medicare Medicaid,medicated vantage plans and also on the federal exchange. So it's not arequirement on the commercials, but I bet you they're going to follow becausethey always do well have to make available to patients the informationon their claims at the patient's request. This is a lot of information and I'msure we're going to see a great flowering of companies offering apps orwebsite tools, Por Patiens, to aggregate this information into theirown personal medical records and dashboards. Now this, then, is going tomake it entirely different for providers like myself, I still seepatients currently by Tela Medicine and telephone on a weekly basis, and when Isee a new patient, I get the usual history and then sometimes I send awayfor records, but I often don't because by the time they get there, you knowyou know more about the patient. That's in the record anyway. It's verydisappointing. The way things were, I think in three to five years, when Isee a new patient, I'm probably going to ask permission to I'm probably goingto look at their information before I see them and have that history of myfingertips, I will see the diagnosies. I will see the providers. I will seeall the medications that they've filled going back several years and whatpharmacy they filled. The Mat. The KIRSACS also requires thathospitals send a notification of admission, transferd discharge out tocertain healthcare providers, the ones...

...presumably the rule, be operationalizedin a way thatit's. The one the patient seen most recently whenever admissiontransfered discharge occurs so I'll start getting messages out of the bluethat you know the this list of patients got admitted yesterday and these twopatients got discharge yesterday and all this information is likely going tobecome rapidly consumable in electronic health records. Ind Your Emr, so onething is a provietor you need to do is make sure your organizations indiscussion with your emr provider, about where r they with the timeline.How are they going to handle this? What do they see and really pick theirbrains about it? And you know when's it going to be available in yourelectronic health record. It's going to be a huge opportunity to do moreinformed care, but I think we're also going to have much more pointed andincisive discussions with patients, because they're going to see all kindsof stuff they didn't see before and they're Goingna want to talk about it,which will be good for them. It'll be good for us. It won't always becomfortable, hmmthat's, a great point and a to keep points here that if wecan take dive into a little bit further, you know, as you mentioned, there'sgoing to be a rowing number of or volume of data- that's going to becoming at providers and there's also the same amount of datais going to becoming at patients. So if you could talk kind of a two part, question B tthey come together. So how are providers going to use going to bemanaging the amount of data that they're going to be receiving to makeit really meaningful and then also on the kind of that same front? You know:how are we going to educate or how should we educate patience to reallyinterpret and understand the data that they're going to now be able to receiveas a result of the Karzak Yeah? So that's really two different audiencesand we're going to have increasing requirements that providers haveportals available for patients where...

...they can look up their own stuff out ofthe providers organization themselves. So I don't see any way for it to workcomfortably until the MR companies have programmed in some dashboards that getfed off of these claim database, and these admission discharge summariesdirected to the Mr, not in a PDF, that's have to click on separately, butsomething that ports that data over to live fields. In my electronic medicalrecord, so I will actually have an opportunity. I hope to look up what theintramedical history was. That's occurred since the last time. I sawthat patient and it'll pop up there for me, but that means then I have toschedule in the time to look at that each time. I think it's rapidly goingto become the standard of care that, if you don't look at it, you had anopportunity to look at it and I think, within ten years it's going to be seenas negligence not to be show that you actively considered this additionalinformation that was available for treatment of your patient yeah, and Ithink that also on that topic, you know the about intigration. I think you're,absolutely right. I think integration is going to be the key and how thatdata flows through the electronic health record in the worklow of theprovider and really get to you know beyond workflow to knowledge float anda lot of the technology side of the rule is really focusing on a use ofapplication program interfaces and Apis. You may hear the term fire as anothertechnology standard and what that means, if you decode it treditionally, we movedocuments. We move conudy of care document, ccds that have snapshops ofclinical data from a specific encounter or even an episode inside of a hospitalwhich there's certain data elements that could be parsed in a structuredate inside of the HR, but with this new use of technology in these APIinterfaces, it's really going to allow...

