Connected Communities Implementation Grant
Process Improvement Plan
Grantee Organization:Reliant Medical Group
Overall Goal of Connected Communities Grant Project for Grantee and Collaborators:
Objectives for each use case:
Use Case 1:Incorporate results of MA Prescription Monitoring Program (PMP) into patient-level CCDs sent to EMS, hospitals, SNFs and VNA Care Network
- Objective 1
- Objective 2
- Objective 3
Use Case 2:Alert Reliant PCP/care manager and VNA Care Network home health of a shared patient’s admit or discharge
- Objective 1
- Objective 2
- Objective 3
Use Case 3:Alert Reliant PCP/care manager and VNA Care Network home health when Vital EMS ambulance is dispatched to a shared patient
- Objective 1
- Objective 2
- Objective 3
Use Case 4:Send encounter-level CCDs to VNA Care Network when a shared patient is seen by Reliant PCP or specialist
- Objective 1
- Objective 2
- Objective 3
Use Case 5:Send CCD to ER at collaborating organization when Reliant patient is seen there
- Objective 1
- Objective 2
- Objective 3
Use Case 6: Send CCD to AdCare Hospital, VNA Care Network or SNF when Reliant patient is seen there
- Objective 1
- Objective 2
- Objective 3
Use Case 7: Send CCD to Vital EMS ambulance when dispatched for Reliant patient
- Objective 1
- Objective 2
- Objective 3
Use Case 1: Incorporate results of MA Prescription Monitoring Program (PMP) into patient-level CCDs sent to EMS, hospitals, SNFs and VNA Care Network
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: MetroWest Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Milford Regional Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: St. Vincent Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: UMass Memorial Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: AdCare Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Holy Trinity Nursing and Rehabilitation Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Jewish Healthcare Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Notre Dame Long Term Care Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Life Care Center of Auburn
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: VNA Care Network and Hospice
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 2: Alert Reliant PCP/Care Manager and VNA Care Network home health of a shared patient’s admit or discharge
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: MetroWest Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Milford Regional Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: St. Vincent Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: UMass Memorial Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: AdCare Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Holy Trinity Nursing and Rehabilitation Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Jewish Healthcare Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Notre Dame Long Term Care Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Life Care Center of Auburn
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: VNA Care Network and Hospice
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 3:Alert Reliant PCP/care manager and VNA Care Network home health when Vital EMS ambulance is dispatched to a shared patient
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: VNA Care Network
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Vital EMS
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 4: Send encounter-level CCDs to VNA Care Network when a shared patient is seen by Reliant PCP or specialist
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: VNA Care Network
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 5: Send CCD to ER at collaborating organization when Reliant patient is seen there
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: MetroWest Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Milford Regional Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: St. Vincent Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: UMass Memorial Medical Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 6: Send CCD to AdCare Hospital, VNA Care Network or SNF when Reliant patient is seen there
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: AdCare Hospital
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Holy Trinity Nursing and Rehabilitation Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Jewish Healthcare Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Notre Dame Long Term Care Center
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Life Care Center of Auburn
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: VNA Care Network
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Use Case 7: Send CCD to Vital EMS ambulance when dispatched for Reliant patient
Original workflow activity that will be impacted by implementing use case (original workflow activities may not align with process improvement activity line for line) / Process improvement activity (Please list activities that must be implemented, or have been implemented, in order to achieve the objectives of this use case.) / Anticipated Date of Completion / Actual Date of Completion (To be added with submission of Milestone 3)
Trading Partner/Collaborating Organization: Reliant Medical Group
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Trading Partner/Collaborating Organization: Vital EMS
1. / 1.
2. / 2.
3. / 3.
4. / 4.
5. / 5.
Identified Risks:
- Risk 1
- Risk 2
- Risk 3
1