Transcript Slide 1

A Public Utility
for Electronically Exchanging
Clinical Information in Central
Massachusetts
HealthAlliance Hospital Grand Rounds
March 3rd, 2009
Larry Garber, M.D.
Fallon Clinic Medical Director of Informatics
SAFE Health Principal Investigator
Agenda
Health Information Exchanges
What are they?
Why do we need them?
Review of SAFE Health project
HealthAlliance Hospital’s role in SAFE Health
Current status of SAFE Health project
The future of SAFE Health
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EMRs are great,
however…
Hospitals don’t easily interface to
office EMRs
ERs don’t know your outpatient information
30% of ER visits lack important medical
information, half of which are “critical”
15% of ER admissions could be avoided if
the ER had outpatient information
150,000 preventable ADEs ($8 Billion
nationwide wasted) each year occur at the
time of admission due to inadequate
knowledge of outpatient medication history
Hospitals don’t easily interface to
office EMRs
Your EMR won’t have ER notes or discharge
summaries unless you scan them in
Only 6% of small practice EHR’s are
interfaced to hospital information systems
2 million adverse events each year are
due to inadequate communication at time
of discharge
Most offices don’t have lab and
imaging interfaces
Costly to interface to lab and radiology
systems
Only 50% of small practice EHR’s are
interfaced to lab systems
5-20% of lab and x-rays are ordered
redundantly because original results can’t be
found
40% of Prostate Cancer malpractice cases in
MA (2002-2007) were due to failure to
transmit/receive test results
Most offices don’t have all of the
patient’s physicians in their practice
Visits are split 50/50 between PCP’s and
specialists
Average Medicare patient sees 6.4 different
MDs per year
25% of prescriptions are not known by the
treating physician
Patient data missing 80% of time in one study
25% of PCPs lack consult note 4 weeks after
outpatient consultation
20% of medical errors are due to inadequate
availability of patient information
EMRs are great, however…
Without interfaces to the other
parts of the healthcare system,
EMRs will fall short of their
goal to improve the quality and
safety of healthcare while
reducing costs
EMRs are great, however…
Each interface costs $5,000 - $20,000 in
hardware, software, and consultant time
A small office EMR should have at least:
Lab
Imaging
Hospital
Pharmacy
Other physician practices?
Interfaces can double the cost of EMRs
The Solution:
Health Information Exchanges
(HIEs)
Lab
Rx
Imaging
Payers
Hospital
MD
HIE
Rehab
LTC &
SNF
Other
MD’s
DPH
Patients
VNA
Local Health Information
Exchanges
Regional Health Information
Organizations (RHIOs)
National Health Information
Network (NHIN)
Health Information Exchange (HIE)
Lab
Rx
Each organization
has 1 interface Hospital
Central hub only
routes
MD
clinical data
Only patient
Other
demographic MD’s
data stored
Patients
centrally
Imaging
Payers
HIE
Rehab
LTC &
SNF
DPH
VNA
Community Portals and Health
Record Banks vs. True HIEs
Clinical data stored centrally and viewed
through website (portal)
Often can use CCOW to synchronize user
and patient context between EMR and portal
Clinicians have to learn to use two systems
Can’t directly use portal data in EMR (e.g.
allergies, medication list, immunization
history, etc…)
Personal Health Records (PHRs)
vs. HIEs
Clinical data stored centrally
Larger focus on patient access to data (for now)
Less focus on downloads into EMRs or
Provider/Ancillary/Payer healthcare
transactions (for now)
Over time, the distinctions will blur as HIEs
emphasize patient portals, and PHRs/PHPs
interface more Providers/Ancillaries/Payers
Patient enrollment is a bottleneck to data flow
The Benefits of HIEs:
All achieved with MDs using their own EHR
Improved coordination of care
PCP  Specialist
Inpatient  Outpatient
Improved patient safety
Improved quality of care
Reduced redundant testing
Fewer hospital days
Fewer adverse events (3% reduction)
Better medical history on patients in ER (2%
reduction)
Excellent Patient Service
“I ran out of one of my pills. Not sure
which one. I lost my wife’s note… ”
We can know our patients better than
they know themselves
Other Benefits of HIEs:
Automated public health reporting
Automated bio-surveillance
Quality Measurements/Benchmarks
Facilitates research
Reduces the cost of interfaces
Reduces barriers to adopting EMRs
Value of National HIE Network
$337 Billion savings during 10-year
implementation period
$78 Billion savings each year thereafter:
$34 Billion to providers/facilities
$22 Billion to payers
$13 Billion to reference laboratories
 $8 Billion to imaging centers
 $1 Billion to pharmacies
 $0.1 Billion to Public Health agencies
Legislation for HIEs - State
MA Health Care Reform Act of 2008
$15M for community-based HIEs and EHRs
All hospitals and community health centers
must implement interoperable electronic
health records systems by 2015
Legislation for HIEs - Federal
American Recovery and Reinvestment Act of 2009
$1B in up-front grants for EHR and HIE
implementation
Up to $64K for MDs and $11M for hospitals if:
using EHR in a meaningful manner
submits clinical quality measures
EHR is connected to a
Health Information Exchange
Secure Architecture For Exchanging
Health Information
A Public Utility for
Electronically Exchanging
Clinical Information in Central
Massachusetts
Funding for SAFE Health
$1.5 Million Agency for Healthcare Research
and Quality (AHRQ) Grant #1 UC1 HS015220
(10/2004 9/2009)
$4.2 Million donated by:
Fallon Clinic
Fallon Community Health Plan
HealthAlliance Hospital
UMass Memorial Medical Center
Objective of SAFE Health
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Build and operate a health information
exchange infrastructure for Central
Massachusetts to securely enable real
time aggregation and presentation of
patients’ health information from
multiple different organizations in order
to improve patient safety, quality of
care, and efficiency of healthcare
delivery.