...and enable for discreet data exchange.So if IAM working on a person- and I want to just look at their- you- usethe example of medication. History is a great one. How do I pull in the contextof that person's medication history across many different providers, evenpharmacies and payers into a single view? Inside of my electronic healthrecord in order to do a proper reconciliation process, so I thinkyou're absolutely right. I think that I'm excited about with the use of thisrule is the kind of widespread use and adoption of the technologies that passDi screet data back and forth, and then the work will be with the providers andtheir technology partners of how do we make that data representative and bethe most value for providers in te patients inside of inside of a clinicalworkwell? And that's exactly the discussion that the provider should behaving with their current Emr record company yeah? How are they going to dothis and you need to start thinking about your workflows and how are yougoing to consume and make use of this information and have a discussion withthe medical record? That's supporting you!So the two Mesh up between what you need to do in new workflows and whatthey can support on their platform. Yeah perfect- and you know, and so aswe bring the kind of the patient into this, I know there's a there's, alwaysan education process with patients on their clinical care. You know what are the things that theyneed to do to be a participant as part of the overall care team, but now, asthey're, going to start gaining greater access to theirdata kind of what are the inherent, they need Herin wrisk with the head and ow. Should providers andorganizations be prepared to educate patients on how and what they shouldthink of, as relates to starting to receive more and more of their clinicaldata in a consumable manner on their apple choice, you know, I think, we'regoing to see a whole range of patient...

...involvement like we always do. Somepatients will not pay attention to this at all, and other people are going toget very engaged. If you have patients and I'm sure the listeners do like- Ihave that coming because they've been looking at stuff on the Internet andthey got a couple questions about what they saw on the Internet. Well, howmuch more likely are they to ask a question about something they saw onthe APP related to a new claimer diagnosas somebody else put on and maynot have taken the time to discuss it with them. I'm anticipating that I'llstart getting questions about what did this other diagnosis mean? What is thisother medication for? What was this other doctor thinking and sometimesI'll be able to guess, and often I won't know, and sometimes I'll feelcompelled or a little anxious or scared about my God how's this treatment,interacting with what I'm doing I'll, have to make that phone call, which isall good for relate reducing medication, airs, but boy, I'm sure for people withmultiple chronic illnesses. It's going to make medical decision making morecomplicated will get better decisions, but it's going to be more complicated.It's going to take some more time. Luckily, and EM coding allows upcodingfor higher degrees of medical decision complication. So when we think about in you know aswe're educating patients for educating providers for working through theclinical workclothes, if you could share some of the you know where yousee value already, think providers would receive value with this kind ofgreater access to data either from the provisioning of care perspective. Butalso is we're more and more of the reimbursement models or supporting carecoordination and value base cares. How do these models get accelerated orenhanced or Ou oes? The access to data support them in these differenceendeavors. Well, I think the big value is going to be again on when you get anew patient in because now you'll have access to a comprehensive body ofprevious medical history that it's not...

...just hitten miss what the patientremembers and they forget a lot and they get a lot wrong. You'll see whatactually went on huge benefit for new patients. I think it'll be a bi benefitfor patients who either have poor memories or embarrassed by aspect of oftheir illness, and don't want to tell you everything just because they don'twant to get into that stuff, because now you'll start seeing it and thenyou'll have to help them feel comfortable. In that difficultconversation, I think there is huge opportunity to meet the requirements ofcare coordination. New billing units like chronic care, complex care andMedicaid the new principal care units where you can get an extra fee forcoordinating and managing a PA, a person's care across multiple providers.Because of set up properly in the electronic medical record. You canprove that you looked and acted on what other providers did by what fields youclick on. If you acknowledge you saw that new treatment came in and you puta line in your note: You've just justified, building principal caremanagement or complex care management, potentially some other codes. Likebrief screening and intervention for risky drinking and treatment, there areall kinds of data documentation to not only do care coordination, but to proveyou did it, which will end up getting linked to performance measures and willhelp you make your performance incentive bonus, because providerspayers especially are going to want you to be all over somebody that just gotout of the hospital they're all about incentivizing transitions of care outof the Er or out of the hospital, and I think we're going to see a lot ofbilling arrangements where, if you can document that as soon as somebody, yougot that message under the new rule that admission transfer in dischargethat somebody was in the air just out of the hospital. If you can show you dosomething, you'll get a bonus payment and you can actually think those outyourself and propose them to payers. Yit doesn't have to be just the payersidea. We can come up with our own ideas.

