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

Health Information Exchange:
Past Present And Future
FSU COM
Lonnie Draper, M.D.
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
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.
The History of Medical Informatics
• Medical Informatics is a new field of medicine
• 1945 - 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
• 1965 - the National Library of Medicine started MEDLINE
• 1966 - 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
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.
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
Types of Information
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
Current Software Issues
Current
Communication
Issues
BBRHIO Service Area
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
The Future
What is the Value of Local HIE?
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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
Why Should I Care
Value of HIE & Interoperability
Providers
Providers
Concerns with HIE & EHR
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HIPAA
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.
New Errors
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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)
References
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Blumenthal D. Stimulating the adoption of health information technology, N Engl J Med. 2009 Apr 9;360(15):14779. 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.
2008 Oct-Dec;33(4):361-7.
Goldzweig CL, Towfigh A, Maglione M, Shekelle PG. Costs and benefits of health information technology: new
trends from the literature. Health Aff (Millwood). 2009 Mar-Apr;28(2):w282-93. 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;293:1197-1203.
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 426-432
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. 2009 Aug;57(8):1388-94. Epub 2009 Jun 22.
• END
Current Infrastructure Issues
The four displayed screens demonstrate some
of Avocare’s security features including a
DECLEARATION OF ENTITELMENT for
patient record access as well as a BREAKTHE-GLASS function for emergency access to
patient opt-out records.
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.
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%.