When Jennifer D’Angelo was asked to describe her feelings on where healthcare is headed, particularly in the behavioral health space, the world she used was ‘hopeful.’ Having spent 20 years in the industry, she has certainly seen plenty of fits and starts, but believes the piece are being put into place to “make great strides” in care delivery.
One of those very critical pieces was the recent implementation of PreManage ED, a collaborative care management tool that enables providers to view patient information from ED visits across multiple facilities, upon admission. It’s precisely the kind of initiative that can help “wrap our hands” around the opioid crisis, says D’Angelo.
In this interview, she talks about the work her team is doing at Bergen New Bridge Medical Center to improve behavioral healthcare, both within and outside the organization, the role artificial intelligence can play in facilitating data sharing, and why advocacy is so important to her.
- Viewing ED data in real-time with PreManage ED: “It’s incredibly valuable.”
- Getting data in the hands of providers – “It can’t be a clunky process.”
- Expansion to community partners
- Tying with PDMP reports
- “If a patient is at a high risk for prescription usage, we’re able to see that.”
- Leveraging data to curb opioid abuse
- “If we’re going to get our hands around this crisis, data sharing is critical.”
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It comes down to ease of use and being able to operationalize it into your workflow. Getting data quickly into the hands of providers as soon as a patient is admitted has to be seamless. It can’t be a clunky process.
It’s really critical when you’re dealing with substance abuse and the behavioral health population to have comments from other ED experiences at your fingertips so you can better treat that patient and not agitate him or her upon arrival.
Tying that into a pre-existing HIN is where I see the true value in all of this, along with the partnerships that have been formed. We’re looking at how to do that from a legal and a logistical standpoint, but it’s something I envision would be a real benefit for everyone.
It’s one of the coolest things we’re doing, especially in trying to treat the opioid population; getting as much information as we can upon admission is how we can best serve our patients.
Gamble: Hi Jennifer, thank you for making some time for this. We spoke in early 2018, but I know a lot has changed since then at New Bridge.
D’Angelo: It has. At that point, we were rolling out several different initiatives and doing some system upgrades and modernization. Now that we’ve successfully completed all of that, we’re looking at operationalizing a lot of the processes and keeping the flow going of systems we have put in place. We’ve recently rolled out PreManage ED, a collaborative care management tool from Collective Medical Technologies.
I’m not sure if you’re familiar with it, but Collective Medical is a nationwide company that takes ED information and moves it into a portal that can be accessed by multidisciplinary providers. They’ve just recently launched it in New Jersey, and it’s already in place in several other states. It acts like an HIE portal, but we’re finding the information is even more valuable because it’s available in real-time and enables providers to see all the ED visits for participating hospitals. We were the first of three hospitals in New Jersey to go live with the system back in December.
As hospitals come onboard this collaborative network, we’re able to quickly view ED visits across the state, which usually would take days to put together, if it’s even possible. To be able to access that as soon as the patient is admitted to the ED is incredibly valuable.
Gamble: Has that been a missing piece, as far as enabling providers to obtain data from outside of the system, or is it a matter of being able to do it so quickly?
D’Angelo: I think it’s a matter of accessing it so quickly — that’s what’s been missing. It comes down to ease of use and being able to operationalize it into y our workflow. Getting data quickly into the hands of providers as soon as a patient is admitted has to be seamless. It can’t be a clunky process.
For example, if we have a patient admitted who has had five ED visits in 12 months, it triggers an alert. Providers are able to see that right away — it’s incredible. We recently had a patient that had been admitted to three other EDs in five different locations across the state, within a 14-day period. With this tool, our providers could access that information.
Gamble: I’m sure that makes a significant difference.
D’Angelo: Absolutely. And they’re able to see what the patient was admitted for. The New Jersey Hospital Association (NJHA) has vetted this tool, and we are partnering with our community providers to make it available for free. We’re looking to onboard Care Plus NJ, county jails, and homeless shelters so we can get a sense of the ins and outs and where these patients are going for continuation of care and coordination of that care.