Now! That's great, I think it's! Youknow that. Example, it's really utilizing this capitalizing on thisinteroperability initiative in order to play offense as a provider organization,so not necessarily back on your heels and looking at this is a newrequirement of my organization. But how do I take this level of access of datawork on how to operationalize it withinside of my organization tosupport some of the initiatives like haire coordination and value based carethat I'm already under way with in order to recognize any upsideopportunity or accelerate that upsite opportunity faster as well as go backin and have conversations with payers an and in order to create a bettercontract for your organization, based on your enhanced performance that youcan deliver based on greater access to data? So that's a it's in a veryinteresting point in how you can tie this all together with your haircoordination activities, yeah, but boy. It's going to it's going to requirechange. It's going to require a lot of change on the part of providers likemyself, I'm going to have to do what I do differently and I want to urgepeople listening not to think that the way to handle this is to avoid it asmuch as possible and pretended asn't happening. That will be a failedstrategy and you're also going to have to insist on change from your medicalrecord platform, and it's going to be a heavy lift for both of you. But it'sgoing to be a good thing. It's going to be intetreting time just to frame whata big change it is. You know the default in confidentiality right now ismost organizations believe that they cannot share information unless theyget permission first now in most of the country. This is not actually true ifyour state has no more stringent requirements than HIPPA. HIPPA allowsthe sharing of information, absentpatient consent between treatmentproviders, sot you and somebody else, treating the patient and even allowssharing of information over the patient objection. Unless you have a policythat says you'll accept that objection,...

...this turn so the default is, youhaven't been sharing information unless you got permission first under this,you are required, under this rule, to share information unless the patientsays don't share information. It changes what has been apt in sharing ofinformation to apt outsharing of information. There are some exceptionsand you can read them on the ONC technical assistante website, ther areight exceptions, but it pretty much. The only big one is that the pagustsays they don't want to, and your policy and state law gives them thatthat latitude, but you need to really switch your thinking. The new world isan opt out of sharing, not an opt into sharing, which is going to haveworkflow issues in your medical records department. Unless you get it builtinto your medical record, I don't see any way for your medical records peopleto survive unless your medical record changes. That's a great point. I thinkthat you know there's two things here. I think from a technology perspective,the electronic medical record needs to have a robust consent managementprocess in place so that it adheres to the model around the kind of the upoutmethodology of of interoperability and Dava sharing, but also has the abilityto adjust any of the exceptions that may be present based on state based onperson or program, so to ensure that only data is being shared when andwhere appropriate outside of a traditional ot thout model. So I thinkyou're right. I think the flexibility inconfigurability of a consent- moduleinside of electronic health records is a big deal for this opportunity fromdivmore broader access, Tho data sharing from a patient perspective. ButI also think that it's going to be important that we're sharing andeducating the patients on this new model so that they are aware of thereof the the access that their data is...

...going to be enabled to, but then alsohow they can be able to use that information themselves through theirown APP as well. So I think they're G, they're GOINGNA have one they're goingto have a lot more questions to. I think it will drive us to use more ofthe care coordination codes because I, as the physician, don't have time tohave all those conversations I need to have a nurse or a health educator,that's being covered under the care coordination codes for TheiReimbursement to answer as many those questions as possible and have thoselonger, discussions will have more informed patience, but it's going totake time to inform them, and you can't b have physicians or even nurses doingall of it. We're really going to need to think how we can build into that andhow we can staff into it for the patients that want to have thosediscussions absolutely and Tin kind OAS. We shipped into you, brought up a pointand hone F. Your previous comments around the kind of the standard ofpractice is changing from a provider perspective and how how they can stayahead of that. So can you tell us a little bit about the standard ofpractice and what that means and how you see that changing as a result ofthese interoperability initiatives and greater access to data, I think there'sgoing to be a higher standard of care of what is expected of me as a provider.Looking at that data right now, I'm expected to ask the patient what theyremember and what's Gong on reasonably, but I'm not required to go. Ask alltheir individual providers periodically. But if there is this easy method oflooking at what everybody else does I think the new standard when we're fiveto ten years out from now, is going to be I'm going to be expected to havereviewed and take an account and if I didn't and I make a bad decisionbecause I didn't know about something- I think there'll be some liabilityattached to that. And you know it's a little scary for me as a provider tohave that extra burden. But it's very reassuring to me as a as a person whois family members with multiple complex...