SAFE Health
Architecture
23
High Level Design Goals
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No central clinical data repository
One central demographic repository (EMPI)
Preservation of data and transaction ownership
Minimize duplicate data from multiple sources
Secure and auditable; Protect patient privacy
Scalable and high performance
Interoperable with other local health information
exchanges and the NHIN
No rip and replace – leveraging existing systems
Integrate seamlessly into varied physician
workflows
Minimize cost
Levels of Participation – current & planned
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Portal access – web browser access to display
patient information
Practice management system integration –
medical summary prints out automatically when
patients arrive triggered by ADT
EHR integration – One or two-way integration
with existing information systems to display patient
information while in those systems and supply data
to the SAFE Health network.
Clinical information supplier– Ancillary systems
that receive orders and provide results, or health
insurance carriers that only feed patient data to
SAFE Health network.
Privacy and Security
User Authentication – performed by each entity
Patient Authorization
 Opt-in consent for “Pulls”
 Ordering/Referring/Authoring/CCd provider for “Pushes”
 Privacy Notice covers “Pushes” as well as release of
demographics to Core Server
Encryption - HTTPS
Audit trails – maintained within each Local
SAFE Health server as well as the Core Server
26
Patient Opt-in Consent Automation
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When patient who has been at more than one
participating entity, arrives at a participating entity
and a consent form hasn’t authorized all of the
entities that the patient is registered at yet, a
consent form automatically prints on the registration
clerk’s local printer.
Consent is to authorize a participating entity to both
disclose as well as view patient information
Patients can authorize any or all of the current
entities participating in SAFE Health, or they can
authorize all current and future healthcare
providers in the state of Massachusetts
Patient Opt-in Consent Automation
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Patients can authorize their medical insurance
carrier(s) to provide information to SAFEHealth,
but these payers can not view information.
Consent only needs to be signed once at one
organization to authorized any or all entities
Consent can be revoked from any or all entities
for future disclosures and viewing, but past
disclosures cannot be revoked.
Patients cannot refuse to participate in the
“Push” of results to ordering/referring/
authoring/CCd MD
Patient Opt-in Consent Automation
After the consent form is signed, a clerk
clicks on patient’s name in the worklist to
acknowledge that form was or was not
signed and which entities were authorized,
triggering clinical data to be exchanged
between these authorized entities and
imported into the local EHRs
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Current Status
of SAFE Health
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Current Status of SAFE Health
SAFEHealth went live on
th
June 24 , 2009!
31
Current Status (continued)
For any patient that presents to the
HealthAlliance Hospital Leominster Campus
ER or Fallon Clinic Leominster or Fitchburg
sites that chooses to participate, regardless
of PCP site or health insurance
HealthAlliance Hospital Leominster Campus
ER provides Fallon Clinic with ER Summaries
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Current Status (Continued)
Fallon Clinic provides visit notes with:
Medication List
Allergies
Problem List
Immunization History
Code Status and Advance Directive Status
PCP and phone number
Vital Signs
Recent Lab and Radiology Results
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No confidential notes
What do ER Doctors Want to See?
Phase 1
Phase 2
34 Shapiro JS, Kuperman G, et al. J Am Med Inform Assoc. 2007;14:700–705.
Future Plans for SAFE Health
Integration with any hospital, physician
practice/group, or other provider in the region
that wishes to participate
Integration with any imaging center, reference
lab, or other ancillary service in the region
that wishes to participate
Integration with any health insurance carrier
that is willing to provide patient information to
the SAFE Health network
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Potential Physician
Concerns
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Potential Physician Concerns
Will I be overwhelmed with too much data?
If the same data comes from 2 sources, will
I see duplicates?
Will the data be incorporated into my EHR
so I can use it to defend my decisions in
court if necessary?
Will the incorporated data be in a discrete
data format that matches my EMR so I can
do decision support with it?
Potential Physician Concerns
Will my staff and I be overwhelmed getting
consent to use the HIE from each patient?
Will it be too easy for patients to transfer
their care to competing practices?
Will it be easier for lawyers to access my
records? Can they case-find through the
HIE?
Summary
Clinical data sharing has great potential to
help us and our patients with:
Quality
Safety
Efficiency
Service
Implementation of an EMR
SAFE Health is a low-cost, secure Health
Information Exchange for our region
Questions? www.SAFEHealth.org
Lab
Rx
Imaging
Payers
Hospital
MD
HIE
Rehab
LTC &
SNF
Other
MD’s
DPH
Patients
VNA
Larry Garber, MD
[email protected]
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