THE HEALTH INFORMATION TECHNOLOGY SUMMIT

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1 THE HEALTH INFORMATION TECHNOLOGY SUMMIT

2 1.05 Community-Based Collaborations: HIT Community-Based Collaborations 101 October 22 10:15 AM 60 minutes Frisse and me

3 A Short History of the J. Marc Overhage, MD, PhD, FACP, FACMI CEO and President, Associate Professor of Medicine, Indiana University School of Medicine Senior Investigator, Regenstrief Institute

4 Indianapolis, Indiana 1.5 million population base 12th largest city in U.S.A. Home to Indiana s only medical school State Department of Health Referral center for entire state (7 million)

5

6 % of Central Indiana market Indianapolis Landscape Other Wishard St. Francis Community St. Vincent Clarian Other South Bend LabCorp MACL (Quest) Wishard Community St. Francis St. Vincent s Clarian Other M-Plan Medicaid Anthem RxHub Hospitals Laboratories Outpatient RX Physician practices Health insurers % Patient Days % Lab Tests % RXs Cleared % Physicians % Covered Lives Other St. Francis Care Group St. Vincent CPI MMG AHN IUMG Other Medicare Medicaid United IHN Corvel ICM M-Plan Sagamore Anthem

7 Regenstrief Institute INPC IUSM I3 ICareConnect BioCrossroads

8 Founded in 1969 by Sam Regenstrief Affiliated with IU School of Medicine ~$12M annual budget largely from federal grants Pioneers in medical informatics Standards: HL7, LOINC EMRs: RMRS, INPC Founded in 1999 by 50 community physicians as the Central Indiana Coalition to Reinvent Health Care Early seed funding from Health & Hospital Corporation of Marion County Initiated community clinical messaging concept Founded in 2002 by the Central Indiana Corporate Partnership Economic development organization promoting academic/industry collaboration in life sciences

9 Initial RMRS Aims Eliminate the logistic problems associated with the paper record Standardize the care process. Deliver information in a more organized and useful way. Actively process this record and provide decision support to clinicians. Analyze and understand the data to improve the health of populations

10 INPC Project Goal Demonstrate the feasibility and benefit of a community wide electronic medical record system in acute care situations.

11 Statewide Regional County Vital Vital statistics statistics Hospitalizations Hospitalizations Newborn Newborn screening screening Emergency Emergency room room visits visits Immunizations Immunizations Hospital laboratory results Hospital laboratory results Lead Lead Hospital Hospital pathology pathology results results Reportable Reportable conditions conditions Hospital radiology results Hospital radiology results Sentinel Sentinel hospitals hospitals Hospital Hospital medications medications ISDH ISDH laboratory laboratory Organization Technology Management Repository Clinical care Research Result delivery CDSS Immunizations Immunizations Primary Primary care care visits visits MCHD MCHD laboratory laboratory Data Data Standardization Patient Patient Provider Labels Labels Answers On-line surveillance ELR BT Clinical Trials

12 Functions Results retrieval Clinical messaging/document delivery Data entry Reporting Clinical decision support Public health surveillance Medical reference access

13 Users Most central Indiana med/surgical hospital emergency departments Hospital based providers (expanding) Ambulatory physicians (approximately 40%) Homeless care network Public school clinics Marion County Health Department Indiana State Department of Health

14 Hospital Geographic Coverage

15

16 The Indiana Network for Patient Care Public Health Public Health MRF Consolidating the Silos St. Vincent MRF Electronic Medical Record System IUMG MRF Global Patient Index Concept Dictionary Clarian MRF Community MRF Global Patient Index Wishard MRF Concept Dictionary

17 Public Health VA St. Vincent St. Francis Global Patient Index IUMG PC IUMG SC Concept Dictionary MMG Global Provider Index Community Other Radiology Clarian Health Partners Laboratory Real time HL7 RxHUB Wishard Health Services Patient: John Doe MRN: Patient: John Doe Diagnosis: MRN: WBC: Diagnosis: 14,000/cm WBC: 14,000/cm 3 ADT Pharmacy Transcription

18 Regional Local

19 Data reuse Clinical care Emergency room Primary care Inpatient Public health (state and local HD) Immunization registry Reportable conditions Surveillance Health services research Clinical research Accreditation reports

