• Providers will have an up-to-the-minute view of a patient’s health history at the point of care
• Accessing the Virtual Health Record puts the power of information and collaboration in the hands of the clinician—enabling more accurate diagnoses, faster and more effective treatment, and better outcomes for the patient

Little Rock, Arkansas – May, 2019  SHARE is happy to announce our new participant; Chenal Family Therapy has joined the only statewide health information exchange. Chenal Family Therapy is the newest group of behavioral health clinics to join the SHARE network! With locations in West Little Rock, Conway, North Little Rock, Bryant, White Hall, Rogers (NWA), Hot Springs, De Queen, Cabot, Heber Springs, El Dorado, Fort Smith, Texarkana and Jonesboro. Chenal Family Therapy is encouraging, empowering and equipping patients for a better state of health throughout Arkansas.

Chenal Family Therapy is providing high quality, patient-centered therapy, medication management and counseling. Access to SHARE will give the therapists, nurses and care team, that see patients in over 20 counties in Arkansas, secure access to important health information such as, updated patient records, discharge summaries, medication histories and demographic information. This ensures every care provider in a patient’s chain of care has consistent and current information, and that their health records are more secure and accessible than with paper files being faxed or mailed.

About Chenal Family Therapy:

Chenal Family Therapy is a team of passionate and caring therapists covering in Arkansas, with 15 locations and more to come. They were founded in 2010 by their Practice Director, Ken Clark, MA, LMFT. They do individual, couples and family therapy for kids, teens, and adults, as well as psychological testing services. They also offer psychiatric evaluations, medication management, and registered dietitian services. Healing Relationships through Individual, Couples & Family Therapy is their mission and vision.

Find out more here:

https://www.chenaltherapy.com/

 

Healthcare simply consists of thousands of interlinked processes that result in a very complex system. If we focus on the processes of care one at a time, we can fundamentally change the game and deal with the challenges facing healthcare. Meaningful quality improvement must be data-driven. This is particularly true for quality control in healthcare. You’re basically dead in the water if you try to work with healthcare providers and you don’t have good data. I think everybody recognizes that.

The right data in the right format, at the right time, in the right hands is crucial.  If clinician teams are going to manage care, they need data. They need the right data delivered in the right format, at the right time, and in the right place. And the data must be delivered into the right hands—the clinicians’ care team is involved in operating and improving any given process of care.

If quality improvement is going to work in healthcare—if we are going to realize value—it means, we must engage clinicians. Clinicians (nurses and providers’ care team) are the frontline workers who understand and own the processes of care. But we live in a pristine time. I once received from an email from a physician leader at a leading national delivery system. I’m going to withhold the name of the delivery system, but I can tell you that if you ask knowledgeable people to list of top 10 delivery systems in the country, almost everyone would put the same organization on their list. Despite that, this physician wrote to me lamenting how difficult it was for him to get his peer physicians to see a new future. And in his email, he succinctly described the problem by saying that his physicians were “historically encumbered and demoralized.” And I love the succinctness of his description because what he is basically saying is they’re clinging to the past and are demoralized because they don’t see a new future. And in that short phrase, this very excellent physician leader encapsulated the problem and points us towards the solution.

View the full Spring Newsletter here.

• Empower Health Care Solutions, a Provider-led Arkansas Shared Savings Entity (PASSE) expands connection with SHARE to include real-time ADTs (Admission, Discharge and Transfers)
• Utilizing SHARE in addressing the overall health care needs of Medicaid beneficiaries who have complex behavioral health or intellectual and developmental disability (IDD) service needs
• Use of the Virtual Health Record (VHR) and Secure Messaging (SM) to coordinate and integrate treatment delivery across all of the individual’s providers

Little Rock, Arkansas – April, 2019 The only statewide HIE in Arkansas, State Health Alliance for Records Exchange announce a ground-breaking partnership that will enable more efficient healthcare services for patients across rural Arkansas who have complex behavioral health or intellectual and developmental disability (IDD) service needs.

By enhancing the connection with Empower Health Care Solutions, a Provider-led Arkansas Shared Savings Entity (PASSE) to the statewide HIE network, which includes Admission, Discharge and Transfer (ADT) data exchange, this integration of ADTs will have faster and more complete access to their patients’ most critical health information. The enhanced information access will improve patients’ care coordination, reduce treatment delays and assist with the elimination of unnecessary admission to the emergency room.

Additionally, SHARE provides Empower Health Care Solutions with 24-hour daily reports when the members are admitted and discharged from the emergency department or have an inpatient discharge. This collaboration is a continued effort to improve patient outcomes of Medicaid beneficiaries throughout Arkansas. The care coordinators are also using the VHR that displays information as a traditional clinical chart, with tabs to separate patient information into groups for easy chart review. It retrieves and shows all available data for a selected patient gathered from all participants within SHARE to enable a single, consolidated view of a patient’s health history. By also using SM the care coordinators are also able to communicate with providers and healthcare teams taking care of patients who have complex behavioral health or intellectual and developmental disability (IDD) needs.

Empower Health Care Solutions can view the following patient data through the SHARE VHR:

• Admission, Discharge and Transfer reports
• Allergies, Problems, Medications
• Demographic and Insurance information
• Laboratory results
• Radiology reports, image links
• Discharge Summaries
• Continuity of Care Documents
• Progress Notes

As the healthcare landscape continues to transform, HIEs may play a key role in providing data that fuels innovation. SHARE and Empower Health Care Solutions are working together to contribute to these innovation efforts such as population health initiatives and identifying potential social determinants of health.

About Empower Healthcare Solutions:  Empower is run by six organizations working together. Empower Healthcare Solutions, LLC (Empower) is a Provider-led Arkansas Shared Savings Entity (PASSE). This new model of care was developed to address the overall health care needs of Medicaid beneficiaries who have complex behavioral health or intellectual and developmental disability (IDD) service needs. Goals of the PASSE program are to:

• Coordinate and integrate treatment delivery across all of the individual’s providers
• Improve total health outcomes for the target population
• Increase local services capacity to help individuals with IDD access quality care and support services within their own communities
• Ensure flexibility in the individuals’ service array to address all of their health care needs
• Slow or decrease spending growth and costly acute care stays by promoting efficient and effective services

Arkansas Community Health Network (ACHN). ACHN is composed of four health care systems: Baxter Regional Health System, North Arkansas Medical System, Unity Health, and White River Health System.

