Creating Health Information Exchanges: The Indiana Network for Patient Care
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Transcript of Creating Health Information Exchanges: The Indiana Network for Patient Care
Creating Health Information Creating Health Information Exchanges: Exchanges:
The Indiana Network for The Indiana Network for Patient CarePatient Care
Shaun Grannis, MD, MS Shaun Grannis, MD, MS
Research ScientistResearch Scientist
Regenstrief Institute / IU School of MedicineRegenstrief Institute / IU School of Medicine
Silos of InformationSilos of Information
Electronic Electronic Medical Record Medical Record
SystemSystem
Jane Receives Jane Receives Immunizations @ Health Immunizations @ Health
DepartmentDepartment
Data delivered Data delivered to to
immunization immunization registryregistry
Jane Receives Jane Receives Immunizations and other Immunizations and other
care (measurements, care (measurements, labs, diagnoses, etc) @ labs, diagnoses, etc) @
Clinical PracticeClinical Practice
Data delivered Data delivered to EMRto EMR
ImmunizatioImmunization Registryn Registry
Silos of InformationSilos of Information
ImmunizatioImmunization Registryn Registry
Electronic Electronic Medical Record Medical Record
SystemSystem
Registry Registry Web Web
InterfaceInterface
EMR EMR InterfaceInterface
??????????????????????
INPC - Humble Beginnings INPC - Humble Beginnings
Regenstrief tasked in 1972 to Regenstrief tasked in 1972 to “stitch” these silos of information “stitch” these silos of information together -> the Regenstrief Medical together -> the Regenstrief Medical Record System (RMRS/Wishard) Record System (RMRS/Wishard)
In 1994, began stitching together In 1994, began stitching together information across institutions information across institutions (INPC/Indianapolis)(INPC/Indianapolis)
In 2003, working towards stitching In 2003, working towards stitching the state together (INPC/Indiana)the state together (INPC/Indiana)
Consolidating the SilosConsolidating the Silos
ImmunizatioImmunization Registryn Registry
Electronic Electronic Medical Record Medical Record
SystemSystem
Patient ID: 123LMNOPPatient ID: 123LMNOPName: Jane Doe Name: Jane Doe DOB: 01/01/04DOB: 01/01/04SSN: N/A SSN: N/A Address: 555 Johnson RoadAddress: 555 Johnson RoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202
Patient ID: 6789XYZPatient ID: 6789XYZName: Jane Ellen DoeName: Jane Ellen DoeDOB: 01/01/04DOB: 01/01/04SSN:123-45-6789SSN:123-45-6789Address: 555 Johnson Address: 555 Johnson RoadRoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202
Global Global Patient Patient IndexIndex
Concept Concept DictionaryDictionary
Global ID:Global ID: 4567845678Name: Name: Jane Ellen Doe Jane Ellen Doe Lots of Demographics..Lots of Demographics..MRF1 ID: MRF1 ID: OU81247OU81247MRF2 ID: MRF2 ID: 45643564564356PH MRF ID: PH MRF ID: 123LMNOP123LMNOPMRF3 ID:MRF3 ID: 6789XYZ6789XYZ
DTaP Dose Count:DTaP Dose Count: 30936-930936-9HIB Dose Count:HIB Dose Count: 30938-530938-5IPV Dose Count:IPV Dose Count: 33555-433555-4VZV Dose Count:VZV Dose Count: 30943-530943-5MMR Dose Count:MMR Dose Count: 30940-130940-1HepB Dose Count:HepB Dose Count: 30937-730937-7
Jane Doe’s Immunizations:Jane Doe’s Immunizations:
3/1/043/1/04 DipTetaPurDipTetaPur3/1/043/1/04 HemInfBHemInfB3/1/043/1/04 PolioVirPolioVir3/1/043/1/04 HepaBHepaB
Jane Ellen Doe’s Shots:Jane Ellen Doe’s Shots:
5/1/045/1/04 DTaP ImmDTaP Imm5/1/045/1/04 HIB ImmHIB Imm5/1/045/1/04 IPV ImmIPV Imm7/9/047/9/04 DTaP ImmDTaP Imm7/9/047/9/04 IPV ImmIPV Imm
30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30937-30937-77
30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30936-30936-9 9 33555-33555-44
Consolidating the SilosConsolidating the Silos
ImmunizatioImmunization Registryn Registry
Electronic Electronic Medical Record Medical Record
SystemSystem
Global Global Patient Patient IndexIndex
Concept Concept DictionaryDictionary
St. St. Vincent Vincent
MRFMRF
Clarian Clarian MRFMRF
Wishard Wishard MRFMRF
Community MRFCommunity MRF
Public Public Health MRFHealth MRF
Global Global Patient Patient IndexIndex
IUMG MRFIUMG MRF
Concept Concept DictionaryDictionary
The Indiana Network for Patient The Indiana Network for Patient CareCare
INPC System DesignINPC System Design Separate medical record vault per Separate medical record vault per
institutioninstitution Each vault in separate physical files, Each vault in separate physical files,
but centrally locatedbut centrally located Standardized data structure – All use Standardized data structure – All use
same software and observation codes same software and observation codes Patient demographics linking via Patient demographics linking via
global registryglobal registry Combine on the fly when neededCombine on the fly when needed
INPC – Participants INPC – Participants Includes 17 hospitals from the 5 major Includes 17 hospitals from the 5 major
