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all right everybody can see that okay yes great well good morning everyone welcome to our webinar on idi alerts connecting montana hospitals my name is ah young huff and i'm one of the outreach coordinators at big sky care connect and i'll be your host for this session and we really appreciate your attendance to learn more about our electronic solution to assist montana hospitals with the pandemic so if you have any questions throughout the session please feel free to use the chat function kelly will be monitoring the chat for us so we're going to just start out with few words from gene branscomb who is the acting cao of big sky care connect well thank you young and thank you so much for joining us today we are simply excited about the advancements that have happened over just the last six months in the establishment of a health information exchange in montana and before i dive into that i first would to just uh give each and every one of you a pat on the back and just really uh heartfelt thanks for the heroism that you show each and every day and your staff show each and every day for the work that's being done during this time of the pandemic it has certainly been an unusual year and the hospitals are in the midst of that and just again i very much appreciate that work that you do we have been working on the health information exchange for a few years now and actually just signed a technology vendor back in march and are looking to stand up to hie by the end of the year we have a technology solution that really is in place to help each and every one of you achieve the triple aim and we're excited to do that of course that's what we'd be talking about today if we didn't have a pandemic and because of the pandemic we really looked at what kind of technology that we could advance on behalf of patients in montana that can be tools utilized in healthcare facilities to help you manage the pandemic and we're so delighted to have a partner like collective medical that you'll hear from today that is going to connect to emergency departments across montana and of course with this technology innovation that we're going to be showing you today it comes at the bequest in the hard work of a board of representative healthcare stakeholders and that includes hospital ceos and of course the montana hospital association so it comes at no surprise that the hospital association came forward and said this is a this is a tool that hospitals could really utilize the sooner the better and again we put all our kind of eggs in this basket of really helping you out during this pandemic working on this is a top priority as we continue to roll out the health information exchange so with that thank you so much for joining i think you're gonna be delighted with the information that you're seeing today we're available to answer any question and look forward to hearing those questions as the presentation proceeds thank you gene all right now i would like to share with you a message from rich rasmussen montana hospital association's president and ceo i want to thank all of you for joining us here on this annual meeting for big sky care connect i'm going to spend just a couple moments talking to you about collective medical technology's ed optimization tool now mha was fortunate to have the opportunity to work with the federal government's assistant secretary for public response or asper early on during the pandemic mha worked with asper on a project to send out a series of mini grants to our members asper then came back to the state hospital associations and mha and said we have an opportunity or providing an opportunity for you to do something additional second mile for your members and it needs to align with a certain set of federal guidance to bring hospitals together to allow for a project that would accelerate adoption or use of a vaccine and also allow for a greater collaboration between providers and so as the association began to look at what those opportunities were that were out there in the marketplace one of them that came to mind was clearly the ed optimization tool that collective medical technologies has now many of you might have heard the term eddie emergency department information exchange used in the past and that is the tool but a new name and so the optimization tool is designed to connect emergency departments all across the state of montana and if you look at our peer states around us all of them are using the ed optimization tool now what does that mean for us it means it creates an opportunity for our hospitals to collaborate between emergency departments allow those clinicians who are working in the eds to be able to immediately examine a patient but also look at where that patient may have been treated subsequently and what care plans are currently logged for that patient is that patient uh in need of any specific medications that might not be present upon admission or upon entering the emergency department so essentially anything that would happen within the scope of care delivered in an ed our clinicians in montana would have would have access to that and it would allow them to be able to see where that patient has been so for example if someone presents symptomatically for on covet 19 we would be able to immediately look and see where that patient may have been anywhere else in the last couple of weeks that allows us to immediately be able to help with any contact tracing that takes place but would also allow our hospitals too to be able to learn more about the origins of where that person may have been and then certainly if there's any other health conditions that may have been recorded at any point in the past for which they came to the emergency department