Beacon Health Options (Beacon). Beacon is the nation’s largest organization exclusively dedicated to assessing and addressing the clinical and social needs of individuals experiencing mental illness, addiction and developmental disabilities. In Arkansas, since 2010, Beacon has had contracts with the Department of Human Services to assist in administering the behavioral health care delivery system.

Independent Case Management (ICM). ICM is a statewide premier provider of home and community-based supports to individuals with intellectual and developmental disabilities.

Statera. Statera is an entity comprised of leaders and innovators committed to serving the long-term support services needs of Arkansans, including those with behavioral health and developmental disability diagnoses. Together, the representatives of Statera have vast health care experience, spanning home health, hospice, skilled nursing facilities, assisted living facilities, independent care facilities, institutional pharmacies, retail pharmacies, medical clinics, rural health clinics, non-emergency transportation services; and full-service rehabilitation therapy businesses throughout Arkansas. 

The Arkansas Healthcare Alliance, LLC. The Alliance is comprised of approximately 22 well-established inpatient and outpatient providers, who strive to provide quality behavioral health, substance use disorder, and intellectual and developmental disability services. Together, the Alliance offers individualized treatment to tens of thousands of Arkansas infants, children, adolescents, adults, and families.

Woodruff Health Group, LLC (ARcare/pharmacist). ARcare operates as a Federally Qualified Health Center (FQHC). In addition, ARcare is the statewide provider of medical and case management services for the Ryan White HIV/AIDS program. Over the last 30 years, ARcare has created a health care home through a network of 36 primary care clinics, three pharmacies, and four wellness centers to serve underserved communities and provide access to quality health care.

To learn more visit: https://www.getempowerhealth.com

 

• Promoting Behavioral Health Data Exchange with Perspectives Behavioral Health Management
• Improving Comprehensive Patient Care
• Identifying High Risk Patients

Little Rock, Ark. March 2019 ­- Health information exchanges (HIEs) play a hand in enabling more practical, timely health data exchange to participating healthcare organizations and their patients.  While electronic health record (EHR) systems and health data exchange solutions have been common tools within hospitals and physician practices for close to a decade, many behavioral healthcare providers are just beginning to integrate EHR use into care delivery. This includes integration with HIEs for a more complete picture of health of the patient.

The only statewide HIE in Arkansas, State Health Alliance for Records Exchange (SHARE), has now integrated with Perspectives Behavioral Health Management, that use Credible, a behavioral health EHR, to improve comprehensive care throughout West Arkansas. This includes records such as diagnostic evaluation, diagnoses, discharge plan/summary, medications and continuity of care documents (CCDs).

With this integration, SHARE excludes sensitive labs, psychotherapy notes and substance abuse information adhering to 42 CFR Part 2. SHARE also, provides Perspectives Behavioral Health Management access to 24 hour daily reports notifying the behavioral health clinic providers and care coordinators when their patients are admitted and discharged from the emergency department and inpatient discharges.

Perspectives Behavioral Health Management’s main clinic is located in Fort Smith, Arkansas and provides care at Clarksville, Greenwood, Mulberry clinics and also sees patients at over 20 school based treatment programs throughout the Fort Smith region. Perspectives Behavioral Health Management services Day Treatment (adult), Traditional office-based counseling (child/adult), Psychological testing (child/adult), School-Based Services (child), and Crisis Intervention services.

These efforts to include behavioral health in the electronic data exchange mark progress toward enabling more comprehensive, complete patient care. Despite a growing awareness of the importance of behavioral health data to primary care providers and hospitals, behavioral health data sharing continues to lag behind.

With this integration of behavioral health data into SHARE it ultimately results in a more complete picture of a patient’s health and assists with information gaps. Integrating behavioral health and other data types into SHARE is imperative to mitigating these information gaps and avoiding potential inhibitors to positive patient health outcomes resulting in improving managed mental health.

About Perspectives Behavioral Health Management

The philosophy of Perspectives Behavioral Health Management, LLC is to provide top quality care to individuals and families served to help them achieve their treatment plan goals. Key principles of treatment include evidenced based practices to accurately assess and intervene for remediation and/or management of mental health symptoms across all populations served.  Integration of cultural sensitivity and family involvement are part of treatment to enhance success. Each patient has individual needs and goals which are the priority of treatment.  PBHM will assess and treat in a compassionate manner. Services are designed to help patients' transition into a less restrictive environment as they complete their goals.

Perspectives Behavioral Health Management, LLC, has earned a reputation for providing quality mental health services in a timely and efficient manner. We have a multidisciplinary team approach to treatment which utilizes the skills of the psychiatrists, therapists, paraprofessionals, and nurses working together under the physician’s supervision, in order to facilitate a comprehensive and constructive plan of care for the patients that we treat.  The treatment team works in collaboration with the consumer to develop the most appropriate plan of care given the presenting problem, needs/desires of the consumer, and resources available to that Individual We Serve

Our Mission is to provide quality outpatient mental health services based on sound business practices. Central to our Mission is our desire to be the premier provider of quality outpatient mental health services in the State of Arkansas by providing a multitude of innovative services based on need and available resources while assisting both the family and community in the promotion of healing and change.

We will:

• Provide excellence through our use of progressive and proactive services
• Attract highly qualified personnel
• Develop community partnerships
• Value professionalism, teamwork, integrity, and responsibility
• Continually assess program delivery

Services provided include:  Day Treatment (adult), Traditional office-based counseling (child/adult), Psychological testing (child/adult), School-Based Services (child), and Crisis Intervention services.

For more information, visit: https://www.pbhm.com

 

 

Little Rock, Arkansas– MANA, Medical Associates of Northwest Arkansas, one of the largest medical groups of local independent physicians in Northwest Arkansas, has connected with the State Health Alliance for Records Exchange (SHARE) the only Statewide Health Information Exchange (HIE) that facilitates the secure exchange of patient health information among hospitals, physicians, clinicians and other members of the medical community. MANA is physician owned and patient centered with one purpose to improve quality of life by providing compassionate, comprehensive, quality healthcare.

“MANA is committed to delivering high-quality care in a professional and caring environment to improve the health and well-being of the patients in North and Northwest Arkansas,” said Anne Santifer, SHARE Executive Director. By connecting with SHARE, they will further their commitment by exchanging information more efficiently with referring physicians and providing referral doctors and hospitals with the patient information they need at the point of care.

