Next Steps in Healthcare Beyond EHR/HIE


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  • All of these sites of care have different systems that identify you as a person. They are not coordinated, may not hold current data, and may even have you identified more than once as transcription errors and system limitations may have the same person identified more than once in the same system. Imagine if you took every card that identified you within your wallet and assume these organizations merged (or perhaps just agreed) to reconcile your demographic record once and to update all the individual systems that identified you when a change occurs. This is largely what is being asked of an EMPI within these new Health Enterprises. Needless to say, this is a daunting and continuous task. Further, it must be a flexible and proven solution that holds data validity as its number one priority. For instance, at Kaiser Permanente in Northern California, they use OPF functionality to reconcile clinical results with person information prior to these being written to its clinical data repository. Thus, the need to ensure the RIGHT person is identified is critical prior to combining and updating clinical records.
  • Next Steps in Healthcare Beyond EHR/HIE

    1. 1. Next Steps in Healthcare Beyond EHR/HIE Brian Yeaman MD CMIO NRHS Medical Informatics Officer NPHO
    2. 2. Healthcare Reform <ul><li>An emphasis has been placed on technology to accomplish: </li></ul><ul><ul><li>Reduced Adverse Events </li></ul></ul><ul><ul><li>Reduced Duplication of Testing </li></ul></ul><ul><ul><li>Improved Disease Management </li></ul></ul><ul><ul><li>Improved Transitions of Care </li></ul></ul><ul><ul><li>Improved Patient Safety </li></ul></ul><ul><ul><li>Improved Transparency in Cost and Coverage </li></ul></ul>
    3. 3. Healthcare Reform <ul><li>Stimulus funding has been provided to hospitals and providers to </li></ul><ul><ul><li>Adopt EHR’s </li></ul></ul><ul><ul><li>Engage HIE </li></ul></ul><ul><ul><li>Meet the Meaningful Use Criteria </li></ul></ul>
    4. 4. Meaningful Use <ul><li>Can we really meet the goals of 2011 and 2012? </li></ul><ul><li>Where do we go after 2011 and 2012? </li></ul><ul><li>Seed money provided to answer those questions. Enter the…. </li></ul>
    5. 5. Beacon Funding Opportunity
    6. 6. Beacon Funding Opportunity
    7. 7. Beacon Funding Opportunity <ul><li>$220 million dollars via ARRA at the discretion of the ONC </li></ul><ul><li>15 communities nation wide </li></ul><ul><li>Up to 20 Million per community </li></ul><ul><li>Advanced communities ready to incorporate HIT to advance community-level care coordination and quality monitoring and feedback </li></ul>
    8. 8. Baseline Adoption <ul><li>Geographical Area </li></ul><ul><ul><li>Zip Code/County Lines/Referral Areas (Dartmouth Atlas) </li></ul></ul><ul><li>EHR Adoption </li></ul><ul><ul><li>Urban 30% of all healthcare providers </li></ul></ul><ul><ul><li>Rural 25% </li></ul></ul><ul><li>Some form of HIE adoption </li></ul><ul><li>e-prescribing </li></ul>
    9. 9. Baseline Adoption <ul><li>Collaboration </li></ul><ul><ul><li>SHIECAP (State HIE) </li></ul></ul><ul><ul><li>REC (Regional Extension Centers) </li></ul></ul><ul><ul><li>State Agency (Health Department) </li></ul></ul><ul><ul><li>Universities </li></ul></ul><ul><ul><li>Public Health </li></ul></ul><ul><ul><li>Research </li></ul></ul><ul><ul><li>Payers </li></ul></ul><ul><ul><li>Employers </li></ul></ul><ul><ul><li>Hospitals </li></ul></ul><ul><ul><li>Foundations </li></ul></ul><ul><ul><li>Free Care </li></ul></ul><ul><ul><li>Tribal Health </li></ul></ul><ul><ul><li>VA </li></ul></ul>
