A Merge White Paper. Closed Loop Referral Management: A Cost-Effective Strategy for Meaningful Interoperability

Transcription

1 A Merge White Paper Closed Loop Referral Management: A Cost-Effective Strategy for Meaningful Interoperability

2 Financial pressures in hospitals and other care settings are increasing as the U.S. healthcare system moves away from fee-for-service reimbursement models and toward value or outcomes-based care. Imaging departments are also experiencing these challenges and radiologists must make patient-centered care a priority to drive bottom-line success. Providers of all kinds, including medical imaging practices, have been leveraging electronic health records (EHRs) and enterprise-wide imaging strategies to help improve interoperability within their own systems for quite some time. However, organizations are now beginning to realize the limitations of their existing interoperability strategies. Today, most medical imaging providers can likely only serve the physicians that are a part of their closed network and have limited reach into the community using traditional models. These limitations include: Relying on printing and hand delivery of images and reports Faxing reports Using costly, point-to-point HL7 interfaces to electronically exchange reports and images Health information exchanges (HIEs) can extend an organization s outreach into its community of providers but there are gaps. Specifically, there are substantial barriers related to obtaining and managing consent for image exchanges throughout the HIE. Furthermore, achieving a positive return on investment for a single HL7 interface would require processing tens of thousands of transactions per year, over several years. As a result of these challenges, many provider organizations are beginning to realize that now is the ideal time to begin leveraging other new strategies to connect with referring physicians and institutions, networks, and other systems outside their own four walls. Figure 1: Traditional Interoperability PACS VENDOR 1 MULTIPLE IMAGING CENTERS AND HOSPITALS EHR VENDOR 1 PACS VENDOR 2 MULTIPLE REFERRING PRACTICES EHR VENDOR 2 EHR VENDOR 3 PACS VENDOR 3 EHR VENDOR 4 PACS VENDOR 4 MULTIPLE PACS SYSTEMS EHR VENDOR 5 PACS VENDOR 5 EHR VENDOR 6 MULTIPLE EHR VENDORS PACS VENDOR 6 EHR VENDOR 7 This diagram represents current interoperability where there are costly point-to-point connections that only provide access to a fraction of all providers in a given community. In order to connect all providers in a community, such as the Chicago area, you would need to build 1 million connections. Not only is this cost prohibitive, but it would take years to complete. There is a more effective way to interoperate. CLOSED LOOP REFERRAL MANAGEMENT A MERGE WHITE PAPER 2

3 While point-to-point connectivity is certainly desired, many organizations are unwilling to or financially incapable of creating and maintaining an infrastructure-intensive initiative. However, today the marketplace is being transformed with new service-based technologies that provide unprecedented nation-wide physician connectivity without forcing organizations to incur the upfront cost, time, and resources of a traditional infrastructure build out. By leveraging a technology that uses modern techniques to deliver clinical messages into the EHR, sharing, exchanging, and gathering images across the care continuum without having to add additional infrastructure can become a reality. With a simple, cost-effective, HIPAA secure, cloud based technology, providers can better understand their patients longitudinal records, minimize unnecessary imaging tests, reduce radiation exposure, and ultimately enhance the overall patient experience. A Closer Look at Closed Loop Referral Management There is a substantial need for affordable and efficient connectivity between physician practices, hospitals and imaging centers, as well as a way to effectively manage those interactions. According to the Healthcare Advisory Board, each year in the United States, 800 million imaging studies are performed, with 372 million of them done on an outpatient basis. Additionally, 12 percent of every primary care physician visit in the United States results in an imaging order, according to the United States Centers for Disease Control and Prevention. That equals 44 million studies annually. With the manual processes that exist today, getting the millions of exam reports and images into the hands of clinical decision makers is both inefficient and costly it is money that the industry simply cannot afford to waste. The value of Closed Loop Referral Management comes from delivering information from one location to another without having to build expensive point-to-point connections. This information exchange completes the care cycle by facilitating primary and secondary interactions. The primary interaction begins when a physician orders an imaging exam and concludes when an image-enabled report is delivered back to the referring physician who had requested the exam and into the EHR. An image-enabled report contains the clinical information of a typical report and a link that physicians can click to view diagnostic-quality images wherever they are stored, whether in the cloud or on premise. The four technology components that facilitate this primary interaction include: 1. The EHR where the order for the imaging exam originates 2. Cloud-based or on-premise archive and image viewing platform. 3. The cloud or gateway that serves as storage and the connection between systems 4. The radiology information system (RIS) Many provider organizations are beginning to realize that now is the ideal time to begin leveraging new strategies to connect with referring physicians and institutions, networks, and other systems outside their own four walls Both the EHR and RIS leverage a common technology found in Direct Messaging. (Direct is a technical standard for exchanging health information between entities in a trusted network.) The solutions are connected to the cloud, which serves as a single connection that facilitates access to the entire network, eliminating the need for point-to-point connections between disparate systems. Once the exam and report are complete, the imaging specialist s RIS sends the information back to the physician who ordered the exam and into the EHR. This completes the cycle of the primary interaction. CLOSED LOOP REFERRAL MANAGEMENT A MERGE WHITE PAPER 3