MANA is now live with sharing data through an interface with eClinicalWorks (eCW) and the only Statewide HIE in Arkansas (SHARE), which features a robust patient query and response functionality that lets providers quickly access patient health data from hospitals, physician practices, state health systems and more. This includes records such as medical history, previous diagnoses, lab tests, medications, continuity of care documents (CCDs), immunizations, vitals and allergies. Additionally, SHARE provides access to 24 hour daily reports notifying the primary care clinic providers and care coordinators when their Arkansas Medicaid patients are admitted and discharged from the emergency department and inpatient discharges.

Whatever a patients’ healthcare needs, MANA provides compassionate, expert care to families through their network of specialists that expand from Fayetteville to Harrison Arkansas. “We are pleased to welcome Medical Associates of Northwest Arkansas, one of the nation’s leading medical groups of local independent physicians, to SHARE,” said Justin Villines, HIT Policy Integrator of SHARE. “This connection helps facilitate the seamless and secure exchange of patient health information with Arkansas’ health systems, hospitals and physicians. This delivers substantial benefits for patients, referring physicians and all of the MANA practices.”

MANA includes a wide range of clinics and specialties:

 

Clinics Include:	Specialties Include:
Multi-Specialty: Fayetteville Diagnostic Clinic	Adult Medicine
FirstCare Family Doctors (7 locations)	Asthma Clinic
MANA Urgent Care (2 locations)	Imaging & MRI
Millennium Chiropractic Sports Medicine and Rehab	Mammography/Breast Imaging
Fayetteville Acute Care & Walk-In Clinic (Pediatrics)	Chiropractic
Pinnacle Hills Wellness Clinic and Acute Care & Walk-In Clinic (Pediatrics)	Family Medicine
Renaissance Women's Healthcare	Gastroenterology
The Breast Center- Fayetteville	Gynecology
MANA Family Medicine	Neurology
Fayetteville Wellness Clinic (Pediatrics)	Pediatrics
The Breast Center- Bentonville	Psychiatry
The Breast Center- Harrison	Pulmonary Medicine
MANA MRI	Rheumatology
MANA Imaging	Sleep Medicine
MANA Northwest Arkansas Psychiatry	Urgent Care

Established in 2013, SHARE has successfully connected members consisting of hospital systems, physician groups, public health registries, individual practitioners, state and regional HIEs. SHARE is connected to the national eHealth Exchange and is also a member of DirectTrust, which enables its members to securely exchange information nationally with other providers who are using DirectTrust. SHARE participates with the Strategic Health Information Exchange Collaborative (SHIEC). Health information exchanges (HIEs) are connecting nation­wide to seamlessly deliver patient health information across state lines and across health systems, improving the patient experience by making health information available when­ever and wherever care occurs.

About MANA Physicians and Clinics

Medical Associates of Northwest Arkansas (MANA) is an independent physician group that includes family medicine, pediatrics, women’s health and an array of specialists and advanced health services. Our mission is to improve quality of life by providing compassionate, comprehensive, quality healthcare.

An Independent Physician Group

MANA physicians and clinics have a reputation for excellence as leaders in the healthcare community for over 50 years.

• Fayetteville Diagnostic Clinic was established in 1957 to provide internal medicine and specialty care for adults.
• In 1983, Drs. Joe T. Robinson and Terry Payton opened Northwest Arkansas Pediatric Clinic, now Northwest Arkansas Pediatrics. Since then the pediatric practice has continued to attract top graduates from the University of Arkansas School of Medicine and Arkansas Children’s Hospital as well as other top programs.
• In 1994, a group of family medicine doctors established FirstCare Family Doctors, that now has 7 locations serving the Northwest Arkansas community with quality family care.
• In 1999, Fayetteville Diagnostic Clinic physicians partnered with Northwest Arkansas Pediatrics and FirstCare Family Doctors to create a unique medical group, Medical Associates of Northwest Arkansas (MANA).
• In 2000, we added MediServe Walk-In Clinic to serve residents, students, and visitors seven days a week. These clinics are now called MANA Urgent Care.
• In 2003, Drs. Danna Grear and Kevin Pope established the first independent facility in Arkansas dedicated solely to breast imaging, The Breast Center. The Breast Center was the first in the area to offer digital mammography and first in the state to offer Breast MRI with Dr. Steven Harms, a world-renowned radiologist.
• Dr. Kathleen Paulson approached MANA in 2005 to open a gynecology practice, Renaissance Women’s Healthcare, dedicated to educating women about their health from their first appointment through menopause.
• In 2009, MANA physicians acquired the first 3T MRI in Northwest Arkansas to provide patients and physicians with faster scans and better images.
• In 2012, added Automated Whole Breast Ultrasound for women with dense breast tissue at The Breast Center. 
• MANA Imaging began providing lung cancer screening and was named an Accredited Lung Cancer Screening Center in 2017. 
• Expanded family medicine and pediatrics to Benton County in 2018.
• Our top priority is to provide the best care to our patients for optimum health. We believe in listening and sharing with our patients. Our Mission is to improve quality of life by providing compassionate, comprehensive, quality healthcare.

Physician Owned

MANA clinics are independent, physician-owned practices. As a physician-owned practice, our physicians can focus on compassionate, quality, patient care, and retain the quality, personal clinic environment. Physicians make the decisions that shape excellent patient care in our practices.

By working together, MANA physicians can responsibly manage the costs associated with health care, improve our practice efficiencies, and enhance overall care for patients. A board of directors elected by the physicians governs MANA. The board is advised and assisted by four principal leaders: Jason Wilson, Chief Executive Officer; Paula Maxwell, Chief Operating Officer; John Jordin, Chief Informational Officer; and Paula Storment, Chief Financial Officer.

Innovative Care

MANA clinics are at the forefront of innovative health care. Our physicians provide an array of advanced diagnostic testing and preventive screening including laboratory services, breast cancer screening, general imaging, advanced pulmonary testing, colon cancer screening and endoscopy. View advanced health services.

 

• CHI St. Vincent Infirmary, CHI St. Vincent North, CHI St. Vincent Hot Springs and CHI St. Vincent Morrilton hospitals expand connection with SHARE to include Continuity of Care Documents (CCDs)
• 30+ CHI St. Vincent Heart Clinics Arkansas are integrating to share patient data with referral partners to include Continuity of Care Documents (CCDs)
• 80+ Primary Care and Specialty Care clinics expand connections to seamlessly deliver patient health information (Laboratory Results, Radiology Reports and Discharge Summaries) across the state

 

Little Rock, Arkansas – February, 2019 The only statewide HIE in Arkansas, State Health Alliance for Records Exchange (SHARE), announce a ground-breaking partnership that will enable more efficient healthcare services for patients across rural Arkansas. This expands connections to CHI St. Vincent by exchanging important information such as lab results, updated patient records and demographic information. By integrating with the only Statewide Health Information Exchange (HIE) it ensures every care provider in a patient’s chain of care has consistent and current information, and that their records are more secure and accessible.