    10. 10. Beacon Funding Opportunity <ul><li>Abstract </li></ul><ul><li>Full Narrative </li></ul><ul><li>Study Initiatives and Metrics </li></ul><ul><li>Budgets </li></ul><ul><li>Timelines </li></ul><ul><li>Key Stakeholders </li></ul><ul><li>Letters of Support </li></ul><ul><li>Sustainability Models </li></ul>
    11. 11. Baseline Funding Opportunity <ul><li>Did I mention from the time of the FOA release to final grant proposal submission there were only… </li></ul><ul><li>6 Weeks? </li></ul>
    12. 13. Norman’s Baseline <ul><li>2006 began a community EHR selection process for inpatient and outpatient </li></ul><ul><li>NPHO led clinical integration model </li></ul><ul><li>Shared resources, group contracts, local support and experts to reduce expense </li></ul><ul><li>2007 hospital and first practice kick off new systems </li></ul><ul><li>2010 nearly 100 providers live in ambulatory EHRs and 2 live HIEs </li></ul>
    13. 14. Community Health Record <ul><li>Benefits </li></ul><ul><ul><li>Reproducible EHR model </li></ul></ul><ul><ul><li>More accurate problem and medical lists </li></ul></ul><ul><ul><li>Reduction in adverse medication reactions </li></ul></ul><ul><ul><li>More accurate drug allergy lists </li></ul></ul><ul><ul><li>Less duplication of testing </li></ul></ul><ul><ul><li>Capability to interact with personal health records </li></ul></ul><ul><ul><li>ED, Intensivists, Hospitalists, EMS web views </li></ul></ul>
    14. 15. NPHO Clinical Integration <ul><li>Big Picture Early Wins for Physician’s </li></ul><ul><ul><li>Local Adoption of EHR’s </li></ul></ul><ul><ul><li>Assist Physicians in preparation for P4P </li></ul></ul><ul><ul><li>E-prescribing Initiatives 2% Medicare Bonus </li></ul></ul><ul><ul><li>PQRI 2% Medicare Bonus </li></ul></ul><ul><ul><li>Preparation for “Meaningful Use” and ARRA payments via the government </li></ul></ul>
    15. 16. Local Model Physician Portal https connectivity HIE Server Contains Lab, DI, ICD, CPT, Rx compendiums Primary Care Physician Using EHR application Cardiologist or other Using EHR application Nephrologist or other WITHOUT EHR application Administrative Portal https connectivity Registers new users, sets security
    16. 17. Local HIE <ul><li>Locally named OPHX (Oklahoma Physician Health eXchange) </li></ul><ul><li>Quality Officer </li></ul><ul><li>Centralized Quality and Performance Reporting </li></ul><ul><li>Potential for Chronic Disease Management </li></ul>
    17. 18. Hospital Data <ul><li>Large volumes </li></ul><ul><li>Low Hanging Fruit: </li></ul><ul><ul><li>Labs </li></ul></ul><ul><ul><li>Vitals </li></ul></ul><ul><ul><li>ICD9’s </li></ul></ul><ul><ul><li>Encounter History </li></ul></ul><ul><ul><li>Reports and Dictation Next Step </li></ul></ul>
    18. 19. Oklahoma City HIE <ul><li>Desire for a Network </li></ul><ul><li>Modeled after NE Oklahoma Network entitled SMRTNET </li></ul><ul><li>Low Cost, High Adoption Rate </li></ul><ul><li>Begin With Hospital Data and Grow Connections to Other Data Streams </li></ul><ul><li>Live October of 2008 SMRTNET </li></ul>
    19. 20. Participating Hospitals in the Oklahoma City Metro <ul><li>OU Medical Center </li></ul><ul><li>St Anthony’s </li></ul><ul><li>INTEGRIS Canadian </li></ul><ul><li>Norman Regional </li></ul><ul><li>Edmond Medical Center </li></ul><ul><li>INTEGRIS Baptist </li></ul><ul><li>Moore Health Center </li></ul><ul><li>INTEGRIS Southwest </li></ul><ul><li>Midwest Regional </li></ul><ul><li>Mercy Health Center </li></ul><ul><li>Oklahoma Heart Hospital </li></ul>
