1 Bay Area Transformation Partnership Advantages of Cross-Organizational Use of Secure Texting LifeSpan – Post-Acute Leadership Summit May 16, 2017

2 Presenters Dave Mooradian, MD, Chief Medical Information Officer, Emergency Department, Anne Arundel Medical Center Reshma Modi, DO, Medical Director, Skilled Nursing Facility Provider, Adfinitas Health Erin Devine, MBA, BSN, RN, CDON, UM Baltimore Washington Medical Center High Risk Care Coordinator, Skilled Nursing Facilities Cindy Gingrich, MSIM, PMP, CPHIMS - BATP Project Management Consultant (Anne Arundel Medical Center & UM Baltimore Washington Medical Center)

3 Disclaimer Presenters have no conflicts of interest related to the products or services contained in this presentation.

4 Objectives The Bay Area Transformation Partnership (BATP)Who we are Secure Texting landscape How we are using secure texting to improve communication as patients move across care settings Case Study: ‘Before’ and ‘After’ secure texting Adfinitas Health providers in the Skilled Nursing Facilities (SNF) and Emergency Departments (Anne Arundel Medical Center, University of Maryland Baltimore Washington Medical Center) Single technology solution, multiple organizations (CRISP-hosted) Review Additional Use Cases How to sign-up for access to cross-organizational secure texting

5 Bay Area Transformation PartnershipHSCRC funded grant to improve care coordination between hospitals and community partners, resulting in better chronic care management and cost savings Anne Arundel Medical Center University of Maryland Baltimore Washington Medical Center Community Care Management Agencies The Coordinating Center Department of Aging & Disabilities Adfinitas Health – Skilled Nursing Facility Providers Physician House Call Service (Capital Coordinated Medicine) Behavioral Health resources

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8 Secure Texting Skilled Nursing Facility Provider to/from Emergency Department Provider

9 I’ll take a message and leave a note for the doctorBefore Secure Texting I’ll take a message and leave a note for the doctor Wait on Hold 1 2 3 … - Non-provider interpretation - Sometimes message never reaches the right ER doctor …… 4 5 Send the patient and paperwork to the ED What does this note mean? I have questions Do I call the facility and try to find this provider? I don’t have time or know whether it would help. I’ll admit and treat. Shift changes at the SNF? Shift changes in the ER? Which ER doctor will see the patient?

10 … After Secure Texting 3 1 2 4 Fast Efficient Direct AAMC ED AttendingOr UMBWMC ED Attending No more waiting on hold to leave a message! 4 ED Doc reads ASAP (no phone call interruption) Direct response to SNFist No interpretation by intermediary I know who you are and we share this patient ‘together’ Can easily ‘call’ or ‘text’ the SNFist Can pass the message at change of shift Direct connection benefits occur ‘days’ afterward (i.e. medication questions) Send the patient and paperwork to the ED

11 Example – SNFist to ED Provider CommunicationOriginally from: Melissa Barksdale, CRNP Date: 5/4/17 11:24 PM Hello. ‘’ DOB: ‘x/x/x’ is coming from Heritage Harbour SNF for Left hip wound large amount of bleeding that is pulsating. Nurse unsure if it is an old surgical wound. Dx Left hip wound infection, could not obtain much more hx than that as the nurse and wound nurse are trying to maintain pressure to this pulsating wound. BP 101/50, P 103, Pulse Ox 95% on RA. Thank you. Originally from: David Mooradian Date: 5/5/17 2:02 AM Looks like decub. No bleeding here. May need to follow with wound center Dave Mooradian, MD, Chief Medical Information Officer, Emergency Department, Anne Arundel Medical Center

12 Example – SNFist to/from ED ProvidersSNF Provider To: ED Attending UMBWMC Hi, Taana Viviano here at severna park. Sending in by 911 for witnessed unresponsive episode sitting in WC and then gen T-C sz activity for approx 2 min. All VSS, bs 140. After 5 min started to open eyes to name. Diaphoretic. +h/o cva with chr L paresis. Call with any questions ED Provider # 1 From: Chirag Chaudhari, MD Date: 5/1/17 1:27 PM Got it thanks. Shift Change in the ED (Doc #1 passes text to Doc # 2 before leaving) ED Provider # 2 From: Bethany Radin, DO Date: 5/1/17 5:04 PM Hi. Dr Radin. I just saw . No further seizures. No obvious cause other than his prior stroke. Started him on keppra. To follow up w dr Singh neurology From: Taana Viviano, MD Date: 5/1/17 5:06 PM Ok thanks