so there are ways in which we can utilize this tool not only in covin 19 in our response today but also in other use cases that can help us to improve care delivery in our state let's give you an example of one doctor shopping we know that montana is a state that struggles with opioid addictions so the ability to be able to track a patient when they come into an emergency department to immediately see whether or not that same patient was seeking a prescription say in oregon or washington or idaho all surrounding states that use the ed optimization tool if we're also trying to identify those frequent flyers that come through our eds so that we can do a better job of managing that patient's care and reduce cost that is also a use case that can be used perhaps if we're trying to address issues related to human trafficking the tool also has the ability for us to be able to potentially use it to address those issues as well so there are a number of utilizations for the ev optimization and so we believe that our hospitals will have the opportunity to use this not only in responding to covet 19 today to share what's going on in our emergency departments to accelerate the use and deployment of vaccines and to share information with our state labs but also other use cases that can help us to improve health care in montana so we're delighted to be part of this effort to improve access to cutting-edge technologies that will allow us to align with our peer states and will also empower us uh with tools that can improve health care i can improve our outcomes and improve the quality of care that's delivered in montana so that's what we're doing right now with the evd optimization tool and we hope each of you will take the opportunity to learn more and to sign up mha has worked with asper to pay the first two years of subscription fees related to it so there's no cost for hospitals to use the ed optimization tool and so with that we hope that you will use this as an opportunity to onboard your emergency department and use it as a tool so that you can collaborate with your facilities all across the state of montana this is something that is being used as i mentioned a number of other states and certain as we see in the mountain west with the growth of covet 19 and the large number of patients that migrate to montana during these holiday seasons having this uh beginning in this fall and certainly throughout the ski season in the spring and then into our our summer season here it will allow us to be able to also attract uh patient uh activities in their home states when they come to montana so we believe it's a very effective tool and we encourage each of you to use it and we appreciate the opportunity to spend this moment with you today talking about our involvement and helping to bring the ed optimization tool from collective medical technologies to our providers in montana great now we will hear from mha's foundation executive director victoria uh about the asper grant hello my name is victorious and i'm the executive director of the foundation here at the montana hospital association and i just wanted to provide a little bit of background about the ask for grant assistant secretary for preparedness and response as i think rich has mentioned this was an opportunity that was made available through asper to hospital associations throughout the country to help with response to the cobia pandemic the strategy that we chose to apply for which is this emergency department optimization option through cmt um is something that as rich has mentioned has other uses in addition to covid response but the nice thing about this is that it will help you manage the response to covid better and it will also link emergency departments with the state's lab and with their imtracks program to help track immunizations so we're excited about that and we hope that will prove very useful we have sufficient funding to offer two years of subscription to each of you for free and in addition to that sean becker with mha ventures is going to be working to help people get up and going with this and provide some support and some logistics as the project rolls out he can talk a little bit more clearly about big sky careconnect and their role in in helping make this a reality throughout hospital eds in montana i hope you'll be very interested in taking advantage of this i hope you'll find it an extraordinarily useful and helpful way both to manage the pandemic and to manage other continuing threats subsequent to the pandemic great thank you so now i will turn the time over to sean becker from mha good morning everybody bird that background of yours the plastic they put you in the basement so my office is the covid is the respiratory er in case anything happens so if we have a er come in with respiratory issues that we don't know if kobot's involved i grab my laptop run out and they wheel him into here yeah there's a critical access hospital ceo uh example right there you're in the respiratory unit your office yep hey so i don't have much more to go beyond what rich and victoria had to say just to point out there are two aims for this meeting this morning one is to get you excited about uh the the asper funded solution uh and the other is to really kind of answer any questions concerns uh that you may have as we go through the overview of implementation and so we're we really need a plan from every hospital in the state by the end of the year was the goal on how we were going to ramp this up in your facilities so thank you for joining us this morning and looking forward to your all of your questions turn it over to you i young thank you sean well for those of you who aren't familiar with the skycarenet overview topics guy and our platform so we were established