Rwmn toc archive 20110218

Redwood MedNet Transition of Care (ToC) Messaging Service

Pilot Project Brief - Redwood MedNet : : Cal eConnect IZ Demonstration : : HIMSS FHA Direct Demonstration

Status of this document: ARCHIVED DRAFT FROM FEBRUARY 2011
Link to more current page: Cal eConnect ToC Demonstration
Link to Cal eConnect Direct Messaging Grant

Background

Care handoffs between hospitals and providers of post-acute care can expose patients to potential adverse effects when poor communication interferes with clinician collaboration on patient medication and follow-up instructions. These risks are potentially preventable with better communication during transitions of care. Redwood MedNet will test Direct Messaging as a candidate solution for targeted electronic delivery of discharge or transfer information during patient transitions between care settings. Direct Messaging solutions will be developed by adhering to the workflow requirements of each participating healthcare facility.
 
 

Use Cases

[1] Send Discharge Summary to Eligible Provider:
  + Capture patient functional status, medication history and care plan in a Direct Message
  + Send Direct Message to appropriate care provider
 
  The following table shows seven common documents in the current workflow for SNF patients admitted to a local hospital, or discharged from the hospital to the SNF. Although a majority of the content is in an electronic format, each site prints the documents and faxes them to the other site. This is an ideal opportunity for investigation of the Direct Messaging use case with regard to which data types are optimally served by unsolicited push transport.
 

clinical data	Hospital	SNF
Patient Care Plan	electronic	electronic
Current Status	electronic	handwritten
Medication List	electronic	electronic
Current Physician Orders	handwritten	electronic
Clinical Test Results	electronic	electronic
History & Physical	electronic	electronic
Functional Status	electronic	electronic

[2] Send Care Summary to Patient:
+ Capture patient functional status, medication history and care plan in a Direct Message
+ Send Direct Message to Microsoft HealthVault, if in use as the patient's personal health record (PHR)

Participants

site	Eligible Provider?	EHR	Work Flow Focus
Healdsburg District Hospital	yes	HMS	Send discharge summaries to primary care provider
Mendocino Coast District Hospital	yes	Meditech	Send patient summaries to long-term care

Production Timeline

If funded by a grant proposal submitted to Cal eConnect, this project will launch in March 2011. Production is expected to take 6 to 12 weeks per interface. Enrollment of eligible providers will be scheduled between March and September 2011 on a first come, first serve basis. Grant funds are limited, and can pay for deployment of only one or two use cases at a handful of participating sites.