Keystone Health Information Exchange (KeyHIE) Director Jim Younkin is excited about the many grant initiatives his organization is working on, but probably is most eager to start one that hasn’t even been awarded yet. KeyHIE, the health information exchange that interconnects the Danville-based Geisinger Health System and five other regional northeast Pennsylvania hospitals—Community Medical Center (Scranton), Evangelical Community Hospital (Lewisburg), Mid-Valley Hospital (Peckville), Moses Taylor Hospital (Scranton), and Shamokin Area Community Hospital (Coal Township)—is waiting to hear about grant funding for its long-term care project offered by the Office of the National Coordinator of Health Information Technology (ONC) through the State Health Information Exchange Cooperative Agreement Program.
The long-term care project is underway and will extract information that long-term care facilities already send electronically to the Centers for Medicare and Medicaid Services (CMS) and deliver it to KeyHIE via a continuity of care document (CCD) format that will allow clinicians using the exchange to view that information. “If you think of how many long-term care facilities and how few of them have an electronic health record—instead of waiting for them all to get connected to an electronic health record and a health exchange, we can provide this intermediate tool to enable them to participate in a health information exchange with very little upfront cost,” says Younkin.
If KeyHIE is granted funding, the project will begin in February and connect up to 60 sites in Pennsylvania. KeyHIE also plans to publish a tool kit that other long-term/home health centers can download to start exchanging data.
Coordinating COPD, CHS Patients through the Keystone Beacon Community
Not only has Younkin and his team been hard at work with the long-term care facility project, but they have also been simultaneously working on initiatives stemming from the Beacon Community grant and the Agency for Healthcare Research and Quality (AHRQ) grant. The Keystone Beacon Community Grant, which began in April 2010, is focusing on chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHS) patient care coordination. “COPD and CHS are [diseases] that by deploying case managers to help coordinate their care,” Younkin says, “we can show a significant improvement in their number of admissions and readmissions and reduce those.”
KeyHIE will structure care coordination for these chronic diseases in a three-tiered model. The first piece is the inpatient component, which is a module embedded in the hospital’s electronic health record (EHR) that makes sure COPD and CHS patients get proper follow-up care. The module has reminders for a phone call check-up and a post-discharge medication reconciliation. The second tier involves case management from about 20 to 25 ambulatory case managers who will embed into physician practices starting this March 2011. “We can send a real-time alert through the health exchange to the care manager and/or to the patient’s primary care physician to notify them when the patient is in the hospital,” says Younkin. The messages will be transmitted to either a physician portal or through the facility’s EHR. Those patients who don’t have a designated care manager can contact a designated call center, the third facet of this model, that will help patients to transition from acute care.
Currently, Geisinger with the help of the United Kingdom-based GE Healthcare is working on development of portals for both providers and patients. Later this summer, patients will be able to log into a portal to manage their own health information in a personal health record format that will allow them to publish information to KeyHIE to make available to clinicians. Patients will also have the ability to view and download information like their discharge summaries. Community engagement and user testing will be kicking off in the next two months.