back in 2018 as a nonprofit organization to establish and operate montana's statewide hie and endorsed by governor bullock so big sky care connect has the infrastructure and the partnership with elective medical already in place to support this statewide preparedness effort so we have already established a necessary participation and data sharing framework in montana and we can assist in amplifying the data exchange and contributing information to better informed decisions at the point of care there's a lot of evidence out there on the benefits of statewide hie participation and more and more data is being shared to quantify some of those value propositions so the hospitals that have been participating in their state or regional hies have already realized better outcomes with reductions in readmission rates decreasing duplicative services increase increasing revenue from better documentation cost savings from avoiding adverse events just to name a few but as gene mentioned our ultimate goal is to help hospitals in montana achieve the quadruple aim in improving outcomes improving clinician and patient experience and lowering costs so we partner with inner systems who is our vendor for the hie platform and we're currently underway in standing up the statewide hie so we built the foundation with integration tools and privacy and security measures and we're currently working on bringing in the data from participating healthcare organizations to build a robust comprehensive patient record so along with the comprehensive patient record we'll also be providing medication history with data from doctor first and if you don't have direct secure messaging we can provide that as well and patient event notifications and that will all be part of our course services so the event notification can actually help you meet the new requirements from cms that's that will be coming to you in the spring of 2021 where they'll require hospitals to electronically share idt notifications with their patients primary care providers so if you don't have something in place for that already this could be a quick return on investment for you so statewide hivs have really demonstrated their value during the kobe 19 pandemic by providing a platform where vital patient information and hospital status can be shared in real time efficiently and cost effectively so big sky care connect quickly responded to help address the pandemic in montana by partnering with collective medical to provide a value-added service of our ed alerts platform which is the focus of our webinar today so big sky care connect is we're also working with the montana state to help providers gain easier access to the public health data including coven 19 test results so once we get connected in the future um cobin 19 results could be available to you in the provider portal in big sky platform as well as through our ed alerts notification system so we chose to partner with collective medical because of their proven track record their ed optimization has known to reduce high utilizer encounters by 81 percent 30-day readmissions by 78 retention rate of 63 percent for those enrolled in medication-assisted treatment programs and 50 reduction in violent incidents so bscc's ed alerts will feature a bi-directional ehr integration with collective medical that receives real-time adt and cognitive care information from all of our connected entities across the state as well as collective medical's already existing extensive network additionally hie automatically pushes the alerts and the curated care information directly into the existing hospital ed's workflow allowing the care team members to immediate insight into properly care for the patients so without further ado i will introduce you to brian cauley at this time um he is the enterprise sales executive at collective medical and he's going to show us what this is all about and how the system works thank you ayoung good morning everybody appreciate you all being here i know it's uh is is still a little bit dark and early but here we are so thank you for your participation we will just go ahead and jump right into it and ayong can you just confirm that you're able to see my screen if you would please yes we can thank you so just as a quick uh overview of the agenda we'll talk a little bit about who collective medical is um we'll go through an overview of the ed alerts and what that means for your hospital and then we'll actually jump into an example portal to show you what that looks like and what that feels like for your providers on the back end as users collective medical is the nation's leading care coordination platform we connect all points of care to provide visibility into at-risk and high-risk patients at the p int of care we are 100 focused on real-time collaboration not simply to to move data from point a to point b but derive meaningful and valuable insights to support and encourage more informed clinical decisions on those high-risk patients as they transition through the healthcare continuum what that means for your providers is receiving real-time notifications with the most relevant and important information on these patients uh leading to improved quality and outcomes reduce cost through performance metrics uh like i young talked about reduce readmissions and over utilization increase throughput and reduce unnecessary workups better management of behavioral health and substance use patients etc etc we are actually live in 42 states across the country we do have identifiable patient information across all 50 states that is due to our partnerships with not only hospitals and health systems but acos we partner with every major health plan in the in the nation we also partner with post-acute providers ambulatory providers as