4 The secondary interaction, which follows the initial response from imaging center to referring physician or primary interaction, takes place when the ordering physician wants to share the report and images with another physician, such as a specialist. The ordering physician simply shares the imageenabled report via the cloud with the other physician where he/she can receive the data in the EHR or on the web to determine the next steps in a patient s care. The secondary interaction fills a critical gap in traditional image sharing methods that typically rely on sending CDs with images. How It Works Closed Loop Referral Management enables organizations to create an integrated data and imaging management strategy. It allows providers to take full advantage of the technologies available to acquire, analyze, store, and share patient data. In a service-based approach, health systems, integrated delivery networks (IDNs), and other health enterprises subscribe to the delivery system to create an electronic workflow that provides nation-wide access to patient information, clinical images, and reports. The delivery system provides a cloud-based network that leverages a health information service provider (HISP) for secure messaging. The HISP provides the services necessary for data exchanges, such as backbone transport, universal addressing, security and trust, messaging gateway, and storage. The HISP uses the Direct Messaging standard established by the Office of the National Coordinator for Health Information Technology (ONC), which enables participants to send encrypted health information to known, trusted recipients over the internet. Direct Messaging is much like sending secure messages. Using the Direct standard enables users to push information to one or more recipients who have a Direct address. One function of the HISP is to provide an up-to-date directory of Direct addresses. The Direct addresses may route to an inbox of a physician, a task or workflow queue handled by one or more people, a data repository, or registry or other types of endpoints. THE VALUE OF CLOSED LOOP REFERRAL MANAGEMENT The benefits of this strategy are realized at multiple levels: Compliance Using Closed Loop Referral Management helps create the connectivity for organizations to comply with their specific requirements, such as electronically generating 30% of their radiology orders via CPOE, and electronically viewing more than 10% of their clinical images via Certified EHR Technology. Avoid Creating and Managing Network Infrastructure With Closed Loop Referral Management, organizations can simply subscribe and begin exchanging information, rather than purchasing, implementing, and maintaining massive infrastructure. This convenience eliminates the need to manage connections between physicians and avoids the challenges associated with managing permissions for sharing patient data, since it is handled by the service. Resolve Interface Challenges Closed Loop Referral Management enables organizations to share reports and image links with referring physicians without the need to build custom, costly interfaces. With this delivery model, interfaces are built into the system, so referring physicians receive the imaging data within their existing EHRs. The result is that the service-based program connects referring physicians at a lower cost and leverages an organization s existing infrastructure to deliver imaging data to community physicians. Improve Referral Revenues Closed Loop Referral Management encourages increased referrals by simplifying how community physicians access patient data. The streamlined process improves physician workflow and the overall referral experience. Reduce Operational Costs Viewing and sharing images electronically over an advanced imaging network eliminates the need to burn CDs for image transport. This can lead to considerable savings, since each CD costs about $8 to burn, labor costs of importing images from a single CD can reach $30 to $40, and CD courier costs are virtually eliminated. Improve Patient Care and Safety Having images available when and where they re needed reduces duplicative exams that expose patients to further radiation. Also, having easy access to images avoids delays in care delivery and helps improve clinical decision making, which ultimately benefits clinical effectiveness and the patient experience. CLOSED LOOP REFERRAL MANAGEMENT A MERGE WHITE PAPER 4

5 It s important to note that Closed Loop Referral Management is not just about Direct Messaging. It s also about connecting to EHRs and EHR networks via application programming interfaces (APIs) to create a network of networks. Putting a Cost-Effective Interoperability Strategy to Work Closed Loop Referral Management streamlines physician workflow and helps healthcare organizations retain and grow their referral businesses. Delivering reports with links to images to the EHRs of referring physicians allows them to maintain their workflow. And if this level of communication isn t supported by their EHR, a web-based portal can be easily accessed to obtain reports and images. Getting buy-in from referring physicians is best accomplished by demonstrating how this network can generate a tremendous return on investment. For example, building enough HL7 interfaces to reach all the providers in Chicago alone would require one million interfaces. At an estimated $20,000 to $50,000 for each bi-directional interface, this quickly becomes an insurmountable expense. With a cloud-based interoperability strategy, healthcare organizations can deliver this same level of extension into a given community for pennies per transaction. What to Look for in an Interoperability Solution Provider To maximize the value that a Closed Loop Referral Management strategy can provide, there are some key items to consider when evaluating service providers: Vendor-Neutral Approach Getting locked into proprietary technology defeats the purpose of interoperability. An interoperability service needs to easily connect with an organization s existing solutions, such as the EHR, RIS, PACS, HIE, and others. Figure 2: Closed Loop Referral Management RESULT WITH IMAGE ACCESS ROUTED ORDER EXAM WITH CDS CONSULT PERFORM EXAM AND READ IMAGES ORDER FLOWS TO YOUR RIS/HIS EXAM AUTHORIZED EXAM SCHEDULED iconnect Network Services is the Closed Loop Referral Management solution that is a network of health networks, connecting everyone without costly and time consuming point-to-point interfaces CLOSED LOOP REFERRAL MANAGEMENT A MERGE WHITE PAPER 5