By enhancing the connection with CHI St. Vincent hospitals and clinics to the statewide HIE network, which will include bi-directional data exchange, health care providers participating in the clinically integrated network and referral partnerships will have faster and more complete access to their patients’ most critical health information. The enhanced information access will improve patients’ care coordination, reduce treatment delays, eliminate unnecessary testing and allow care providers to make more targeted diagnoses and treatment recommendations.

Additionally, SHARE provides CHI St. Vincent with data to enable enhanced 30-day readmission event notifications, as well as 24-hour daily reports when their primary care practices’ Medicaid patients are admitted and discharged from the emergency department or have an inpatient discharge. This collaboration is to improve population health analysis, patient outcomes and success with health care quality initiatives such as accountable care, meaningful use, clinically integrated networks, MIPS/MACRA and medical home programs.

"We enthusiastically support CHI St. Vincent’s vision of higher quality, better coordinated care for individuals living in rural Arkansas," said Anne Santifer, Executive Director at SHARE. “CHI St. Vincent is among the most ambitious health care systems in the state — they are implementing state-of-the-art technology that will significantly improve collaboration among providers in their area. Ultimately, this will improve patient outcomes and potentially reduce overall health care costs for everyone” said Justin Villines, HIT Policy Integrator at SHARE.

As the healthcare landscape continues to transform, HIEs may play a key role in providing data that fuels innovation. SHARE and CHI St. Vincent are working together to contribute to these innovation efforts such as population health initiatives and identifying potential social determinants of health. “This collaboration with SHARE will enable CHI St. Vincent to move forward with our mission ensuring a healthy future for those we serve, while excelling our system performance while we advance personal and community health beyond our traditional acute care focus.” “Sharing information among health care providers is fundamental to providing the highest quality of care for our citizens.” said Christi Whatley, Vice President & Chief Quality Officer, CHI St. Vincent.

CHI St. Vincent continues to remain committed to delivering the highest quality of care for patients and the communities it serves while simultaneously driving efficiencies to address the challenges facing healthcare providers and ensuring a sustainable future for its healing ministry in Arkansas.

About CHI St. Vincent:

CHI St. Vincent, a regional health network serving Arkansas, is part of Catholic Health Initiatives. We have served Arkansas since 1888 with a history of many firsts. Headquartered in Little Rock, our networks include primary care, specialty clinics, urgent care, hospitals, home health, rehabilitation and surgery centers. Together with more than 4,500 coworkers, 1,000 medical staff, and 500 volunteers, we consistently receive praise for advancements in care. Our growing Medical Group includes more than 300 providers across almost every medical and surgical specialty.  For more information, visit:  https://www.chistvincent.com

 

Despite widespread support for organ donation, a severe shortage in the number of organs donated exists. More than 118,000 Americans are on a waiting list for a kidney, heart, liver or other vital organ, and another person is added to that list every 16 minutes. Statistics reveal an average of 18 individuals will die each day while waiting for an available organ. Estimates indicate that more than 25,000 Americans die each year under circumstances that would allow them to become organ donors, but an average of only about 5,000 a year actually donate.

However, knowing this shortage, ARORA uses SHARE (Arkansas’ Statewide Health Information Exchange) to access patient’s information in real time from hospitals and clinics across the State of Arkansas. This allows real-time decisions on if a patient is eligible for organ donation based on their diagnosis, laboratory results, progress notes as well as many other factors. Before having access to SHARE, Paul Coulter, Donation Development Liaison stated “ARORA staff had to drive to hospitals and review the patient’s medical chart before we could deem the patient a candidate for organ donation. This would take many hours,” he said.

During this summer Paul stated “SHARE simply helped restore the life of someone on the waiting list by allowing our providers to have real-time access to a medical history to determine if donation was possible.  We had a family who mentioned their loved one had a cancer diagnosis, but didn’t know all the details.  We researched the patient’s medical records and didn’t find the cancer diagnosis. We then checked SHARE where we found the complete story regarding the cancer, which resulted in the patient becoming a tissue donor. Because of SHARE’s ability to display multiple hospitals’ visits, we were easily able to find the information needed. Without SHARE, this patient would not have been able to enhance the lives of others due to the lack of information.  Donation provides hope and healing for donor families as they know their loved ones helped others in a time of great need.

Paul stated that “Research indicates the primary reason for not donating is lack of education about the subject. A single, multi-organ donor can provide as many as seven organs—heart, liver, two kidneys, two lungs pancreas, and intestine for transplantation—as well as tissue, including corneas, heart valves, skin and bone. Less than one per cent of all deaths are potential organ donors, which also greatly limits the number of organs available for transplant.”

As part of the United Network for Organ Sharing (UNOS), ARORA is certified by the Centers for Medicare and Medicaid Services (CMS). There are three organ transplant centers in Arkansas: Arkansas Children's Hospital, Baptist Health Medical Center and UAMS, all located in Little Rock. Arkansas Children’s Hospital performs heart and kidney transplants; Baptist Medical Center performs heart transplants; and UAMS performs kidney and liver transplants. Surgical centers throughout the state perform tissue transplants, including bone, skin, and cornea grafts.

Since 1988, more than 336,000 kidney transplants have been performed annually across the United States with a success rate of 95 percent. In 2012 there were more than 28,000 organ transplants and more than 450,000 tissue transplants. Each transplant procedure, over the past several years, has shown an increase in not only the number of cases performed each year, but in the success rate as well.

Simply put, having access to SHARE has saved our agency time and resources while making every effort to provide organs and tissues for life-saving and life-enhancing transplantations.

About Arkansas Regional Organ Recovery Agency (ARORA)

The Arkansas Regional Organ Recovery Agency (ARORA) was established in 1987 as a non-profit, independent organ procurement agency. ARORA is headquartered in Little Rock, with a satellite office in northwest Arkansas located in Fayetteville. Serving 64 counties in the state, ARORA is managed by an executive director who reports to a board of directors. ARORA is also served by an Advisory Council, consisting of transplant surgeons, related physicians, donor family members, transplant recipients, hospital administrators and public representatives.