well as commonwealth and care quality so we have a very in-depth robust network where we actually receive this data from we are live with north of a thousand hospitals and more than thirty one thirty one hundred partners overall ah young showed a a similar screenshot to this on the right but just to kind of reiterate your hospital's adt is transmitted to big sky care connect big sky care connect and collective medical have a bi-directional feed we then aggregate and curate that data from them and send that back to you into those notifications via an hl7 message directly into your trackboard when we think about the asymmetry of health data and the ubiquity of healthcare information it's extremely difficult to truly understand a longitudinal history of your patients as they present now to be clear we're not talking about every patient that presents to your facility really we're focusing on those uh 10 12 15 of patients that carry that carry risk with them conversely when you think about providers who have a mutual uh treatment relationship with these patients it's often uh difficult or unaware for them to actually coordinate with other providers leading to again unnecessary workups and inappropriate interventions etc etc if we think about the traditional traditional healthcare system and how that might look for a patient as their journey continues through this is just an example but a patient presents to a hospital with the chs exacerbation with shortness of back shortness of breath they might be admitted to admitted to the hospital a few days later they may get discharged to a skilled nursing facility and from there they may get discharged home now that patient may have an exacerbation a couple of days later they call 9-1-1 the ambulance routes them to a different hospital that's on a different system so ultimately this new hospital has no idea that they had all of these other encounters uh previously they may end up doing similar workups patient may end up getting admitted they may end up getting discharged and so this cycle continues with collective we'll just fast forward to that secondary ed encounter as opposed to this hospital continuing to do those workups and potentially admitting this patient again they now receive that real-time notification that tells them this patient was seen at this ed they were admitted at this facility they were had to stay at this skilled nursing facility here's potentially some recommendations on what we have for care so the the coordination is then very easy for them to communicate with that hospital and potentially other providers um and they may have a completely different work up that enables them to avoid that readmission they might be able to safely treat that patient and discharge them to homer self-care you are now able to intervene on these cyclical hospital utilization patterns and provide better quality and and better outcomes for these patients in bucket one we talked about the sources where we where we get our data from from different uh different provider sources across the country so we'll just kind of pass through that in terms of data aggregate aggregation in the second bucket we um curate and aggregate these uh enormous and robust data sources to be able to provide you with that actionable information at the point of care which puts us into the third bucket we have a comprehensive patient matching algorithm in addition to determinist deterministic risk and deep learning models that enable us to curate that data for your providers putting us into the fourth bucket being able to deliver those notifications directly back to your providers in real time in addition to providing reports to really benchmark how you are managing some of those high-risk populations in a stratified view how this all works your patient presents to the ed they check in as they normally would that information is then sent back to collective metal medical where we then query our database to find out what information we may have on this patient and what is relevant to your hospital in terms of do we need to send a notification back to your providers if so we will then send that hl7 message directly into your trackboard where an icon can be clicked and that notification can then be viewed we've talked about the real-time delivery into your trackboard there are other modalities that we can deliver those uh notifications as well say for example if you have providers that don't necessarily operate directly out of the ed that could be case managers social workers et cetera et cetera we have the ability to send notifications to them via text message email fax printer really whatever means necessary for them to be able to stay involved we will certainly work to accommodate that and then lastly the ability to actually log into the collective platform and view a more in-depth uh view of that patient itself themselves um just a few screenshots to kind of give you an idea of what this interface or integration looks like into your emr so you can see here uh here is a screenshot of cerner specifically epic you can see on the left side there's the eddie column like rich had talked about where it would show the icon if a notification is available for that patient and then just a quick one for metatech as well so when we talk about these notifications what does that actually mean so we have uh built out a set of best practices where our hospitals have kind of given us a benchmark on what uh really what is some of that important data that that we need to know about these patients so uh high utilization patterns this could be something like five ed visits in a span of 12 months uh could be traveling patients has this patient visited three eds in the past 90 days if they have any care guidelines written on