RHIOs: CHINs or Champs?RHIOs: CHINs or Champs?

Health TechNetHealth TechNet

Robert Steffel, Executive DirectorHealthBridge

rsteffel@healthbridge.org

October 21, 2005

22

Greater Cincinnati Greater Cincinnati DemographicsDemographics

• 2.2 million population2.2 million population

• 14 county tri-state area (OH, KY, IN)14 county tri-state area (OH, KY, IN)

• 25 hospitals / $4 billion annual expenses25 hospitals / $4 billion annual expenses

• 3 dominate private health plans3 dominate private health plans

• Approximately 4,000 active physicians Approximately 4,000 active physicians

• Engaged employers / Low Engaged employers / Low reimbursementreimbursement

• History of collaborative activitiesHistory of collaborative activities

33

HealthBridge TimelineHealthBridge Timeline

• 1997: Funded by 5 Health Systems & 2 1997: Funded by 5 Health Systems & 2 Insurers Insurers – Began service as a community-wide MD portalBegan service as a community-wide MD portal– A true multi-stakeholder collaborativeA true multi-stakeholder collaborative

• 2000: Purchased Axolotl Clinical Messaging2000: Purchased Axolotl Clinical Messaging– Community license funded by “content providers”Community license funded by “content providers”

• 2003: Public health/physician alerts added2003: Public health/physician alerts added

• 2004: Syndromic Surveillance added2004: Syndromic Surveillance added

• 2005: Ambulatory Order Entry (In Process)2005: Ambulatory Order Entry (In Process)

44

The HealthBridge Portal Homepage

55

HealthBridge Clinical Messaging System Overview

Fax ElectronicMail MD EMRs

Clinical Messaging

Servers

HealthBridge Clinical Messaging System Overview

Mercy HealthPartners Health AllianceTriHealth

St. ElizabethCincinnatiChildren’s

Health Systems – 17 HospitalsLab Results, Radiology Reports, Transcribed Reports, ADT

Transactions

Physician Access to Clinical Results

-Data Feeds (HL-7)-MD Directory-Patient Index

-HIPAA Access Audit

Syndromic Surveillance

RODS Lab

LabOne

MD Dictation

AncillaryData Feeds

Community

Standards

Public Health

Health Alerts

Awaiting Action InboxAwaiting Action Inbox

Clinical Messaging Electronic “Inbox”HealthBridge Clinical “Inbox”

Note lab, radiology & transcribed reports

from several hospitals for a two physician

office

Inbox by Abnormal ViewInbox by Abnormal View

HealthBridge Clinical “Inbox”

Results sorted by

abnormal lab values

Community Standard CBC Result

Sample of a Clinical Messaging CBC ResultCommunity Standard CBC Result

Final View = “EMR Light”Final View = “EMR Light”

Final View- Used To Access All Electronic Results for a Practice

1010

Community Patient IndexCommunity Patient Index

1111

Public Health Alert Public Health Alert

1212

Sept 2005 – Results SentSept 2005 – Results Sent

Typical Physician Office (before HealthBridge)

Physician Office

With electronic “inbox”

Paper to ElectronicPaper to Electronic

1414

Results Per EnvelopeResults Per Envelope

Before & After Daily PrintingBefore & After Daily Printing

GSH & NorthMedical Records

prints at GSH

North RadiologyResults

GSH & North Labresults print at

GSH

North CardiologyResults

Results ofDictation/ Test

Prints in MedicalRecords

continuously

Departmenthighlights

physician name onresults

Multiple pagesstapled together

Mailroom picks upevery one hour

Each pile sortedinto mail bins of

specific letter

Stacks resortedwithin each letter

alphabetically

Current Process for Mailing Dictation/ Test ResultsMonday through Friday

Results ofDictation/ Test

Prints indepartmentcontinuously

Departmenthighlights

physician name onresults

Multiple pagesstapled togetherby department

Volunteer sortsalphabetically

Volunteer printsoff labels

Volunteer folds &stuffs envielopes

Labels placed onenvelopes

Reports picked upby mailroom 2x/

day

Mailroom prints offlabels for each

report

Reports folded,stuffed in

envelopes &labeled

Results printed indepartment

Departmentmatches all

reports for eachtest, if applicable

Multiple pagesstapled together

Departmenthighlights

physician name

Mailroom picks upreports 3-4x/day

Mail sorted byweight

Mail sent topresort

End

GSH Cardiology &Radiology

Results ofDictation/ Test

Prints indepartmentscontinuously

Departmenthighlights

physician name onresults

Multiple pagesstapled together

Mailroom picks up2x/day

Mailroom datestamps reports

Medicenter North

Reports sortedroughly into

several piles byalphabet

Start

At 3PM?? Dictation/ testresults automatically print off

in mailroom sortedalphabetically

Mailroom pulls pulls offreports by grouping and

places in envelopes with clearlabels for addresses & sorts

by weight

Mailed to be weightedmoved to next room,

weighted and metered

Picked up by presort at4:30 pm

End

Conversion of Dictation/Test Results to Clinical MessagingProposed May 2002

Before After

Problems, Choices & Problems, Choices & Lessons LearnedLessons Learned

1717

Key Issues We Had To Key Issues We Had To AddressAddress

Respond to pressure to start a CHINRespond to pressure to start a CHIN

Fund and form a collaborative networkFund and form a collaborative network

Offer content/services that deliver valueOffer content/services that deliver value

Build trust, collaboration & utilizationBuild trust, collaboration & utilization

Show value of stakeholder participationShow value of stakeholder participation