13 Example: Post hospital discharge - SNFist to/from HospitalistFrom: Reshma Modi, DO Date: 4/13/17 3:08 PM Hi Elizabeth This is Reshma Modi from Waugh Chapel I was told you were trying to get a hold of us regarding a MOLST form for a patient .... From: Elizabeth Young, PA-C Date: 4/14/17 6:39 PM Hello! Yes thanks, Dr Modi for getting back to me. I discharged patient [x] to Waugh chapel. The person who admitted him discussed/filled out a MOLST with him, but apparently just the front and the Care manager advised me she was contacted to get the back portion filled out. I wasn't quite sure how to go about discussing it with him to complete it since I have no contact information while at rehab so the care manager suggested that possibly one of the clinicians at Waugh chapel could go over it with him. I'm not sure if that is a possibility, but I appreciate your assistance either way. Thanks again From: Reshma Modi, DO Date: 4/18/17 12:17 PM Hi Elizabeth Sorry for late response Don't worry , we took care of it :) Dr. Reshma Modi, Adfinitas Health Provider, Skilled Nursing Facility

14 H O W T E X Search for and select ED Attending at appropriate hospitalSNFist sees a message asking permission for the message to be forwarded to a specific ED Provider. Now they know who the ED Doctor is! SNFist can type a text message, send a photo or video or send a voice message

15 How we do it ED Administrative staff log in to the generic ‘AAMC ED Attending’ ID and set auto forward ‘on’ so that messages go directly to the ED provider who is in charge of receiving secure texts for that shift. ED Provider logs in to their own Doc Halo account to receive the messages SNFists can send to the generic ‘AAMC ED Attending’ or ‘UM BWMC ED Attending’ Doc Halo ID’s 7x24x365

16 CRISP-hosted Doc Halo Secure TextingEnables multiple organizations to use the same software application Shared organization lists (i.e. phone book) so they can see who is on Doc Halo (organizations, departments, titles) Collaboration -> We study and improve processes together Multiple EMR challenge Information needed by each role varies (we learn thru texting who needs what & when) Workflows Opportunities for improvement in communication, care coordination and avoiding preventable utilization

17 Skilled Nursing Facilities and Emergency DepartmentSecure Texting Skilled Nursing Facilities and Emergency Department

18 Additional Use Cases Community care manager receiving Encounter Notifications via Doc Halo ED care manager to community care manager SNF Social Worker to/from Community Care Manager ED to Specialists for Urgent Follow-up (i.e. Cardiology) Specialist consultation from ED, Hospitalist or SNF Complimentary to Telemedicine Inter-organizational secure texting Erin Devine, MBA, BSN, RN, CDON, UM Baltimore Washington Medical Center High Risk Care Coordinator, Skilled Nursing Facilities

19 Example: Encounter Notification for a patient discharge from hospital via secure textingAdditional Information: Admit Source: Admit Reason: Death Indicator: N Death Date: Diagnosis Code: Diagnosis Description: Discharge Disposition: *O/P FINAL/HOME Discharge To Location: Hospital Service: Race: White Ethnicity: Past Encounter Information: Past Emergency Visits: 1 Past Inpatient Visits: 0 Your Facility Site: Your Facility MRN: 5/15/2017 6:32 AM Fwd: User , API Patient Information: Patient Name: Gender: Female DOB: Address: Home Phone: Work Phone: Cell Phone: Facility Information: Hospital/Org. Name: Baltimore Washington Medical Center Hospital MRN: xxxxxx Event: Emergency Discharge Event Time: 05/15/ :18:50

20 Access to CRISP Doc HaloFocus is on cross-organizational use If you are part of a regional partnership, please contact your project manager If you are not part of a regional partnership, please contact the CRISP Support Team at: or call and ask about obtaining access to Doc Halo secure texting for cross-organizational use

21 Bay Area Transformation Partnership (BATP) Advantages of Cross-Organizational Use of Secure Texting Thank you

22 Extra slides

23 After Secure Texting SNFist can quickly and securely text the right ER Doctor , establishing a direct communication link. ED provider can respond as soon as possible via text or by pressing the phone icon in the text message.