them you will receive a notification any past history of sepsis any past safety and security event now this could be not just physical or verbal but non-physical as well i.e has the patient left ama with an iv still in place have they [Music] had any sort of property destruction anything like that so pretty broad range of um events that fall under that category and then lastly and certainly not least uh any uh past positive covid19 lab result so when we talk about covid that's certainly a huge highlight right now and i know it's it's been a big conversation focal point of these webinars specifically but really collective built out a functionality to enable hospitals to identify track trace and treat covid19 patients more effectively and just to give you an idea of the prevalence of of these patients actually moving across not only the nation but just the health care continuum in general this is a screenshot of collective medical's network and all of the patients that have transitioned from one hospital to another that have had opposite positive coven 19 lab results so you can see pretty significant and and hopefully this helps kind of understand the importance of uh receiving that information the moment that patient presents to your facility and just uh we'll go over this in a little bit more detail when i show you the actual uh portal but this is what you would see on that notification you can see under the karen sites it shows right there at the top uh this patient had a positive lab result on this date and then this is what it would look like if if somebody were to actually log into the collective the collective portal it would be right there at the top under the patient demographics identifying them as having a positive lab result now i i don't show you this slide necessarily to highlight collective medical's network growth rather going back to what rich had talked about earlier doctor shopping high utilization traveling patients uh uh high popular uh places for seasonal travel and you can see in 2019 really the extensiveness of of patients moving across the healthcare landscape and and really just how how important it is to understand not just the patient sitting in front of you but ultimately what uh what they've been treated for uh in other counties other states other facilities lastly we'll just talk quickly about what the implementation process looks like pretty pretty straightforward on our end from collective medical we just need to establish a secure vpn we would then build out the return notifications to your emr establish single sign-on and then request a historical uh patient file so that we can ingest that and you are then seeing uh seeing value from day one so with that i'll go ahead and jump right into [Music] the portal itself ian can you confirm that you're seeing ruby valley cool so this is obviously just an example uh emr trackboard but to to give you hopefully a better concept of of what this looks like for an end user if i'm a provider looking at my ed track board have all the same standard information right patient's name their chief complaint and then a number of icons typically populating here does that patient need labs do they need imaging do they need an ekg et cetera et cetera in this emr example you can see that we built out an icon just a 8 by 11 piece of printer paper which indicates that that is the ed notification so if i'm a provider and i see this populate on a patient now again this is in real time so this is this would populate before your provider even sees this patient so i'm able to click that icon i would simply a a pdf would would open and it's this one page document and we'll kind of go through this here at the top you will see immediately why that notification was triggered you can see here that this notification for bill tyler triggered because he has a care guideline written below that you will see any past safety and security events that we talked about a brief synopsis of what happened what type of event it was and then an aggregated total over the last 18 months next you would see care recommendations these are typically three to five bullet points of the most pertinent relevant information to help those providers make make better decisions for those patients or at least understand uh maybe how how they need to approach that workup this is also synonymous with the care care guideline the care history will show you past medical and surgical history as well as behavioral health social determinants etc etc recent visit summary will show you all visits over the past 12 months i apologize that says six but over the past 12 months for any inpatient observation or skilled nursing facility visit it would show you the admit date the facility what type the diagnosis and what the discharge disposition was and it will also show you the emergency department visits below that as well similarly what what facility it was what the diagnosis disposition as well and then we will see a quantitative view of all ed visits over the past 12 months it will show you the hospital the visit count and then the total quantitative number there we are going to skip past the pdmp section right now this is something that we are actively working on in montana it is not uh approved and stood up yet but in the works you will lastly see a list of providers that are part of that patient's care team you will see the provider's name their specialty and their contact information and then just to mention on on a last note here uh if if the patient has had any uh specific documents uploaded into the collective platform whether that is advanced directives pulsed orders uh pain contracts etc uh it would mention that those are available in uh for you to view in the portal down here and just to kind of