20 Clinical Data Standards Current HL7 messages for most as the envelope DICOM messages for images as the envelope LOINC for laboratory results content CPT-4 for procedures content ICD-9 for diagnoses content NDC and RxNorm for medications content Anticipated Organisms for microbiology content

21

22

23

24

25 Board Composition Hospital systems Clarian Health Partners St. Francis Hospitals and Health System St. Vincent Health Care Wishard Health Services Community Hospitals of Indiana Government City of Indianapolis Public Health State Department of Health Marion County Health Department Research IU School of Medicine Regenstrief Institute Medical societies Indianapolis Medical Society Indiana State Medical Association Economic development BioCrossroads / Central Indiana Corporate Partnership

26 Management Business units Product/service focus Products/services Organizational Structure Individual-identified data and applications for clinical care Results delivery Shared EMR Health transactions Decision support Disease management Public health Board of Directors Management Aggregated, de-identified data and applications for research and analysis Clinical Trials Screening Pharmacovigilance Research support Best practice Quality reporting Community Forum Technology Advisory Group Clinical Advisory Group Information Analysis Technology Applications and knowledge for research and commercial sales Software Sales Consulting Spin-offs

27 - Confidentiality While numerous measures in in place to protect confidentiality of patient s data, the provider has to know who the patient is. Secure physical network Encryption Authentication Agreements Device controls

28 Participants Agreement How can participants share health data to treat patients? Who may have access to PHI for treatment purposes? What information is to be stored on the network? How may the PHI be used for research purposes? What are other considerations? Equipment. Consistency of data. Other uses of information. Indemnification.. Governance Disposition of information upon termination Security

29 Patient data Applications & tools Application Framework Credentialing Claims clearing Eligibility/referrals/pre-certification Increasingly structured clinical data Major urban hospitals Non-hospital labs Pharmacies Physician offices Biological samples Payors Results delivery Decision-support Disease management & community health improvement 4 Public health lab reporting 5 Research Public health surveillance Clinical trials screening & management Direct support of patient care Research Admin functions

30 Level HIE Taxonomy Description Non-electronic data Machinetransportable data Machine-organizable data Machine-interpretable data Examples Mail, No PC/information phone technology PC-based and manual fax, secure Fax/ of scanned documents Secure of free text or Structured messages, incompatible/proprietary file non-standard content/data formats, HL-7 message Automated entry of LOINC results Structured from an messages, external lab into standardized a primary care content/data provider s electronic health record

31 Annual Savings Nationally L4 N/A Other Other Provider $1.29B Pharmacy $8.17B Radiology $8.82B $12.2B $10.4B Provider -$0.037B -$0.980 $0.094B $13.9B Public Public Health Health Total value: $78 billion $21.6B Payer Payer $13.1B Laboratory Provider Net: $34B per year Provider system maintenance cost of $10.5B not reflected in diagram

32 Achieving full value requires Percent 100 structured data 19% Capture electronically Source: Center for Information Technology Leadership, IHIE calculations % Connect & interface 76% Standardize and store data

33 CHCF Model

34 CHCF Model

35 Annual economic value ($M) Beneficiaries 1 Benefits Accrue to Stakeholders Credentialing Physicians Hospitals Eligibility checking Patients Physicians Hospitals Payors Across System LONG-TERM ECONOMIC BENEFIT TO CENTRAL INDIANA WILL EXCEED $120M ANNUALLY Public health Results delivery Research Decision support Patients Hospitals Labs Public health (1) Includes quality of care/other non-economic beneficiaries as well Source: BCG Analysis & Estimates Patients Physicians Hospitals Labs Patients Researchers Investigators Pharma companies Patients Physicians Hospitals Payors Employers Disease mgmt Patients Physicians Hospitals Public health Payors Employers

36 C!TL economic model Annual Savings Indianapolis L4 N/A Other Other Provider $14M Pharmacy -$23M $86M Radiology $166M $696M $353M Provider -$56M $281M $1M Public Public Health Health Total value: $560M $321M Payer Payer $138M Laboratory Provider Net: $244M per year

37 Acknowledgement Agency for Healthcare Research and Quality BioCrossroads Central Indiana Corporate Partnership National Cancer Institute National Library of Medicine Regenstrief Foundation

38

39 J. Marc Overhage, MD, PhD Regenstrief Institute, Inc Indiana University School of Medicine 1050 Wishard Blvd Indianapolis, IN Voice: Facsimile: Web address:

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