 

 

 

Located in El Dorado, Arkansas, Medical Center of South Arkansas is dedicated to providing advanced healthcare in South Arkansas through inpatient and outpatient services as well as community outreach. Medical Center of South Arkansas currently is connected to SHARE sending admissions, discharges and transfers (ADTs) that includes Diagnosis, Allergies and Vitals.

To further continued health information exchange with SHARE they will start integration with all of their Medical Center of South Arkansas, South Arkansas Physicians Services (SAPS) medical group clinics. Integrating their EMR systems will allow for laboratory results, radiology reports, discharge summaries from all of SAPS clinics to be shared with the patients’ healthcare teams throughout South Arkansas.

SAPS will also be able to view the SHARE Virtual Health Record (VHR) which displays information as a traditional clinical chart, with tabs to separate patient information into groups for easy chart review. SHARE retrieves and shows all available data for a selected patient gathered from all participants within SHARE to enable a single, consolidated view of a patient’s health history.

SAPS providers and care coordinators will be able to view the following patient data through SHARE VHR if they have been seen outside of Medical Center of South Arkansas clinics, as long as the healthcare facilities are connected to SHARE, Arkansas’ only Statewide Health Information Exchange:

• Admission, Discharge and Transfer reports
• Allergies, Problems, Medications
• Demographic and Insurance information
• Laboratory results
• Radiology reports, image links
• Discharge Summaries
• Continuity of Care Documents
• Progress Notes

Medical Center of South Arkansas, South Arkansas Physicians Services medical group clinics provide outpatient clinic services that include: long-term care services, heart care, cancer, neurology, pulmonology, pediatric care, women's health care, pain management, radiology, surgery, therapy, rehabilitation, urology, weight reduction, wound healing, and mammography services, as well as services for ear, nose, and throat problems.

About Medical Center of South Arkansas:

Medical Center of South Arkansas is your community healthcare provider, a 166-bed general acute care facility accredited by The Joint Commission. Medical Center of South Arkansas also provides stellar cardiac care in our accredited Chest Pain Center and is equipped to offer neonatal specialty care. We believe in the power of people to create great care. We’re more than 100 healthcare professionals strong. And we work hard every day to be a place of healing, caring and connection for patients and families in the community we call home.

Learn more about Medical Center of South Arkansas at: https://www.themedcenter.net/ (link is external) Or view their fact sheet for more information.

SHARE is now collaborating with six medical clinics at 1^st Choice Healthcare in Northeast Arkansas.  SHARE is providing access to daily reports when their patients are admitted and discharged from the Emergency Room and Inpatient Encounter Discharges in the last 24 hours.

1st Choice Healthcare, is a community health center, providing compassionate, affordable health care for all individuals to improve lives and build healthier communities. At the heart of any community is the health of its people. At 1st Choice Healthcare, their reason for being is the patients’ health and the health of their neighbors. Whether they are sick and need treatment, or want to stay healthy and avoid problems, they are here for ALL patients. They have programs and screenings to help patients learn about their health and make healthy choices. 1^st Choice Healthcare offers comprehensive medical services to ensure patients receive all the medical services needed. They offer a number of diagnostic tests and services within their medical clinics that take care of patients’ in Clay, Randolph, Lawrence, Sharp, Fulton, Greene, and the surrounding counties.

1st Choice Healthcare includes (6) locations in Ash Flatt, Corning, Salem, Paragould, Pocahontas and Walnut Ridge, (12) physicians, (11) APRNs with offices in six counties in Northeast Arkansas. The data exchange services from SHARE will provide secure access to important information such as lab results, recent diagnosis, updated medications, updated patient records and demographic information. This ensures every care provider in the patient’s chain of care has consistent and current information, and that their records are more secure and accessible. Together, we are working to change health care to better serve the residents of Northeast Arkansas.

About 1st Choice Healthcare

 

A non-profit, FTCA Deemed, community governed organization. 1st Choice Healthcare has a governing body, composed of volunteers from the communities served. At least 51% of the board must be consumers of our services.

That means patients are always assured that 1st Choice Healthcare centers are:

• Open to all residents, regardless of insurance status
• Provide reduced cost care based on ability to pay
• Tailor services to fit the special needs and priorities of local communities
• Provide services based on the advice of local residents, businesses, churches, and other organizations
• Offer services that help patients access health care, case management, health education, nutritional counseling, and chronic disease management.

 

At 1st Choice Healthcare, we embrace and practice patient-centered care and we strive to provide all of our patients with the best possible medical care. We encourage each patient to take an active role in their healthcare. We believe that in addition to helping patients when they are sick, we can and should help guide them in making healthy choices for preventive care. 1st Choice Healthcare is a non-profit, Joint Commission accredited, Federally Qualified Health Center. We welcome all members of our community, especially those unable to afford care. We are founded and governed by our community. Our Board of Directors is made up of your friends and neighbors as well as members from other community agencies. We work closely with government and health and human services agencies to bring you complete, high quality, and affordable healthcare.

For more information about 1st Choice Healthcare Click here to visit thier webiste.

Overview of Arkansas PASSE Risk-Based Provider Organization (RBPO) Model

Arkansas developed a hybrid model of provider-sponsored organizations (as opposed to the traditional Managed Care Organization (MCO) approach) called a Provider-owned Arkansas Shared Savings Entity (PASSE), that is targeted to a relatively small group of Medicaid enrollees who represent a significant percentage of Medicaid spending because of their complex medical needs.   Provider-led and owned organizations would become responsible for integrating specialized home and community based services for individuals with who have intensive levels of treatment or care due to mental illness, substance abuse, or intellectual and developmental disabilities with their physical health care.

Organizing the array of services for individuals with lower costs by achieving the appropriate utilization of services. Care coordination is expected to improve health outcomes and lower costs by decreasing gaps in care, thereby lowering the rates of crisis and acute care, decreasing duplication of services, and improving medication management.  States have demonstrated savings through lower rates of emergency department (ED) visits, reduction in hospital admissions for ambulatory sensitive conditions and reductions in hospital readmissions.