...illnesses that their healthcareproviders will feel that wait and be looking more and thinking more aboutwhat their other prescribers and treaters and physicians are doing. It'sgoing to take more time, it's going to be a bigger burden in and the standardpractice will change. I think, as it changes, I think some of the billingopportunities are going to change, I'm fully, anticipating that when I see anew patient, I'm going to want fifteen to thirty minutes of time before I seethe patient to read through and think about this stuff- and you know map outin my mind what I want to focus on based on the information I had beforethe meeting, and I think they'll be over time, you can already do that onenm coding. You know it's the total amount of time it doesn't say have tobe the time starting from when you see the patient. It can be before you'reface to face as long as it was time spent on that patient. So I think we'regoing to have to rethink some of our scheduling and we're going to need toget retrained on how we make those billing code choices to support thestandard of practice, because I don't know I'm Goinna. If, if I get thatright now, when I'm working in my health home or I'm working with acertifike me Baybrel health center, that has this kind of informationalready flowing in. There are some places that have this sommintigratedsystems. I really feel that pressure to look at it and I feel bad. If I don't,because I don't want to miss stuff, it's kind of shameful yeah. I think toyour point. I think it's important one as well again on the. How do we takethis initiative as as an advantage inside of my organization and lookingat it from the from an increase reimbursement perspective from the higher level of complecity of decisionmaking so another opportunity, where not waiting but taking proactivemeasures of how to adopt and really optimize attendant to this rule, toincrease reimbursement inside of my organization, yeah and I'm sure,there's going to be tons of training offered you're going to start to see different webinars offered explainingthis, and you certainly need to get...

...more detailed basic education thanwe're able to give you on on this brief event right now, but education will notbe enough. You'll need some individual practice, consultation on how to makethese changes and how to change your work flows and how to think through itas a team. So if you, if your clinic, is limiting what they're doing with youis staff to educational events only and not sit down and get in the weeds andokay, what do we do? Different now team you're going to miss the target you'regoing to miss the target, so be looking for them and be pushing for that withyour leaders and managers and kind of on that note. That kind of leads meinto a question regarding you know: Operationally is going to be someoperational considerations, many hopritinal considerations beyond justclinical with this new initiative. So you know what are your thoughts, docorparks on you know, building out kind of internal KPI measures, OA keepperformance measures on providers and their use of their interoc capabilities,because, as we don't, you know, we need to. We need to measure ourselves ifwe're trying to make a leak forward. So how would you think about kind of ameasurement system or a visibility or tracking of how providers are doingwith these new interoperability kind of measured? You know, I think you hit theNeil on the head Ha. If, if you don't measure it, it doesn't get done and ifwe're serious about executing something, we measure it and we benchmarkourselves and each other over time, and we compare how we're doing individuallyto the group and how we're doing as time goes forward. So I think the realopportunity here is it'll be easy to see what the new data coming in is andthey'll be some key screens that will be developed. That'll present thateither new meds or new patient visits or new hospital discharges oradmissions and it'll be easy to see who got am alert and who did somethingabout that alert? Who opened a page and...

