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Providers Identify Workflow Challenges with Stage 2 Transitions of Care

April 8, 2014
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Health systems working to ensure referral loops are closed and that messages are received and acted upon by the recipient

Although it is early in the attestation period for Stage 2 of meaningful use, the Health IT Policy Committee held a couple of listening sessions to get a sense of any gaps in vendor and provider readiness for Stage 2 transition of care and view, download and transmit requirements. At the April 8 Policy Committee meeting, Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, summarized some of the impressions gleaned from those meetings.

Both vendor and provider panels identified health exchange ecosystem maturity levels and workflow issues as the biggest challenges. Some providers reported difficulty finding trading partners for transitions of care, Tripathi noted. For some rural providers, their only trading partners in the community are providers not eligible for meaningful use such as long-term care providers. Many providers are involved in outreach and education with their referral partners, he said, going so far as to purchase Direct end-points for their for others to help meet the measure.

Another issue is that interoperability between health information service providers (HISPs) is still in its early stages. The lack of common widely deployed provider directory standards or common directory infrastructure makes it difficult to find addressing information on providers participating in disparate HISPs. Providers who practice at multiple organizations are receiving different Direct addresses at each organization, often from different HISPs. This also creates challenges in identifying the appropriate Direct address of a provider to send the transition-of-care information to. “All of these issues recall the early stages of e-mail, with providers like AOL and Prodigy slowly getting adopted,” Tripathi said.

Panelists shared a wide range of timelines, from 30 days to six months, to rework existing workflows. For some providers this is a completely new workflow, he said, while for others it requires reworking a paper workflow and addressing new components such as the electronic sending, receiving, routing and incorporation of data. “Vendors said that although it took only one to two weeks to get system in place, it could take six months for providers to be able to use it because of workflow issues,” Tripathi said. Provider organization need to work through how to best integrate the transition-of-care documents into their existing care referral processes to avoid sending of redundant data. For inbound messages, they have to figure out how to get unsolicited CCD-A documents vetted and routed. Some panelists said their organizations are creating central facility inboxes managed by the HIM department to receive the messages and then route them to the appropriate provider. Providers are working to ensure referral loops are closed and that messages are received and acted upon by the recipient.

Overall, panelists said the view, download and transmit (VDT) would not present a significant challenge for providers because patients are using view and download and there is little demand to transmit to third-party applications yet. Panelists said that provider outreach to patients to inform them about a patient portal is a key step to meeting the 5 percent MU measure.

Provider Panel on Transitions of Care

• David Kendrick, MyHealth Access Network

• Stasia Kahn, Symphony Medical Group

• Lori Johnson, University of Missouri Health Care

• Ryan Bosch, Inova

Provider Panel on View, Download and Transmit

• Fred Brodsky, Group Health Cooperative

• John Berneike, Utah HealthCare Institute

• Jeff Hatcher, Margaret Mary Community Hospital

• Greg Wolverton, ARcare

• Amy Feaster, Centura Health