continue on with the uh care guidelines section we'll just show you a couple of example patients that we put in here so um if you know if if you look at this patient you can see that they have dnr dna adenocarcinoma uh history of chf they have have poor home diabetic control present with dka recommendation if they're altered mental status right away do blood glucose before any other intervention so you can see uh just very succinct um and very um concise on on some of those recommendations to potentially approach this patient's care alternately you can see sally croxton has a history of uh behavioral health substance use disorder she's currently on a view from norseman treatment has a history of schizophrenia anxiety takes valprop acid so you can see that the guidelines really are uh targeted for that patient to be able to determine what's the most appropriate action for me to take with that ah young i think we've gone through it and i'll turn it back to you all right well do you does anybody have any questions for bryant at this time we can talk a little bit about um the platform and any questions you may have at this time hopefully you do have a question so uh there are uh two counties in montana that are the top ten uh busiest in terms of new cases uh per capita every day uh in the united states out of 324 counties number two in the united states is prairie county and number six is powell county and uh coming in at four cases a day and three cases a day uh per thousand population projection lines are not great uh you know obviously those are there's some concentration of infection going on in in the counties but we have we're fortunate position today we have both counties in the haas and the critical access hospitals on the call today if there there is a plan b here that if a facility would like to stand up this service very quickly using a fax machine uh could you talk about that and so if we wanted a rapid implementation what that would look like yeah absolutely um i appreciate you bringing that up sean um so we definitely focused very specifically on integrating directly into an emr trackboard now there there are unequivocally circumstances where it may just not make sense for a hospital um we see this a lot in critical access or maybe they don't operate primarily out of an emr system and it might make more sense to receive a fax or printer so with that being said we absolutely have the ability to send those notifications via fax or printer and if you're talking about timeline and implementation uh doing it that method versus an emr interface is significantly shorter we're talking somewhere between uh being able to stand this up and have notifications being sent to you in a week or two and i do have a question from dear lodge medical how do you prevent the misinformation from being provided to a facility when there might be a registration error for example john f doe presented but was registered as john c doe yep very reasonable question so it goes back to um and and i probably just kind of skimmed over it but uh uh our data matching our excuse me patient matching other algorithms are extremely comprehensive and don't just focus on one uh one component of a demographic or a patient's name so if we have a john c doe register at deer lodge we will match and benchmark that in our database not just based on the name but do we have can we match other providers can we match birthday can we match social security uh can we match uh a whole number of other uh uh other pieces of information versus just looking at that patient's name uh certainly it goes far more in depth than than what what i'm explaining now now there are circumsta ces where uh we may not be able to accurately and 100 confidently be able to match that patient specifically take for example if a patient shows up to your facility uh maybe they're unconscious and don't have an id or whatever the case may be if we absolutely have to we will create a new patient in our database as we or as you obtain more information on that patient whether that's through uh family or law enforcement or whatever the case may be then we can start to uh connect the dots and be able to reconfigure or or merge those two contacts so now that we know those are the same two patients um so hopefully that helps provide some context but again our our matching algorithm goes well beyond just looking specifically at a patient name great we have another question from brad how does security info and alerts get uploaded and entered so uh specifically it sounds like that's uh safety and security events so uh primarily the way that it's uploaded into the collective network and the the collective platform is um having your providers whether that's a nurse or an any physician a pa np whoever that may be can log into the platform it is extraordinarily easy to log safety and security events and i'm happy to uh show show that if that's helpful for anybody but um ultimately it takes just a couple of minutes they upload that information in there and again it's uh populated for 18 months at any subsequent visits that that patient have uh has great um the next question is it only accessible by a provider or would the charge nurse be able to have access i could take that one brian since um your you know use of the product will be through big sky care connect um so for big sky care connect you know your fee schedule is paid upon the number of providers but anyone in your facility including nurses front office people can have access to the system and whoever has access to the the big sky care connect hiv would have the same access for the ed alerts and the next question let's see our emr is hosted by providence epic have you already integrated with that platform in montana um i don't know that we have