...looked at something who entered a note,and I could see two key measures. One is- would be a prevalence measure ofall my patients that had new incoming carecoordination. What percent of thosepatients that I look at some part of that information that I actually open aweb page and consider the new information- and you know for somepractitioners in a practice that may be ninety percent for others. That may befifteen percent, and we can talk about that and practice why we differ likethat. Then I think the other one would be a intensity of action for everypatient that had a change. How many new things TDID. I do. You know how muchdid I and maybe for some, it's it'll be one point: two patient actions, PorPatien with a change and for another it'll, be three actions for patientwith a change. I think we're going to look we're going to need to look firstat some internal process measures to assure that we're actually consideringthe information, because I think getting the process measure rightshould always proceed getting the outcome measure right. It's goodprocess that leads to good outcome. You know, Toyota didn't make great carsjust by rewarding people. If the carburator came out right, they lookedat every point in the process of that carburator and I think for thisinitiative for care coordination. We're going to have to have processindicators that benchmark which, on the staff, are looking and not looking andtrain people up to a level of excellence in that, and then you kickthe outcome in indicators, side of the park. That's exactly right. Exactly iskind of the leading indicators is what you focus on. Then then the resultswill will happen, and you know it's a great point. I think that you know wefocus a lot on from the interoperability rule and datablocking.It's all a technology play when that's not necessarily the case. Technologyobviously is a big component of it from an interoperability perspective. Butwhat we wanted a highlight during this...

...talk was you know. We have to startthinking about policy process procedure. Clinical worklows, patient engagementare all going to be key to the success of this rule. We can get the ones inZeros right on the technology side, but if we don't have the right process andchange management and real looking at how we create value to the agency tothe provider and, most importantly, to the patient, that's where the the realwork is going to be, and I think that's from what I'm hearing from you, DrParks, is that's where a lot a lot of our focus should be. Yes, we will, wewill have the innibration into the HR, but we need to really make sure that wehave good processes in place in order to be successful with this initiativeand really, if we're going to make all this investment, we need to have a goodoutcome for for offs for and for our patients and client care. So you knowone last thing: Dr Parks is were kind of closing what would be one takeawayor a piece of advice that you would give providers in regard to preparingfor this interoperability NISSOP. I know we talked on Aoa number of topicstoday, but what will be some key? Maybe one or a couple of takeaways that youreally want under individuals to take away from this top. I think it's reallycontemplating how your view of practice will change. With this flip ofconfidentiality being an optin okay, I will share to confidentialolthe beingan opt out. You know that you have to actively say you don't want to share tonot share, and most people won't say that, and we don't want most people tosay that and that's going to turn our world upside down. I think the secondthing is, we all need to admit. We haven't got this figured out yet, andwe need to be talking with each other about it. A lot you need to be indiscussions with your electronic medical record people and you need tobe in discussions with your staff. The other thing I think I'd give people isto stay focus, just try and get one or two things done at a time. We've. A lotof what we said. Pre sounds...

...overwhelming, like on performanceindicators. I wouldn't go for more than two at once. I might make a point ofcontacting everybody after discharge from the hospital, and I might make apoint of contacting everybody where I wrote a script and I don't see a claimthat the medication was actually feltd. You kno just two things: Don't try anddo too much at once. Otherwise, you'll feail at everything, if you do one ortwo things successfully, you'll beat most people anyway, that's great advise greatervice in lifeas well. So I wanted to thank you, Dr Parks, for sharing your experience andinsight on this topic. It's become more and more of a priority for providers,vendors and and patience to figure out how we play in this new world openinrobervilliy networks and access to health, your data and really howorganizations and providers can play offense tay head of the curb. So thankyou very much for participating for a great talk today, thank Youj. It wasfun and I look forward to talking with you about it again in the future. AllRight! Thank you, AC to firs at net smart. We understand thechallenges facing provider organizations. Our team will help younavigate changing value, based care models with solutions and services thatmake person centered care or reality will equip you with technology andservices that provide holistic, real time. Views of Care Histories thatinform better decision making and better outcomes visit us today atntstcom Netsmart serving you. So you can serve others thanks for listeningto the net smart carethreads podcast through collaboration and conversation,we can work together to make healthcare more connected than ever before andbetter support the communities we serve to ensure you never miss an episode.Please subscribe to the show in your favorite podcast player, if you useapple, podcast, we'd love for you to give us a quick rating for the show.Just have the number of stars that you think the podcast deserves until nexttime.

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