While the state has borrowed ideas from the experiences of other states, the PASSE approach offers a shared savings management model that is unique to Arkansas.  For more than a year, Governor Asa Hutchinson, Department of Human Services (DHS) and the bipartisan, bicameral Health Reform Legislative Task Force (RLTF) have engaged in an unprecedented effort to examine potential reforms that would make the Arkansas Medicaid programs sustainable for the future. The Stephen Group (TSG) was retained by the Task Force to assess potential reforms.  Through these efforts, two potential service delivery models were identified.

One alternative for DHS was to contract with a small number of full-risk Managed Care Organizations (MCOs) through a competitive process. In a second model, called Diamond Care, DHS would contract with a single Third Party Administrator (TPA) to administer large parts of the Medicaid program. This proposal is a hybrid of the other two proposals, borrowing advantages from each model.

Problem Statement

Arkansas is one of the last Fee for Service (FFS) states in the country, first venturing into Managed Care via a Dental RFP in 2016.  The market is as geographically diverse as any state with its own set of unique and shared challenges with other states, such as the common challenger of transportation needs.  Members prior to 2018 were faced with navigating a complex system of care with little support from various state agencies due to budget constraints and lack of understanding about how to address member needs.  Some providers did offer various levels of care however, without consistency or regular oversight.

The DHS PASSE program concept aims to reengage members into the care delivery system and ensure the access to care, regardless of socioeconomic or physical disposition. The state vision to mandate Care Coordination for the intellectual and developmental disabilities (IDD) and serious and persistent mental illness (SPMI) population ratio at 1:50 with the program being statewide required PASSEs to expand their innovations to support and track member navigation needs statewide.

Members and guardians have been at the mercy of the state or providers to address their unique needs. On some occasions, this approach has worked but in many cases members and guardians have ended up feeling lost in a universe of options and unknowns.   Members having a developmental disability or a behavioral health challenge find it is not easy to handle accessing services on their own.  In the event a member has a chronic and/or behavioral health condition with a developmental disability, the need to stabilize findings support, is crucial and must be timely. When a member with high needs does not understand who to go to in the state, required provider engagement protocol benefits for which they are eligible or a service need and the location, this can be catastrophic as timely engagement and access is key for stabilization.

“Most of FOREVERCARE’s members are high risk with complex and chronic conditions.  An emergency room visit for a patient with chronic conditions can be considered a failure of primary care. The case study demonstrates that prompt access to primary care follow up, previously championed by the Coleman and Naylor models, significantly decreases emergency room visits. The availability of real time alerts through the community registry provides the baseline information to begin an efficient care transition process.” Eric Yoder, MD is a seasoned healthcare executive and consultant with over 30 years of experience in managed care and Medicaid.

The Model

Arkansas’ new PASSE model of care coordination was designed for a group of Medicaid enrollees who represent a significant percentage of Medicaid spending due to their complex medical, behavioral and social service needs. With this new model the state selected individuals with higher levels of care needs for behavioral health, substance use disorder and developmental disability services, in addition to medical care. There were several goals of the PASSE model;

1. Improve the health of Arkansans who need intensive
2. To link providers of physical providers with specialty providers of behavioral health and developmental/intellectual disabilities services;
3. To coordinate care for all community-based services;
4. To allow flexibility in the array of services offered;
5. To increase the number of service providers available in the community to the population covered;
6. To reduce cost of care by coordinating and providing appropriate and preventative care

The Department of Health Services (AR) provided four metrics that should be met to ensure quality patient care and effectiveness of care coordination services:

1. Initiate contact with each member within 15 business days after the first day of the month following attribution to the health plan;
2. Monthly face-to-face contacts with each member;
3. Follow-up with each member within (7) business days of visit to Emergency Room or Urgent- Care Clinic, or discharging from Hospital or Inpatient Psychiatric Unit/Facility;
4. Ensure that all members have selected a PCP, confirm that the member is selecting/providing a referral to a PCP located in a federal qualified health center nearest to member’s community.

 

Based on the requirements, FOREVERCARE model would leverage and employ field based Community Health Workers (CHWs) in a 50:1 ratio with hand held personal devices to automatically track and document events with reporting into FOREVERCARE’s central office. FOREVERCARE would deploy a registry or virtual care navigation tools.

The key is having real time alerts with predefined care transitions for each member regardless of their event details.  To trigger electronically through real time automation and ensuring all tracking and oversight is complete with daily reporting to ensure quality care and effectiveness of care coordination.

Our goal with over 150 Care Coordinators deployed statewide was to enable them with real information and real tools, with real time alerts to better serve members throughout the state. Imagine a world where someone visits the ER at 11:00 PM for chronic pain and the next morning at 8:00AM the member or guardian is called or visited by their assigned Care Coordinator with a planned transition protocol?  How could this happen, how could we define a process, share the right level of information and engage a complex member to renew their faith in the community that we care. At the same time having all the key information relative to the members needs and immediately scheduling the member for a PCP appointment within 72 hours.

By enabling care coordinators with tablets and a basic registry that is connected via HL7 ADT messages to the State HIE State Health Alliance for Records Exchange (SHARE, Arkansas’ only statewide HIE), we can structure the care coordination, collect key quality measures, force preferred navigation protocols, ensure transportation arrives and ensure members make their visit through simple interventions with basic check boxes in the registry.

 

FOREVERCARE along with three other provider–led health plans, deliver access to healthcare through the PASSE model of care, which is unique to Arkansas and provides coordination of physical health, behavioral health and home and community services to vulnerable Arkansans who qualify for these services due to specific health conditions. Care coordination is increasingly important to Medicaid programs and has shown success in improving health outcomes of individuals while reducing costs. SHARE allowed FOREVERCARE to know when their patients are admitted, discharged and transferred to local hospitals across Arkansas as well as surrounding state hospitals. Care Coordinators could then view the following patient data through VHR in real– time:

 

• Admission, Discharge and Transfer reports;
• Allergies, Problems, Medications;
• Demographic and Insurance information;
• Laboratory results;
• Radiology reports, image links;
• Discharge Summaries’
• Continuity of Care Documents and Progress Notes;

 

Using the VHR option, providers of the PASSE had an up-to-the-minute view of a patient’s health history at the point of care.   This information would be critical for our complex members to ensure continuity of care.

