Networking Meeting Goals Identify and develop best practices for - PowerPoint PPT Presentation

Networking Meeting Goals Identify and develop best practices for utilizing Electronic Health Records (EHRs) and associated technology to engage: • Older adults in their own healthcare • Community-Based Organizations (CBOs) across silos of care

Introductions • Name • Institution & GWEP • Role • Brief comment on your current use of the EHR • Fun fact about you

Engaging CBOs in EHR/Coordination: Current Protocols and Lessons Learned Duke University Dartmouth Centers for Health and Aging Rush University Medical Center Rush partner Shawnee Alliance

Geriatric Workforce Seniors Community Trainees Agencies GWEP Primary Health System Care Enhancement Communities Caring for Seniors Duke GWEP www.geriatriceducation.duke.edu

The GWEP: Who are we? Partners: • GWEP faculty—Nursing, identify current Medicine, PA, RD, Epi, Educ, SW resources • Triangle J AAA • Community Resource identify needs and Connection (CRC) gaps • Senior PharmAssist Connect • Durham Partnership for Seniors practices, • Duke Connected Care geriatrics, and community • Senior Advisory Panel (SAP) agencies Duke GWEP www.geriatriceducation.duke.edu

The GWEP: What do we Do? Activities: • Form partnerships identify current • Host CE programs to develop resources geriatric expertise in primary care (GRTs) identify needs and • Provide virtual geriatric gaps consultations (ICTs) • Train A-GNP and MD fellows in Connect practices, geriatrics geriatrics, and community • Evaluate impact on trainees and agencies outcomes at population level Duke GWEP www.geriatriceducation.duke.edu

GRT Educational Program Improved care of older adults Connections: Referrals to ICT, Continuous community Improvement: agencies Focused Competencies: projects Best practices: dementia care, GWEP Faculty medications, transitions Communication: and community IPCP training partners workshop Duke GWEP www.geriatriceducation.duke.edu

Interagency Care Team • Team: Geri Kanne, NP; Marilyn Disco, PharmD, CGP; Melissa Black, MPH; Katie Huffman, MA; Rhonda Mack-Minnifield, MA; Mitch Heflin, MD • Referrals: Over 60, problems with cognition, medication management, high risk transitions • Process: – Call to patient and family member – Chart review by team members – Team discussion identifying resources • Products: Notes generated for GRT and for patient Duke GWEP www.geriatriceducation.duke.edu

ICT Referral: Results Issue Addressed # of Cases Referral Agencies out of 22 Cognition/Depression 17 Behavioral Health; Senior Centers; Duke Family Support; Silver Linings Social Isolation Med Management 14 Pharmacy consult; Senior PharmAssist; Information to pt; RN home visit to check meds Food Insecurity 11 Meals on Wheels; Food Bank; More in My Basket; SNAP Adv. Directives 10 Legal aide; recs to PCP Disease Management 9 Recs to PCP; Lifestyle Medicine Clinic; Just For Us Personal Safety 9 PT/OT; in home aide; Vestibular Clinic; HELP (health equipment loan program) Incontinence products 6 Diaper Bank; Caswell Co Senior Ctr; Wilmington Medical Supply; ActiveStyle Vision 3 Services for the Blind; Low Vision Rehab; OneSight Respite Care 3 Durham Center for Senior Life respite care; Respite Care Vouchers thru NC Respite Care Coalition; C.A.R.E program through DFS Poor Dentition 2 UNC Dentistry Palliative Care 1 Duke HomeCare Bridge Program Life Alert 1 SeniorPharmAssist to order Duke GWEP www.geriatriceducation.duke.edu

ICT Challenges/Solutions • Referral process  e-consult • EMR access for community partners and non-Duke practices • PCP “permission” to contact patient (input of SAP) • Confidentiality in handling info “outside the system” o Consultation with Compliance Officer o “Minimum necessary information” • Ownership and follow up of recommendations • Communication back with PCP and seniors Duke GWEP www.geriatriceducation.duke.edu

E-Consult for Geriatrics Duke GWEP www.geriatriceducation.duke.edu

EMR Access for Community Partner 1. Establish a Business Associates Agreement between Duke and Senior Pharm Assist (SPA) 2. Work with Duke’s OIT to create agreements for remote access using MedLink to Maestrocare (an Epic system) 3. Develop survey to gauge the impact of the EHR on pharmacists at SPA and participants o “Pre-EHR” survey: Pharmacist seeing senior without prior to access to EHR. (Goal=20) o “Post-EHR” survey: Pharmacist seeing senior with access to EHR. (Goal=20) o Survey of seniors gauging attitudes regarding use of EHR on care. Duke GWEP www.geriatriceducation.duke.edu

