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Partners HealthcareAutomating the Transition of Care

Cara Babachicos, CIO, Partners Continuing CareMaureen Banks, President Partners SNF Division & Director 4Next

March 29, 2007

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Partners Overview: Who We Are

• Brigham and Women’s/Faulkner Hospitals• Massachusetts General Hospital

Major Teaching Hospitals

Community Hospitals

• North Shore Medical Center• Newton-Wellesley Hospital

•• Spaulding Rehabilitation Hospital

Shaughnessy Kaplan Rehabilitation Hospital• Rehabilitation Hospital of the Cape and Islands• Partners Home Care• Boston Center, North End, Clark House

McLean HospitalMental Health andNon-Acute Care •

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Who We Are

• Partners Community HealthCare, Inc.Physician Practicesand Network

Physician Organizations

• Massachusetts General Physicians Organization• Brigham & Women’s Physicians Organization

• Brookside Community Health Center• Charlestown HealthCare Center

• Southern Jamaica Plain Health Center

• Chelsea HealthCare Center• MGH Back Bay HealthCare Center

• North End Health Center• Revere HealthCare Center

CommunityHealth Centers

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Our Employees

We have 53,000 employees, providing more jobs than any other nongovernment employer in Massachusetts

Of these:– 18,000 are physicians, nurses and direct caregivers– 13,000 are workers supporting the direct caregivers– 5,000 are involved primarily in medical research

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4NEXT Goals

Goal: Software tool to help facilitate patient’s discharge and transition into a non-acute setting

Focus: – Originally: Case Managers– Currently: Case Managers and Liaisons– Future: Case Managers, Liaisons and Staff Nurse

ROI:– Originally: Shorten LOS in acute hospitals – Currently: Reduce risk of confidentiality breaches

Gold standard for referralContribute to National Patient Safety and JCAHO

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4NEXT Goals

Web-based software product that easily finds appropriate “next” level of care for our patients

Improve patient safety by communicating the critical, minimum level of clinical information – HIPAA Compliant

Assemble patient information and communicate with multiple providers simultaneously

Provide a standard presentation across/from the Partners enterprise

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4Next Business FlowTo provide timely web-based information to clinicians in order to facilitate

a smooth discharge and transition into a non-acute setting

Identifying appropriate non acute providersFacilitating communicationSharing clinical information

Prepare Match Correspond Discharge Assess Respond

Care coordination

Non acute provider

4Next

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Search and Sort (Phase I)

Database from CMS, JCAHO and Partners survey (within New England)

– Over 39,611 active non-acute providers– Over 2,159 non-acute providers in New England

55% have returned Partners more detailed survey of programs and servicesSurveys are on-line for providers to update

Currently used by all acute hospitals at PartnersCurrently 10,000 hits per month

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Search and Sort

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Transition of Care (TOC Phase II)

Utilize Search & Sort to select potential non-acute providers

View, add and attach electronic and paper clinical information

Transmit on-line or fax to potential providers simultaneously

Document two-way real time communication of the patient referral

Track history

Statistics: 12,000 referrals in 200518,719 FY 200680% user growth

– Now over 700 users

Over 10,000 website hits/month

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Transition of Care

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Medication List

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High Performance Medicine

CompleteAnticoagulation

CompletePhysician ContactProceduresDiagnosesFollow up Plan

CompleteAllergies

CompletePre-admission medications

Status7 Essential Data Elements

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Case Prep TimeLarge Acute Facilities

29.6926.27 26.16 24.85

26.76 27.29 27.7624.96

22.7220.54 19.21

23.51

26.93

20.93 21.44 21.90

25.29 25.31 25.8825.86

17.7219.07 18.45

15.15

20.22 21.0623.26

25.0722.35

23.7421.70 22.82 22.64

20.73 20.09 18.87

25.77 25.7427.74

26.46

0.00

5.00

10.00

15.00

20.00

25.00

30.00

35.00

Janu

ary'05

February

'05Marc

h'05Apri

l'05May'

05Ju

ne'05

July'0

5Aug

ust'05

Septem

ber'0

5Octo

ber'0

5Nov

ember'

05Dec

ember'

05Ja

nuary'0

6Febru

ary'06

March'06

April'06

May'06

June

'06Ju

ly '06

August

'06Sep

tembe

r '06

min

utes

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Accept Time Large Acute Facilities

53.0357.36

36.70

49.81

35.2836.2531.41 28.89

32.2436.69 37.04

42.59 41.51 40.5937.11

32.2829.4724.58 26.02 26.05

5.62

14.69

29.08

9.53 10.23 11.5319.13

13.03 10.9215.25 14.46 15.2212.52 12.90 11.96 11.42

7.5213.56

4.60

14.29 16.56

4.670.005.00

10.0015.0020.0025.0030.0035.0040.0045.0050.0055.0060.0065.00

January'0

5February'0

5March

'05April'0

5May'0

5Ju

ne'05

July'0

5Augu

st'05

September'0

5Octo

ber'05

November'

05Dece

mber'05

January'0

6Februa

ry'06

March'0

6April'0

6May'0

6Ju

ne'06Ju

ly '06

August

'06Septe

mber '06

Hou

rs

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Accept time: Cases going to Homecare

0.81 0.89

1.80

1.24

0.580.41 0.36 0.39 0.36 0.39 0.51 0.65 0.58 0.68 0.70 0.740.79

1.21

1.78

1.040.86

1.030.72 0.68

1.08

0.600.40 0.47 0.50 0.44 0.43

0.58 0.530.38 0.44 0.47

0.620.86

0.00

0.50

1.00

1.50

2.00

2.50

3.00

January'0

5February'0

5March

'05April'0

5May'0

5Ju

ne'05Ju

ly'05

August'0

5Septe

mber'05

October'0

5Nove

mber'05

December'

