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Improving Care Transitions at an ACO With mHealth

January 14, 2014
by Rajiv Leventhal
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QIP has found a HIPAA-compliant technology that works
Tom Samuels, CIO, Quality Independent Physicians

One of the fundamental principles of accountable care organizations (ACOs) is to support the efforts of physicians, nurses and other clinicians to make care safer and better coordinate patients’ transitions from hospitals to other settings. Certainly, controlling the transition process can help to reduce unnecessary readmissions—and therefore drastically cut costs.

What’s more, the healthcare industry is the definition of having non-desk employees. And with the constant moving between patients and facilities and house calls, it can be hard for communication to occur. This lack of communication is never a good thing, especially when someone's life could be at stake.

Quality Independent Physicians (QIP)—a group of more than 1,000 physicians in private practice, working together to care for their patients in the Louisville and Lexington, Kentucky areas as well as the Southern Indiana counties of Clark and Scott—was familiar with this problem not too long ago.

About two years ago, QIP started a Medicare Shared Savings program ACO employing nurses to hospitals and nursing homes to follow those Medicare patients around who were attributed to the organization, says Tom Samuels, QIP’s CIO. “At the time, we were struggling with a way to communicate with our doctors in a quick and real-time fashion, and still be HIPAA (Health Insurance Portability and Accountability Act) compliant,” Samuels says, adding that QIP also needed a solution that would be easy enough for physicians to use.

Unfortunately, Samuels says, the only way that could have been done was by faxing, since e-mailing and texting are not HIPAA compliant, meaning protected health information (PHI) couldn’t be included in the messages. “So we started faxing documents to offices with messages such as, ‘Mrs. Jones is getting ready for discharge and is having trouble understanding her medications. Can she get in your office in the next few days?’ Those faxes could get lost or they would come at the end of the day, which didn’t allow for instantaneous communication,” Samuels says. “We looked at secure e-mail services, but I am not going to get a doctor to log onto another web portal and remember another password just to retrieve e-mails from us. It’s an unnecessary burden.”

Six months ago, QIP ended up choosing Louisville-based startup Red e App, a real-time private mobile messaging platform, to allow on-site clinical staff to communicate back to the in-office doctors. Samuels says the app is HIPAA compliant and for physicians, as almost all of them—as well as office managers—have smart phones or at least access to internet. “It looks and feels like texting or like an e-mail, and we can communicate directly to the doctors about patient information to get real-time feedback, get status on a patient, or let doctors know what is going on with a patient,” Samuels says.

One way QIP uses the app in the clinical setting is with care coordinators, who are in the hospital with patients, says Samuels. “The nurse might text a doctor, ‘Mrs. Jones is being discharged to a nursing home for rehab. Can she come to your office in 14 days?’ And the doctor might say yes, or might say he or she will visit the patient in the nursing home,” Samuels explains.

The application can authenticate clinicians, nurses and administrators into a mobile network that helps QIP maintain HIPAA compliance, he says. “And it fosters better transitions of care,” Samuels continues. “To measure the success of this product, we are looking at the percentage of patients seen after discharge within 14 days,” he says. “The Center for Medicare and Medicaid Services (CMS) wants us to see 70 percent of patients within 30 days of discharge, and we have moved that standard to 14 days. Now, we are looking for movement on those percentages because of the app—we’re able to notify office managers and doctors when patients are discharged from hospital. “

Samuels gives another example of the app’s use, saying that since CMS doesn’t provide addresses for new patients assigned to the ACO, previously, office managers would have to go through a series of encrypting and decrypting thumb drives just to get patients’ addresses, which are needed to send them standard ACO welcoming letters. “Now, with Red e App, we can just log in, take that Excel file and e-mail it to office manager directly. He or she can fill it out and send it right back,” boasts Samuels.

Some challenges do remain, but doctors have picked up the process pretty quickly, and adapting has been fairly easy, Samuels says. That doesn’t mean that a little education at times isn’t necessary, though, he admits. “There was one instance of a doctor getting a message on a Sunday from a medical director, and he wasn’t sure if he should respond to it at the time or wait until Monday,” Samuels recalls. “So being responsive is key,” he says.

Additionally, Samuels thinks that the app’s analytics capabilities will allow QIP to track certain trends. “When we send out messages to all of our providers and office managers, or just one or the other, it does tell you how many were sent and how many were opened,” he says. ‘Unfortunately, we don’t have a way to confirm that the [receiver] is reading those messages, but we’re asking for this capability to get better reporting for that.”  

Previously, Samuels knew that if communication among clinicians and office managers was done the right way, it could be very problematic. After all, because of HIPAA restraints, communication must be very secure, and that in itself creates barriers for these doctors, he says. “I know doctors text other doctors and other people about patients with PHI in their messages, but we can’t foster that,” Samuels admits.

But now that has changed, he says. “The number-one goal is better transitions of care for our Medicare patients signed into our ACO. And if we improve communication between the nurses at bedside to the office to the primary care doctors, we’ll be better able to determine the next steps for the patient.”

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