I’ve been doing this for a long time. I’ve seen many HIEs and systems, and I have to say this is an immediate collaborative tool that gives your clinicians information the minute someone is admitted into the ED. It gives you information on a variety of different care providers for that patient — specialists, primary care physicians, psychologists — as well as ED care guidelines.
It’s a contributing portal. You can have it fully integrated with your EMR, and you’re able to contribute to it with information about a patient. For example, if a patient gets easily agitated or has a security event, you can inform others of the behavior they can expect to see. It’s really critical when you’re dealing with substance abuse and the behavioral health population to have comments from other ED experiences at your fingertips so you can better treat that patient and not agitate him or her upon arrival.
It also provides care history and recommendations, which can make a big difference. It also ties in the PDMP reports, so if a patient is at a high risk for prescription usage, we’re able to see that. It tells you the ED visit date and location, the type of ED, any procedures that were done, and the diagnosis. It’s been a phenomenal tool for us.
Gamble: And you went live in December?
D’Angelo: We did. We’re working now to onboard our community stakeholders so they can be tied into this network and manage the patients they care for. That way, if a patient returns to a homeless shelter after being discharged, the care providers at the shelter can see if someone has been to five EDs in the past 30 days. They can also say that they’re part of this community, where any information a provider finds to be valuable can be accessed.
Gamble: Once it went live, what had to be done to keep things moving forward?
D’Angelo: The go-live was pretty straightforward; it was a standard ADT interface to PreManage. We started sending all of our historical data there so it would begin to populate for us, and become available to participating providers. We don’t have EMR integration at this time — it’s something that we are working toward — so the alerts are triggered through a dedicated fax.
When a patient is admitted, we enter the data into our system. It’s sent to PreManage ED, and immediately we receive a fax with critical information on that patient. We also have a portal that we can log into and access information, and it will kick out a triggered fax.
Gamble: In terms of the EMR integration, what does that timeline look like?
D’Angelo: We’re looking at a 3 to 6-month timeline. The system we use is coming out with a major release, and so we’re in the process of scheduling that and hoping to get some integration with that. I’m also trying to leverage this at the state level through the New Jersey Health Information Network (NJHIN), for which I serve on the advisory council. Tying that into a pre-existing HIN is where I see the true value in all of this, along with the partnerships that have been formed. We’re looking at how to do that from a legal and a logistical standpoint, but it’s something I envision would be a real benefit for everyone.
What’s really neat is you can access information from people who have gone out of state. If they go on vacation or live in New York or Pennsylvania part of the time and have providers who are participating, you get the benefit of that information as well.
Gamble: Have you run into roadblocks with different requirements in those neighboring states?
D’Angelo: We really haven’t. This is a pretty straightforward data set — it pulls the same information from each provider. To me, this was an easier lift than some fully integrated HIEs and portals. It’s one of the coolest things we’re doing, especially in trying to treat the opioid population; getting as much information as we can upon admission is how we can best serve our patients.
Gamble: In terms of opioid abuse, how can having these types of tools make an impact?
D’Angelo: What really helps is being able to know right away how many times a patient has been admitted, even within your own facility. While we have that information available in our EMR, this enables us to provide a complete picture — ‘patient was here four times, had a stay at another facility, then came back here’ and compress it into a one-page document. That’s incredibly valuable.
They’re working at the state level to pull in the PMPF information, meaning we’ll also be able to access prescribing patterns, which is a 100 percent assist in the opioid crisis.
Gamble: As far as involvement with the NJHIN, I’m sure that’s critical when it comes to initiatives like interoperability and population health, and making sure organizations are working together to treat the same patients.
D’Angelo: Right. It’s going to require a collaborative approach, with everybody working together and using the portal, to really tackle the opioid epidemic, because they’re not going to just one facility. They’re hopping around to get access to prescription drugs, and if we’re going to get our hands around this crisis, data sharing is critical.
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