    20. 21. eHX (NPHO) SMRTNET NEO, Metro, Tulsa Hospitals / CHCs / HAU Free Clinics NRHS eClinicalWorks (Dr. Local EHR) Dynamed Dynamed (EBM content) Citrix / VPN Problematic Transactional HUB (Consults, Lab, Radiology) (In Development) Internet / Free +eHX $25 $20 $45 for Physician Practices to connect to local network and SMRTNET. This cost could be Subsidized $10 by PHO or Hospital; 1 connection to doc EHR to view inpatient, ED results, Metro information, Surescripts, immunizations, pharmacy history and EBM Surescripts (Pharmacy) OSIIS (Immunizations) HIE Norman to OKC to Statewide Adoption (RHIO -> Local Networks/Hospitals -> Community Providers) PSRS (Preventative Care Registry) (Proposed Connection)
    21. 22. Geographical Area <ul><li>Cleveland, McClain and Garvin Counties </li></ul><ul><li>266 healthcare providers, including all MDs, DOs, NPs and PAs </li></ul><ul><li>75%, are fully utilizing EHRs and have live HIE functionality </li></ul><ul><li>52% of all ambulatory providers have fully implemented EHRs </li></ul><ul><li>57% of primary care physician fully utilize EHRs </li></ul>
    22. 23. Key Stakeholders <ul><li>NRHS </li></ul><ul><li>NRHS Foundation </li></ul><ul><li>NPHO </li></ul><ul><li>SMRTNET </li></ul><ul><li>OU College of Medicine </li></ul><ul><li>OU College of Public Health </li></ul><ul><li>OU Physicians </li></ul><ul><li>OFMQ </li></ul><ul><li>OKPRN (REC) </li></ul><ul><li>30 additional supporters level 2-4 including state agency, the temporary state HIT Coordinator, governor, payers, VA, tribal health, all hospitals in the geographical area and state US congress representatives. </li></ul>
    23. 25. Project Goals <ul><li>Reinforce the model that healthcare is local </li></ul><ul><li>Create a robust PHR interfaced to local HIE </li></ul><ul><li>Strengthen HIE connections </li></ul><ul><li>Incentivize patients to use PHR’s through education, social networking, points and rewards for daily healthcare involvement </li></ul><ul><li>Improve clinical decision support for providers </li></ul><ul><li>Create workflows that make sense </li></ul>
    24. 26. Project Goals <ul><li>Create interfaces for home devices that input vitals into the PHR to the HIE and are viewable in the EHR for the provider </li></ul><ul><li>Enhance or replace current efforts with an improved model of payers and employers plans to keep patients healthy and educated. “Well at Work” programs and disease management programs etc. </li></ul>
    25. 29. Measurables <ul><li>EHR Installation For Free Clinics </li></ul><ul><li>Rural Hospital HIE Connectivity </li></ul><ul><li>Tribal Services </li></ul><ul><li>HIE Connection </li></ul><ul><li>Rural Clinic EHR Adoption </li></ul><ul><li>VLER Potential HIE Connection </li></ul><ul><li>Enhanced CCD </li></ul><ul><li>CapabilityOpen Source PHR with HRASocial Networking Surround </li></ul><ul><li>Points Store For Health Related Purchases </li></ul><ul><li>Lower Aggregate Health Care Costs </li></ul><ul><li>Lower Hospital Readmissions </li></ul><ul><li>Lower Unnecessary ED Visits </li></ul><ul><li>Lower Unnecessary Hospitalizations </li></ul>
    26. 30. Measurables <ul><li>Quality of Life Assessment CAHPSHRA and Calculated Health Age </li></ul><ul><li>Lifestyle Decision Support for Patients </li></ul><ul><li>CHF Management, DM Management, andCOPD Management </li></ul><ul><li>Smoking Cessation </li></ul><ul><li>Alcohol Usage </li></ul><ul><li>Health Age </li></ul><ul><li>Pneumovax Influenza Mammogram PSA Lipid Panels Compliance </li></ul><ul><li>Interface Sharing </li></ul><ul><li>Knowledge Base Sharing </li></ul><ul><li>Report Exchange within HIE </li></ul><ul><li>Condition Surveillance </li></ul>
    27. 31. Move over Batman
    28. 32. EHR/HIE Finish Line <ul><li>Create patient accountability in their care and a viable medical home model </li></ul><ul><li>Disease management and public health initiatives </li></ul><ul><li>Health as a daily function of our lives </li></ul><ul><li>Tear down the walls that create transitions of care </li></ul><ul><li>Reduce overall healthcare expenditures </li></ul>