Once the relationship and partnership was formed with FOREVERCARE PASSE, a phased approach was put into action:

Phase I:   Access to SHAREs’ Virtual Health Record (VHR) & Secure Messaging (SM)

Both applications are web based. This allowed FOREVERCARE PASSE care coordinators and community health workers the ability to use the VHR search functionality and Secure Messaging feature to access to patient information during and after a hospital emergency room admission/discharge and inpatient discharge. The following is what occurred in Phase I:

1. Daily reports on Emergency Room and Inpatient Encounter Discharges in the last 24 hours;
2. Search   individuals’   health   information   for   problems, medications, allergies, and
3. medications to enhance clinical decision making in the field;
4. Alert the receiving PASSE about an individual’s status in the emergency department to provide decision support and prepare for treatment needs that may result in requiring time sensitive treatment or therapy such as trauma, heart attack, or stroke care coordination efforts;

 

Phase II:  Flow of real-time Admission, Discharge and Transfer (ADTs) to FOREVERCARE PASSE Community Registry

To prove the concept, a channel was created to flow all ADTs of the attributed beneficiaries/members, based on FOREVERCARE patient attribution, via SHARE to FOREVERCARE PASSE custom registry platform to trigger automated care transitions for care coordinators. This was built to have real-time ADTs to determine if patient will bounce back to the Emergency Department and/or inpatient encounter for the same or related complaint and supported real- time care coordination efforts.

The following is what occurred in Phase II:

1. Incorporation of the HIE by accessing the patient’s consolidated health history using the flow of real-time ADTs allowed for the intensive care coordination of FOREVERCARE’s patient population;
2. Allowed for tracking of “loyalty customers” to assist with case management;
3. Once FOREVERCARE received the ADT custom registry, the system generated automated tasks and transition protocols mandating the assigned care coordinator contact the patient and schedule PCP visit within 72 hours; In addition, the FOREVERCARE RNs reviewed the entire ADT of the patient record, regardless of which hospital they may go to, which is critical to the success of tracking, monitoring and following up on the patient.

The Results

 

In addition, to the post-acute PCP visit, FOREVERCARE looked at other events that would have a positive impact based on evidenced based models elsewhere in the county.   The number of Emergency Department visits per member should decrease based on similar models. FOREVERCARE data for Emergency Department visits was normalized to 100 users due to the small volume of members in our data set of about 7,500 lives.  As we can see from go live in February 2018 with the immediate engagement by forced navigation protocols from ED alerts to the registry from SHARE HIE the results have been better than expectations.   Continued monitoring and coaching of Care Coordinators through weekly training sessions, daily close reports and directing PCP services gaps with alternative service locations.  In some cases, for complex members we scheduled appointments at BH and PH to ensure continuity of member needs.  The results in Fig 2.0 show a decrease in ED visits of about 42%.  Leveraging the state SHARE HIE and real time HL7 alerts through our registry combined with our community based CHWs and predefined care coordination protocols.

Fig 2.0, Source: Historical Medicaid Paid Claims

Summary

 

The results in fact were not surprising as many care transition programs around the country have experienced similar results.   FOREVERCARE had a perfect opportunity to validate a transition model with pre-defined transition protocol and the infusion of a registry with field-based care coordinators in Arkansas.   Having SHARE HIE as a partner to share HL7 ADT events with FOREVERCARE was the secret sauce that allowed for the automation of the care transitions.

The intent of Arkansas DHS model was to support intense navigation for complex members in the community and provide an avenue for members to re-engage the health delivery system in Arkansas.  Starting with the most complex can be difficult early on but the preliminary results with just basic tools and process have been stellar.

This same basic process if replicated to other populations such as Long Term Services and Support (LTSS) and Aged, Blind, and Disabled (ABD) populations should see very similar results based on the membership activity in any community across the country.  For providers and payers in Medicare or Medicaid choosing to deliver reduce costs, reduce potentially preventable events, and improve quality scores this is a model that is well worth the effort.  Recommend a crawl, walk, run approach for payers or providers undertaking this approach since most clinical teams will push back at the perceived duplication of clinical documents or tools.  In fact, this is non-clinical and should only be seen as navigation for members while at the same time the opportunity to collect gaps in care and seamlessly update your respective electronic health record () or electronic medical record (EMR).

As the healthcare landscape continues to transform, HIEs play a key role in providing data that fuels innovation. SHARE and FOREVERCARE PASSE together contributed to these innovation efforts such as population health initiatives, identifying potential social determinants of health and assisting with payer relations, among other efforts.

Change is difficult but with the right approach and providers with an understanding of how to apply the data the results can change the lives of members in the community.

Author Biographies

 

Eric Yoder, MD is a seasoned healthcare executive and consultant with over 30 years of experience in managed care and Medicaid. He is currently a private consultant primarily to Medicaid health plans large and small and Medicaid adjacent businesses specializing in business development, clinical program optimization, LTSS programs, clinical and behavioral health integration and quality improvement.

Dr. Yoder previously served as senior vice president and Chief Medical Officer for United Healthcare, Community and State which provided Medicaid and Medicare programs serving more than 3 million members in 24 states and the District of Columbia. Recipients were primarily lower income Americans, children and women of childbearing age; Aged, Blind, and Disabled (ABD); chronically ill individuals; supplemental security beneficiaries, Children’s Health Insurance (CHIP).

Dr. Yoder was formerly executive vice president and Chief Medical Officer for Amerigroup Corporation covering 1.3 million in 12 states specializing in Medicaid TANF and CHIP, SSI, ABD and Medicare special needs programs. He previously served as president and Chief Executive Officer of Amerigroup Texas, president and chief operating officer of Amerigroup for the Dallas/Fort Worth region of Texas, and vice president and executive medical director for Amerigroup of Southwest Texas.

Before joining Amerigroup, he served as associate medical director for business development and regional director of emergency services and patient repatriation for the Permanente Medical Association of Texas. Dr. Yoder has been board certified in Emergency Medicine and served in multiple clinical roles including primary care physician, emergency medicine physician and regional Chief of Service for Urgent Care.

Dr. Yoder earned a Bachelor of Science from the University of Maryland, a Medical Doctorate from Duke University School of Medicine, and a Master of Business Administration from the University of Oregon. He completed his emergency medicine residency at the Oregon Health Sciences University.

 

Carolyn Thomas Morris, Ph.D., is of the Red Streak Clan and born for Tangle People, and was born and raised near Shiprock, New Mexico, on the Navajo Nation. Dr. Morris is a licensed Psychologist, and nationally she is one of the few practicing psychologists fluent in the Navajo language. She is a consultant in the public sector health plan market (Medicaid/Medicare), specializing in plan/program development, clinical oversight and care coordination, reducing health disparities and improving population health. She also continues to provide direct patient care in community behavioral health, primary care, and geriatric settings. Dr. Morris serves on the Navajo Technical University Board of Regents and holds an elected position representing the Navajo Nation with the Association of Community College Trustees.