05Ja

nuary'06

February'06

March'06

April'06

May'06

June'06

July '

06Augu

st '06

September '0

6

Hou

rs

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Today’s Challenges

4NEXT necessitates changes in Care Coordination and Nursing work processes for greatest efficiencyRequires new work process vs. retrofit; may have HR considerationsShifts existing relationships with outside facilities with unknown impactBest Practice MandatePush vs PullEase Creates New Challenges

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Non-Acute ReferralBefore 4Next TOC

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Non-Acute Referrals with 4Next TOC

Online Two-Way Communication

Outbound Faxing

Inbound

FaxingElectronic Data

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Future Scope: 4NexTrac

Partners Patients Patients Outside Partners

Partners Continuing Care Entities Other Non-Acute Facilities

4NexTrac – Non-Acute Referral Tracking and Management Module within 4NEXT that will capture 100% of Non-Acute Referrals from Partners institutions and other sources to provide a better understanding of referral and admission trends.

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Dashboard to Prioritize Work

Case List

Patient Info Insurance From SOC/ROC Services Progress

1 Claus, Santa (M)DOB: 1/1/1950

Medicare A MGH 9/15/2006 RN INS

Claus, Santa (M)DOB: 1/1/1950 Medicaid BWH 9/15/2006 RN, HHA

Claus, Santa (M)DOB: 1/1/1950 HMO Blue BIDMC ROC 9/15/

2006RN, PT, OT,

HHAINS, CLN,

ORD, AUTHClaus, Santa (M)

DOB: 1/1/1950Harvard

Vangaurd NWH ROC 9/15/2006 RN, MEAL, PT

Claus, Santa (M)DOB: 1/1/1950 HMO Blue SLM 9/15/2006 RN, RESP AUTH, CLN

Claus, Santa (M)DOB: 1/1/1950 Blue Cross MA MD

Office 9/15/2006 PT, OT CLN

Date Selection Update Filter

StatusCity,State

Home-Medford, MA

Service-Waltham, MA

Home- Boston, MA

Home-Watertown, MA

Service-Bedford, MA

Home-Brookline, MA

Start of Care Date is Past DueStart of Care Date is TodayStart of Care Date is TomorrowStart of Care Date is 2 days from NowStart of Care Date is 3 days from NowStart of Care Date is 4 or more days from Now

New Features

Columns

Filters

For Home Care

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Case List

Patient Info Insurance From DischDate Program Progress

1 Claus, Santa (M)DOB: 1/1/1950

Medicare A MGH Act.9/15/2006 CHF INS

Claus, Santa (M)DOB: 1/1/1950 Medicaid BWH Est.

9/15/2006 STROKE

Claus, Santa (M)DOB: 1/1/1950 HMO Blue BIDMC Est 9/15/

2006 Multi-Trauma INS, CLN, ORD,AUTH

Claus, Santa (M)DOB: 1/1/1950 Harvard Vangaurd NWH Est 9/15/

2006Claus, Santa (M)

DOB: 1/1/1950 HMO Blue SLM 9/15/2006 AUTH, CLN

Claus, Santa (M)DOB: 1/1/1950 Blue Cross MA MD

Office 9/15/2006 AIDS CLN

Date Selection Update Filter

Status

Spaulding RehabilitationHospital

Expected/Actual Discharge Date is Past DueExpected/Actual Discharge Date is TodayExpected Discharge Date is TomorrowExpected Discharge Date is 2 days from nowExpected Discharge Date is 3 days from nowExpected Discharge Date is 4 or more days from nowScreening/Resee Date is TodayScreening/Resee Date is Past DueScreening/Resee Date is Tomorrow

Dashboard to Prioritize Work

New Features

Columns

Filters

For Facilities

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Manage referral Insurance VerifiedOrders received

Cinically Cleared

Managed Care AuthComplete

Patient on Medhold/Delay

Yes No

Yes No

Yes No

N/AYes No

Yes No

Facesheet

Allergies

Precautions

Laboratory

Operative notes

Discharge Info

Print options Site Notes

Transaction History

Last Updated: MGupta @ 12/18/06 @ 2:30pm

SAVE CANCELSEND to REG/ADT

Manage ReferralUsed by Intake and Admitting to insure everyone knows what’s been done

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New Function- Interface

EnterReferral

ManageReferral

InterfaceData

ReviewReferral

ReportingStatistics

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Opportunities

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4Next Architecture

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Clinical ServicesData (CDR, EMPI, Meditech, PEAR)

Patient’s Data in 4Next

Online presentation for Intranet user (Acute)

Data faxed into 4Next via Inbound Fax solution

Manually entered data

4Nextstored data

Online presentation for Internet user (Non-Acute)

Windows presentation for data operations

Outbound fax to deliver patients data to facilities

Print service to local/network printer

(Adobe PDF)

4Next Application

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Infrastructure Diagram

Internet

Intranet

clinical services

Access to Internetvia ISP

PHSWEB79

Non PHS User

Non PHS User

Non PHS User

HTTPS

XML ServiceFi

rew

all

Common Clinical Applications

OE

EMPI

CDR

Printer

Fax serv er (FaxCore)PHS4NFSWEB1 .

Inbound Fax

Outbound Fax

PHS Workstation4Next user

PHS WorkstationOther users

PHSweb87

4NextSQL

PHSSQL171SQLServ er2000

Printer

Printer

Printer

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Architecture

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How will the future look?