6 An End-to-End Solution An interoperability service needs to be comprehensive to provide value. Vendors that only offer a piecemeal approach increase the workload and responsibility of the organization and decrease the value of the service. Experience and Expertise The service provider must have extensive expertise in image management, network infrastructure, and clinical workflows. HL7 Interfaces Included This is vital for making the strategy and the service cost effective. Viewing Reports and Images in Context Having reports and image links sent to physician EHRs allows for the information to be evaluated in context with the patient record and eliminates the workflow disruptions of having to access other systems to retrieve the data. HISP and Gateway Functionality These functions are highly technical and require extensive expertise to implement and maintain. The interoperability service should include this functionality within its subscription. Image Viewing and Sharing Tools These are necessary for the service to function properly, and they should be an integrated suite of solutions that work seamlessly with all EHRs, RIS, and PACS. Using third-party solutions for image viewing and sharing may negate much of the value of the network. How Merge Can Help Merge is a leading provider of innovative enterprise imaging, interoperability, and clinical systems that seek to advance healthcare. Merge s enterprise and cloud-based technologies for image intensive specialties provide access to any image, anywhere, any time. With solutions that have been used by providers for more than 25 years, Merge is helping to reduce costs, improve efficiencies and enhance the quality of healthcare worldwide. Selected solutions pertaining to this white paper are listed below: iconnect Network Services A Closed Loop Referral Management network that automates prior authorization, enables electronic ordering of images, and delivers diagnostic quality images to referring physician EHRs. icns Orders An interoperability solution to simplify patient referrals. icns Authorize An automated prior authorization solution to prevent claims denials. icns Results A results delivery solution that provides access to reports from any device. iconnect Access A zero-download DICOM image and XDS viewer combined into one solution that provides image review for referring physicians. Partnerships Closed Loop Referral Management services are complex to build, which creates challenges in making them simple to use. Beyond the solutions themselves, there are other components to achieve connectivity. These include EHR networks and HISPs, and other connectivity partnerships. The service provider must be able to demonstrate that these partnerships are in place. Building a network of networks provides an extended reach. It s critical that providers have an established technology that leverages other networks to deliver and exchange data. CLOSED LOOP REFERRAL MANAGEMENT A MERGE WHITE PAPER 6

7 Merge Partners Merge works exclusively with select partners to deliver innovative solutions that help improve the electronic healthcare experience. Whether providing software, hardware, or services, our partners provide world-class technologies, that when combined with Merge solutions, enable healthcare organizations to streamline workflow, improve efficiencies, save time, and most importantly deliver better patient care. Key partners that pertain to this white paper include: athenahealth A leading provider of cloud-based services for EHRs, practice management, and care coordination. Merge s partnership with athenahealth provides API functionality and access to a nationwide network of EHRs within physician practices. For more information, visit athenahealth.com Surescripts The Surescripts network supports the most comprehensive ecosystem of healthcare organizations nationwide. Pharmacies, payers, pharmacy benefit managers, physicians, hospitals, health information exchanges, and health technology firms rely on Surescripts to more easily and securely share health information. Guided by the principles of neutrality, transparency, physician, and patient choice, open standards, collaboration, and privacy, Surescripts operates the nation s largest health information network. For more information, visit surescripts.com NextGen Healthcare NextGen is a leading provider of integrated clinical, connectivity, and financial solutions. With this development of this partnership, NextGen Share customers can seamlessly send electronic imaging orders and receive imaging reports from Merge icns customers. Emdeon Emdeon is a leading provider of revenue and payment cycle management and clinical information exchange solutions. With the development of this partnership, Emdeon Clinical Exchange customers have the ability to send electronic referrals and receive radiology reports from Merge icns users. For more information, visit emdeon.com Mirth Mirth partners with Merge to provide HISP functionality for Direct Messaging, For more information, visit mirth.com Merge is the co-founder of the DICOM image standard, has the number one downloaded medical imaging application in the world and holds 90-plus patents in imaging and health information technology. Merge s customer base includes 1,500 hospitals and 6,000 clinics. For more information, visit merge.com or follow ICN-2772 Rev 1.0 Copyright 2015 Merge Healthcare x3 merge.com