Previously, Dr. Morris spent eight years as Senior Director of Native American Affairs with OptumHealth and United Healthcare, Community and State. She has held positions as executive director of an adolescent residential treatment center, special education director, research and evaluation director, and worked as a consulting and clinical psychologist in a wide range of settings. Developed over years working in both the private and public sectors, her guiding professional interest is improving quality, responsiveness and access to healthcare and education for underserved populations. As a Past President of the Society of American Indian Psychologists, she helped guide that organization in its mission of supporting American Indian students prepare for careers as psychologists. Dr. Morris earned her doctorate and master’s degrees at Utah State University and did her undergraduate work at Fort Lewis College in Durango, Colorado.

Mike McCabe, Plan President of FOREVERCARE is a tenured healthcare professional whose passion for the industry has fostered his deep passion and immersion in Healthcare delivery for over 25 years.

Mr. McCabe has worked directly with several states on Health Policy, Innovation, Clinical Innovations, Community Based Care Coordination tools, All Payers Claim Databases, and Information & Benefit Exchanges. His experience designing, building,

and optimizing health plan delivery has resulted in over $10 Billion in revenue for the organizations he has supported.  His leadership in policy and waiver optimization has supported paradigm shifts in state Medicaid delivery systems in over 20 states.

With a Computer Science Degree and A Navy Veteran, Mr. McCabe has tirelessly fine-tuned a vast and varied skills set in Medicaid and Medicare delivery, even coining the term “Eco System of Care” referring to the community and the safety net influence on care via technology or socio-economic impacts to care delivery. His leadership roles with a large National payer for 13 years saw Mr. McCabe managing Medicaid and Medicare technology operational delivery and contract compliance as the Vice President of Technology Operations serving 20 states.  He also led Business Development for the western region and enhanced care delivery through hundreds of innovations for complex members across multiple states and communities with the focused on enabling providers with data and information at the point of care.

Prior to leadership roles with this large national payer Mr. McCabe served as the Director of IT for Sutter Health in Sunnyvale, CA.  In this capacity he managed billing, managed care analytics, and multiple Market innovations such as the first electronic EKG with central reader, and Radiology Dictaphone (Automated Transcriptions).

 

About State Health Alliance for Records Exchange (SHARE): SHARE is Arkansas’ statewide Health Information Exchange (HIE), which is operated by the Office of Health Information Technology (OHIT) at the Arkansas Department of Health.

SHARE’s mission is to advance secure connectivity and serve as a sustainable, interoperable data exchange platform for health- related operations.

SHARE’s vision is to provide a mechanism through which individuals, health care providers, and health organizations can electronically share health-related information to facilitate and strengthen the delivery of healthcare throughout Arkansas. This is designed to lead to improved patient care, informed individual health decisions, better public health outcomes, and cost- effective use of healthcare resources. SHARE is expected to achieve broad acceptance, credibility, and access by employing advanced technologies that ensure efficiency, privacy, and security and continuously evolve to serve Arkansans more effectively.

For more information, visit: SHAREarkansas.com to see the more than 70+ Hospitals, over 1,700 Healthcare Organizations, (25) HIE to HIE connections to date, as well as, a LIVE connection to eHealth Exchange and the Patient Centered Date Home (PCDH) initiative under the Strategic Health Information Exchange Collaborative (SCHIEC).

 

Anne Santifer, Executive Director

Email:  [email protected] Phone: 501.410.1998

Anne Santifer is Director of the Office of Health Information Technology as of August, 2018.  Anne has nearly 10 years of experience in the operations, development, and policy supporting Medicaid quality improvement programs.  She is experienced in program management, Value based programs and data and information technologies supporting health care and social service programs. Prior to joining OHIT, Anne served as the assistant director of health care innovations at Medicaid which included the successful Patient Centered Medical Home program.

 

 

 

Adrian Jones, Account Manager

Email:  [email protected] Phone: 501.410.1999

Adrian Jones is the Account Manager at SHARE. She is responsible for proactively assessing and clarifying customer needs on an ongoing basis. She works collaboratively with SHARE internal teams to ensure implementation and support of SHARE solutions. She received her Bachelors of Science degree from the University of Little Rock (UALR) and her Master’s Degree in Human Resources Management from Webster University. She has a strong passion in healthcare and has worked professionally in the industry in various capacities for over 17 years.

 

 

References

 

Ben-Assuli, O., Shabtai, I., & Leshno, M. (2013). The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses. BMC medical informatics and decision making, 13, 49. doi:10.1186/1472-6947-13-49

Evidence Based Models (Supporting System of Care at the community level)

https://store.samhsa.gov/shin/content/PEP18-CMHI2016/PEP18-CMHI2016.pdf

Evidence Based Models (Supporting Community Based Programs and Services) according to: Http://ww.samsha.gov

Treatment Solutions; An American Addition Centers Resource https://www.samhsa.gov/sites/default/files/programs_campaigns/nitt-ta/2015-report-to- congress.pdf

Evidence Based Intervention and Treatment (supporting ER Diversion Programs) https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/ https://psycnet.apa.org/buy/2011-04924-014Short-term treatment interventions:https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.79.7.843

Naylor Model

Clinical Evidence/guidelines:

Evidence Based Models (Supporting Care Transition Methodologies) and evidence-supported CCM

 

1. Care Transitions Intervention (Coleman)
2. Transitional Care Model (Naylor)
3. Bridge Program
4. Project Boost (Better outcomes for Older Adults through Safe Transitions
5. Grace (Geriatric Resources)
6. Guided Care
7. Project Red
8. Chronic Care Model

 

*Evidence based models according to:  https://www.aoa.gov

Janakiraman, Ramkumar and Park, Eunho and Demirezen, Emre and Kumar, Subodha, The Effects of Health Information Exchange Access on Healthcare Quality and Efficiency: An Empirical Investigation (February 10, 2017). Mays Business School Research Paper No. 2915190. Available at SSRN: https://ssrn.com/abstract=2915190 or https://dx.doi.org/10.2139/ssrn.2915190

K.M. Unertl, K.B. Johnson, N.M. Lorenzi Health information exchange technology on the front lines of healthcare: workflow factors and patterns of use

J. Am. Med. Inform. Assoc., 19 (3) (2012), pp. 392-400