others can chime in we have a technical team that deals with all the onboarding um i don't think other outreach coordinators can chime in have we done our epic yet not too much a young paul um we haven't we've had discussions we've had discussions with providence and we're working with their uh technical team both locally and regionally um but we haven't completed um that work but it certainly is on our roadmap yep and it's definitely doable into inter-system and collective medical are very capable of integrating with epic that should not be a problem right brian i'll actually just add to what uh what you all were talking about um and and folks from big sky know this already but uh providence hospitals specifically st pats and um saint joseph josephs thank you uh have have been long-time partners of collective medical and yes we are already integrated with their facilities yeah and and they use they use the collective technology across their organization across all of providence so it's not a matter of if it's more a matter of when yeah okay we still have some more questions here um are we protected when it comes to sharing information from hospital to hospital or state to state yeah definitely we we follow all hipaa standards we are high trust certified and do not disclose or share information outside of any tpo relationship so data will not be transmitted just arbitrarily if you get a little bit more granular and specifically talk about some of the sensitive information 42 cfr part two etc uh we do have a as well as big sky um you know very very comprehensive structures in terms of um uh opting in opting out so on and so forth yeah and um i mentioned yeah it's intended in transit and at rest so data it's very secure and we have different roles for different people so only certain people that are designated by your facility will be able to break the glass or have access to the sensitive information and we'll have a different role for access for people at the front desk for example or a privacy officer or a clinician so that will all be handled through [Music] through the onboarding process okay the next question how long is implementation and testing have you had any integrations with meditek 615 or expands um so if if we talk just strictly about historical timelines on on the time frame to get this from start to finish usually what we see is somewhere between 8 to 12 weeks depending on how quickly the hospital can uh uh cannon wants to move do they have i.t resources available uh you know is everybody on board and it's it's full throttle so there's there's a little bit of fluctuation there but typically we we um like to say about 12 weeks now if we we'll talk about meditech uh 6.15 and expands so we have integrated with meditek before however we are currently working with them to um build out native integrations for all hospitals that that operate under meta tech so everything previously we've done up to this point has been all uh custom built now we are working on building out these native integrations that is in the process we anticipate that by q1 of 2021 we should be uh either there or very close to being done so the answer to that is that yes meta tech uh meditek integration is absolutely uh available and in the works now if if if we say we'd really like to just get this going right now so that we have those notifications available again we can do the printer or fax to your ed now that takes the 12-week implementation time frame uh down to about four so it takes a pretty significant uh pretty significant amount of time off of doing the emr integration now you may ask okay well if we do printer fax does that alleviate or eliminate the option to do an emr integration the answer is no we can stand up printer or fax and then go back and do the emr integration at a later date just to elaborate on what brian already said um so he's talking about timeline for the that's the collective ed alerts there is a little bit of um pre-work on that you do have to establish adt with big sky care connect first so you'll set up a vpn and then we'll start the integration process for adt and once that's established then we would move on to the collective medical integration so just so sorry i may i may have put the cart before the horse there that's okay i just want to make sure that everybody understands that step um another question i am assuming that the care plan information etc is manually uploaded into the platform as well by someone at the facility similar to the security event that's correct um i don't want to get too far into the weeds with this but we are rolling out smart on fire app to be able to uh have this an automated process where uh information from your emr is actually uploaded into the collective platform but let's not uh uh i don't i don't want to get too focused on that that's certainly a conversation we can maybe have uh one off if hospitals are interested but the answer is yes the care guidelines are uploaded manually again typically these care managers or social workers um uh have you know something either already in place or or are very easily able to put together some of these care plans copy and paste whatever works best for you again it's a very very quick and user-friendly process to get those uploaded and then of course it's available not only to your hospital and providers but anybody on the collective network now has access to that that care guideline as well yeah and i'll just put in a plug st patrick who has been using collective medical for the past couple of years we actually did a webinar and featured them because they told us about how valuable this has been for them and they have actually found this platform to be useful for care coordination with the fqhcs in their community so they