Health Information Exchange: Past Present And Future. FSU COM Lonnie Draper, M.D.

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1 Health Information Exchange: Past Present And Future FSU COM Lonnie Draper, M.D.

2 OBJECTIVES At the conclusion, the participants should be able to: 1) Understand the difference between Health Information Exchange (HIE) and Electronic Health Records (EHR) 2) Know what information is available through a health information exchange 3) Determine the advantages and risks associated with EMRs and HIE

3 Disclosure Lonnie Draper, MD - a pro bono consultant for the BBRHIO, he is also the CEO and primary owner of Avocare, LLC. Avocare has contracts with BBRHIO for software and provides in-kind contributions. He is clinical faculty with Florida State College of Medicine. He created the first version of the Patient listing program on your PDAs used at FSU. He is a practicing emergency physician with Tallahassee Memorial Hospital in the Department of Emergency Medicine. He is on the HIT committee of the Florida Medical Association. He is not associated with any pharmaceutical companies and has not been paid for this presentation.

4 The History of Medical Informatics Medical Informatics is a new field of medicine all health information is on paper, film and magnetic tape base 1950 s - Robert Ledley pioneered electronic computers in biology and medicine 1960s - the first significant informatics projects like MYCIN and INTERNIST the National Library of Medicine started MEDLINE MUMPS was created; was used to create Vista Now there are numerous computerized patient record systems (EMR, HER) This decade - David Blumenthal is encouraging the adoption of health information technology

5 EHR and PHR Electronic Health Record - An aggregate electronic record of health-related information on an individual that is created and collected cumulatively across more than one health care organization and is managed and accessed by licensed clinicians and staff involved in the individual's health and care. Personal Health Record - An electronic, cumulative record of health-related information on an individual, drawn from multiple sources, that is created and managed by the individual. The integrity of the data in the ephr and control over access to the data are the responsibility of the individual.

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7 HIE, RHIO and RHIN Health Information Exchange - HIE is the general term used to describe large-scale electronic communication of patient information between different healthcare providers Regional Health Information Organization -The RHIO is the governing body of the community healthcare providers who as stakeholders define the policy and procedures for HIE Regional Health Information Network -The RHIN platform is the hardware and software that allows for the secure data sharing of electronic patient medical records between different healthcare providers

8 Types of Information

9 Why Health Information Exchange A physician s main job is to gather information and make a decision based on that data The better the information the better the decision Currently information gathering is laborious Most decisions are made with insufficient information The most frequent mistakes are made because of poor information

10 Current Software Issues

11 Current Communication Issues

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13 BBRHIO Service Area

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15 RHIN building blocks Master Patient Index/Regional Master Patient Index (MPI/RMPI) required to identify and match patients from different systems Record Locator Service (RLS) identify patient encounters at each point of care Data paper, electronic, shared, interfaces

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25 The Future

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27 What is the Value of Local HIE? Participation in local physician and hospital owned infrastructure Reduction of state run monopoly influence Advertizing at BigBendHealth.com Reductions in office administrative costs (paper printing, mailing and postage) Increase in staffing efficiencies due to reduced time handling faxes & phone calls Consolidate and reduce data interfacing costs Reductions in employee recruitment and hiring costs

28 Why Should I Care Value of HIE & Interoperability Providers Providers

29 HIPAA Concerns with HIE & EHR Patient consent Policies and procedures System security Access to patient records Errors The simple fact is physicians face these same concerns in the paper world, and the sharing of electronic medical records is safer and more compliant than paper.

30 New Errors Ordering is largest source of preventable hospital error Expectations for reducing medication errors with EMRs is high CPOE is regarded as the solution to medication errors CPOE reduces medication errors up to 81% while creating new error CPOE system facilitated 22 types of medication errors These include: selecting the wrong patient, fragmented CPOE, loss of coherent overview of patients' medications, pharmacy inventory, dual paper and CPOE methods, displays mistaken for dosage guidelines, ignored notices, paper vs. CPOE notices, unclear protocols, rigid rules not tailored to patients, separation of functions can lead to double dosing and incompatible orders, and inflexible ordering formats generate erroneous orders. Three quarters of the house staff reported observing risking practices (Koppel, 2005)

31 References Blumenthal D. Stimulating the adoption of health information technology, N Engl J Med Apr 9;360(15): Epub 2009 Mar 25. Kralewski JE, Dowd BE, Cole-Adeniyi T, Gans D, Malakar L, Elson B. Factors influencing physician use of clinical electronic information technologies after adoption by their medical group practices. Health Care Manage Rev Oct-Dec;33(4): Goldzweig CL, Towfigh A, Maglione M, Shekelle PG. Costs and benefits of health information technology: new trends from the literature. Health Aff (Millwood) Mar-Apr;28(2):w Epub 2009 Jan 27. Ross Koppel, PhD; Joshua P. Metlay, MD, PhD; Abigail Cohen, PhD; Brian Abaluck, BS; A. Russell Localio, JD, MPH, MS; Stephen E. Kimmel, MD, MSCE; Brian L. Strom, MD, MPH, Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, AMA. 2005;293: Jason S. Shapiro MD, Joseph Kannry MD, Mark Lipton MD, Eric Goldberg MD Paul Conocenti MBA, Susan Stuard MBA, Brian M. Wyatt JD and Gilad Kuperman MD, PhD, Approaches to Patient Health Information Exchange and Their Impact on Emergency Medicine, Annals of Emergency Medicine Volume 48, Issue 4, October 2006, Pages Terrell KM, Perkins AJ, Dexter PR, Hui SL, Callahan CM, Miller DK. Computerized decision support to reduce potentially inappropriate prescribing to older emergency department patients: a randomized, controlled trial. J Am Geriatr Soc Aug;57(8): Epub 2009 Jun 22.

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33 Current Infrastructure Issues

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36 The four displayed screens demonstrate some of Avocare s security features including a DECLEARATION OF ENTITELMENT for patient record access as well as a BREAK- THE-GLASS function for emergency access to patient opt-out records.

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39 BBRHIO Mission Improve the safety, outcomes, privacy and efficiency of healthcare Objectives Create a unified healthcare community that is electronically connected. Provide technical business support to providers. Help practices focus on patient care by reducing the burdens of patient data sharing for providers, thus producing a safer and more enjoyable experience for patients. Help streamline office workflow for community interaction by providing efficiencies and cost savings for the healthcare community through reductions in paper based communication.

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42 Stimulus Money $44-64,000 per physician Must demonstrate meaningful use 5 year incentive period via Medicare or Medicaid increase payments 2015 where Medicare payments will decrease by 1%.