Indianapolis hospital systems (95% of non-office Indianapolis hospital systems (95% of non-office care)care)
National and regional laboratoriesNational and regional laboratories Includes county and state public health Includes county and state public health
departmentsdepartments 35% of outpatient practices35% of outpatient practices Both major cardiologyBoth major cardiology
referral centersreferral centers Four homeless care centersFour homeless care centers
INPC hospital participantsINPC hospital participants
Health DepartmentPractice/ClinicHospital
LabCorpLabCorp
QuestQuest
MCHDMCHD
Rx dataRx data
In p
rog
ress
Heart Center of Indiana
The Indiana Heart Hospital
A “Big” Repository by US A “Big” Repository by US StandardsStandards
In the system:In the system:- 1.3 million patients, 5 million 1.3 million patients, 5 million
registration “events”registration “events”- 24 million orders24 million orders- 660 million coded results660 million coded results- 12 million dictated reports12 million dictated reports- 8.8 million radiology reports8.8 million radiology reports- 25 million prescriptions25 million prescriptions- 480,000 EKG tracings480,000 EKG tracings- 45 million radiology images45 million radiology images
Added Per Year:Added Per Year:- 600,000 ambulatory encounters600,000 ambulatory encounters- 50,000 inpatient encounters50,000 inpatient encounters
Docs4Docs - Links to office Docs4Docs - Links to office practicespractices
Results delivery service (Docs4Docs)Results delivery service (Docs4Docs) Results flow through INPC central to Results flow through INPC central to
Docs4Docs and are routed to MD in-Docs4Docs and are routed to MD in-boxesboxes
All hospitals send reports through same All hospitals send reports through same mechanismmechanism
Improved office efficiency and Improved office efficiency and convenienceconvenience
Eliminates mail and (almost) fax costsEliminates mail and (almost) fax costs
Current status Current status 280 practices from 3 Hospital systems 280 practices from 3 Hospital systems
(about 1800 MDs)(about 1800 MDs) Indiana Health Information Exchange Indiana Health Information Exchange
(IHIE) is Regenstrief’s corporate partner(IHIE) is Regenstrief’s corporate partner Scheduled for whole city by end of 2005 Scheduled for whole city by end of 2005
through IHIEthrough IHIE Uses same data streams as structured Uses same data streams as structured
EMR – but simpler structure EMR – but simpler structure Will provide links to all MDs for other Will provide links to all MDs for other
purposespurposes
Founding MembersFounding Members Hospital systemsHospital systems
- Clarian Health PartnersClarian Health Partners- St. Francis Hospitals and Health SystemSt. Francis Hospitals and Health System- St. Vincent Health CareSt. Vincent Health Care- Wishard Health ServicesWishard Health Services- Community Hospitals of IndianaCommunity Hospitals of Indiana
GovernmentGovernment- City of IndianapolisCity of Indianapolis
Public HealthPublic Health- State Department of HealthState Department of Health- Marion County Health DepartmentMarion County Health Department
ResearchResearch- IU School of MedicineIU School of Medicine- Regenstrief InstituteRegenstrief Institute
Medical societiesMedical societies- Indianapolis Medical SocietyIndianapolis Medical Society- Indiana State Medical AssociationIndiana State Medical Association
Economic developmentEconomic development- BioCrossroads / Central IndianaBioCrossroads / Central Indiana
Corporate PartnershipCorporate Partnership
0
20
40
60
80
100
120
140
Credentialing Eligibilitychecking
Public health Results delivery Research Decisionsupport
Disease mgmt
Benefits Accrue to Benefits Accrue to Stakeholders Across SystemStakeholders Across SystemAnnual
economicvalue ($M)
•Patients•Physicians•Hospitals•Labs
•Physicians•Hospitals
•Patients•Physicians•Hospitals•Payors
•Patients•Physicians•Hospitals•Payors•Employers
•Patients•Physicians•Hospitals•Public health
•Payors•Employers
Beneficiaries1 •Patients•Hospitals•Labs•Public health
•Patients•Researchers• Investigators•Pharma companies
(1) Includes quality of care/other non-economic beneficiaries as wellSource: BCG Analysis & Estimates
LONG-TERM ECONOMIC BENEFITTO CENTRAL INDIANA
WILL EXCEED $120M ANNUALLY
LONG-TERM ECONOMIC BENEFITTO CENTRAL INDIANA
WILL EXCEED $120M ANNUALLY
Achieving full value requires Achieving full value requires structured datastructured data
Percent
Capture electronically
Connect & interface
Standardize and store data
0
10
20
30
40
50
60
70
80
90
100
76%
5%
19%
C!TL, BCG calculations
Questions / DiscussionQuestions / Discussion
Shaun Grannis, MD, MS Shaun Grannis, MD, MS Research ScientistResearch Scientist
Regenstrief Institute / IU School of MedicineRegenstrief Institute / IU School of [email protected]@regenstrief.org