have a grant right now where they gave access to all of the the medical clinics and primary care facilities in their community and they're actually using it as a care coordination platform so i just wanted you guys to be aware of that that there are other uses for this platform that goes beyond some of the things that we're talking about today okay the last question we have is um can you provide a rundown of the cost after the two-year subscription an email after the call is fine as well no that's great so i might actually start sharing some slides with you guys to answer that about the next steps so let me do that okay can everybody see my slide yes okay great so um just to talk about the next steps and then we can go into some of the cost information if you haven't already connected to big sky what you would need to do is sign the the participation agreement and the baa with us and then in addition to that there's a collective medical sub license agreement if you want to take advantage of the ed alerts you will have an outreach coordinator assigned to you to take you through all of these steps so rest assured that you know you will have assistance through all of this process but once the participation agreement and the baa and the collective medical sub license is signed that which coordinator will work with you to complete an intake assessment and this provides us with some general information about your facility the key contacts your training preference your connectivity goals and that information is shared with our technical team and you'll be introduced to our technical onboarding analyst the analyst will coordinate a discovery call with you and your ehr vendor and the intersystem rep to kind of scope out the project and then we'll establish a connection most likely a vpn and then we'll start working on the adt interface and once that gets started then we can turn it over to the collective medical team for the interface in from implementation and you can go live with that even before you go live with the big sky care connect so as i mentioned the big sky care connect and mha collaborative will be offering no cost for the service for the first two years and after that the hospital will be responsible for a subscription fee as this feature will be an added service there's a minimum charge established for maintaining the service for 575 dollars per year based on an annual volume of 832 ed visits or less now if you have more than those 833 visits per year it's an additional 69 cents per visit over that so pretty minimal i think big sky is taking the main fee and only having you pay for a portion at hopefully that answered your question okay um and then as far as big sky care connect um i can actually show you the fee structure for that as well so for those of you who are not part of the sky care connect yet we have a share funding plan that is split between the state of montana the payer community and the provider community and obviously the for the provider community that will be supported through annual subscription fees um and their good news is that right now we will not be charging you for the subscription fee until january of 2022 so you will literally get over a year a risk-free trial of our system and included in all of that is the onboarding service after that it is based on a fee schedule based on the tier levels so this is the tier that we have set up it's based on your net patient revenue and so it'll be based on the tier plus uh 144 dollars per provider per year and we can the outreach coordinator can send you all of this information in an email as well we'll definitely follow up with every attendee here um through the email and answer any of your questions but another good news is we do have interpretability net assistance program available right now for a limited time so any of the integration that costs that you may have with your ehr vendor will be eligible for you to apply for this and funding to pay for up to fifty thousand dollars for the cost involved in doing the integration so it's a great time for you to join us um at this time and that does run out um by mid of next year so definitely benefit to signing on now rather than later all right any other questions i got to go back to the chat here thank you bryant paul ayong for all the information and and most of all thank you uh the hospital community for the great questions today this was a valuable um session and hopefully it was valuable use of your time as well there are some other pieces to this that are being worked on it was mentioned that we're connecting to the state lab on the getting the covid positive history for patients we're also preparing for project warp speed on the immunization event and this is part of that package of tools that will be utilized it will connect the state intrax database so find out whether or not somebody has been immunized as well as their other patient coordination treatment planning and pre-authorization advantages that we didn't really get into today but all in all is a significant service so our hope is that as i mentioned the beginning that from this call that we're able to launch into a plan of what this would look like for your facility there are additional levels of approval that need to be made we'd be happy to participate in those discussions but per the assistant secretary of preparedness and response you know our objective is to have a plan uh at the beginning of the year for every hospital in the state on how this could be implemented and when and get things rolling all right thank you sean and thank you brian do you guys have any other questions feel free to um you didn't speak up i don't see anything in the chat thank you thank you so much all right i guess we can conclude at this time