EMR Survey: Impact on Participant Care Duke GWEP www.geriatriceducation.duke.edu

Duke GWEP www.geriatriceducation.duke.edu

EMR Survey: Participant Survey N=37 completed by phone (12 in the “Pre-EHR” group and 15 in the “Post-EHR” group) • Majority “fine with” (33/37) SPA having access to electronic records and think that it is “better care” (30/38) • Others did not object---indifferent or did not understand question • Among those in the EHR group, 12/15 felt it was “fine” --- others were indifferent or did not feel it helped. Duke GWEP www.geriatriceducation.duke.edu

CAPSTONe Pilot • Connecting Agencies, Practices and Seniors through a Trusted Online Network (CAPSTONe) • Secure, online referral system for older adults and their caregivers, community-based organizations, and referring providers • Hypotheses: • Curated resource templates will increase referrals to community resources • Providing a guaranteed referral outcome is valuable to stakeholders

Next Steps • New cohort of GRTs for fall 2017 • EMR-based identification of “at risk” seniors • E-Consult now activated • Review of outcomes o Completion of referrals o Costs to community agencies o Impact on process measures---e.g. high risk medications o Clinical outcomes--- ED visits, readmissions • Continued development of online community resource referral mechanism Duke GWEP www.geriatriceducation.duke.edu

Helen Featherson sontab14@gmail.com Mitch Heflin mitchell.heflin@duke.edu Geri Kanne geraldine.kanne@duke.edu Laura Previll laura.previll@duke.edu Gina Upchurch gina@seniorpharmassist.org Duke GWEP www.geriatriceducation.duke.edu

Using the Electronic Health Record to Engage Patients & Community Providers Thomas N. Williamson Kristi Saunders, MD Daniel S. Moran, MSN, APRN Ellen Flaherty, Ph.D, APRN, AGSF

Electronic Health Record (EHR) of Electronic Health Record (EHR) of Dartmouth-Hitchcock • Dartmouth-Hitchcock’s branding of Epic (eD- H) • Patient Portal (myD-H)  Proxy access via myD-H • Epic CareLink (D-Hconnect) 21

Patient Portal (myD-H) • Patients use myD-H to:  Communicate securely with their health care team  Review office notes  Request, reschedule or cancel appointments  Receive appointment reminders  Request prescription renewals  Receive lab or other test results  Complete any needed health questionnaires  View account balances and make payments  Have proxy access  Search our health library 22

Proxy Access (myD-H) • Proxy access allows a patient representative, with the informed consent of the patient or power of attorney, to securely communicate with the patient’s care team and have access to all the tools of the patient portal • The proxy must use their own login credentials • They should not use the patient’s login credentials 23

Epic CareLink (D-Hconnect) • Read-only access to the patient’s full electronic medical record for Community Based Organizations (CBOs) • Users who regularly need access to patient’s record who are not employed by Dartmouth- Hitchcock Medical Center 24

D-Hconnect Account Information • Signed agreement between your organization and Dartmouth-Hitchcock  Paper form  Active Directory Federation Services  Identity Provider (IdP) – authenticates users through security tokens • Minimal requirements for computer capability • Easy and intuitive to navigate • Variety of training tools • Medical director designates appropriate individual users 25

Accessing D-Hconnect • Uses secure Citrix Portal  Available on iOS, Android, Chrome, Linux, Windows Phone • Emergency Department access with patient consent • View only access to all records including radiology images • Allows entry of referral orders to request labs and appointment for specialty care 26

Communication with D-Hconnect • Cannot send electronic information unless it is attached to a referral • Receive secure messaging in D-Hconnect In Basket  Availability to receive e-mail notification of new D- Hconnect In Basket message  Several types of In Basket messages (i.e., encounter report from a specialist and staff messages) • Designate users to access and mange your In Basket • Clinical data available in real time 27

Geriatrics Workforce Enhancement Program – Connecting with CBOs 2017

NowPow Community Referrals • NowPow is a third-party tool with strong Epic integration • Rush care givers can create social referrals to a wide range of community-based organizations based on social determinants of health and patient conditions • Closed-loop referrals with trusted organizations would allow us to increase communication to and from the CBO