Next Steps in Healthcare Beyond EHR/HIE

Brian Yeaman MD

CMIO NRHS

Medical Informatics Officer NPHO

Healthcare Reform

• An emphasis has been placed on technology to accomplish:– Reduced Adverse Events– Reduced Duplication of Testing– Improved Disease Management– Improved Transitions of Care– Improved Patient Safety– Improved Transparency in Cost and Coverage

Healthcare Reform

• Stimulus funding has been provided to hospitals and providers to – Adopt EHR’s– Engage HIE– Meet the Meaningful Use Criteria

Meaningful Use

• Can we really meet the goals of 2011 and 2012?

• Where do we go after 2011 and 2012?

• Seed money provided to answer those questions. Enter the….

Beacon Funding Opportunity

Beacon Funding Opportunity

Beacon Funding Opportunity

• $220 million dollars via ARRA at the discretion of the ONC

• 15 communities nation wide

• Up to 20 Million per community

• Advanced communities ready to incorporate HIT to advance community-level care coordination and quality monitoring and feedback

Baseline Adoption

• Geographical Area– Zip Code/County Lines/Referral Areas

(Dartmouth Atlas)

• EHR Adoption– Urban 30% of all healthcare providers– Rural 25%

• Some form of HIE adoption

• e-prescribing

Baseline Adoption

• Collaboration– SHIECAP (State HIE)– REC (Regional Extension Centers)– State Agency (Health Department)– Universities– Public Health– Research– Payers– Employers– Hospitals– Foundations– Free Care– Tribal Health– VA

Beacon Funding Opportunity

• Abstract• Full Narrative• Study Initiatives and Metrics• Budgets• Timelines• Key Stakeholders• Letters of Support• Sustainability Models

Baseline Funding Opportunity

Did I mention from the time of the FOA release to final grant proposal submission there were

only…

6 Weeks?

Norman’s Baseline

• 2006 began a community EHR selection process for inpatient and outpatient

• NPHO led clinical integration model• Shared resources, group contracts, local

support and experts to reduce expense• 2007 hospital and first practice kick off

new systems• 2010 nearly 100 providers live in

ambulatory EHRs and 2 live HIEs

Community Health Record

• Benefits– Reproducible EHR model– More accurate problem and medical lists– Reduction in adverse medication reactions– More accurate drug allergy lists– Less duplication of testing– Capability to interact with personal health

records– ED, Intensivists, Hospitalists, EMS web views

NPHO Clinical Integration

• Big Picture Early Wins for Physician’s– Local Adoption of EHR’s– Assist Physicians in preparation for P4P– E-prescribing Initiatives 2% Medicare Bonus– PQRI 2% Medicare Bonus– Preparation for “Meaningful Use” and ARRA

payments via the government

Local Model

Physician Portalhttps connectivity

HIE ServerContains Lab, DI, ICD, CPT, Rx compendiums

Primary Care PhysicianUsing EHR application

Cardiologist or other Using EHR application

Nephrologist or otherWITHOUT EHR application

Administrative Portalhttps connectivityRegisters new users, sets security

Local HIE

• Locally named OPHX (Oklahoma Physician Health eXchange)

• Quality Officer

• Centralized Quality and Performance Reporting

• Potential for Chronic Disease Management

Hospital Data

• Large volumes

• Low Hanging Fruit:– Labs– Vitals – ICD9’s– Encounter History– Reports and Dictation Next Step

Oklahoma City HIE

• Desire for a Network

• Modeled after NE Oklahoma Network entitled SMRTNET

• Low Cost, High Adoption Rate

• Begin With Hospital Data and Grow Connections to Other Data Streams

• Live October of 2008 SMRTNET

Participating Hospitals in theOklahoma City Metro

• OU Medical Center• St Anthony’s• INTEGRIS Canadian• Norman Regional• Edmond Medical

Center• INTEGRIS Baptist

• Moore Health Center• INTEGRIS Southwest• Midwest Regional• Mercy Health Center• Oklahoma Heart

Hospital

eHX (NPHO)

SMRTNET

NEO, Metro, Tulsa Hospitals / CHCs / HAU Free Clinics

NRHS

eClinicalWorks(Dr. Local EHR)

DynamedDynamed(EBM content)

Citrix / VPN Problematic

Transactional HUB

(Consults, Lab, Radiology)(In Development)

Internet / Free +eHX

$25

$20

$45 for Physician Practices to connect to local network and SMRTNET. This cost could be Subsidized $10 by PHO or Hospital;

1 connection to doc EHR to view inpatient, ED results, Metro information, Surescripts, immunizations, pharmacy history and EBM

Surescripts (Pharmacy)

OSIIS(Immunizations)

HIE Norman to OKC to Statewide Adoption

(RHIO -> Local Networks/Hospitals -> Community Providers)

PSRS(Preventative Care Registry)

(Proposed Connection)

Geographical Area

• Cleveland, McClain and Garvin Counties• 266 healthcare providers, including all

MDs, DOs, NPs and PAs • 75%, are fully utilizing EHRs and have live

HIE functionality • 52% of all ambulatory providers have fully

implemented EHRs • 57% of primary care physician fully utilize

EHRs

Key Stakeholders• NRHS• NRHS Foundation• NPHO• SMRTNET• OU College of Medicine• OU College of Public Health• OU Physicians• OFMQ• OKPRN (REC)• 30 additional supporters level 2-4 including state agency,

the temporary state HIT Coordinator, governor, payers, VA, tribal health, all hospitals in the geographical area and state US congress representatives.

Project Goals

• Reinforce the model that healthcare is local• Create a robust PHR interfaced to local HIE• Strengthen HIE connections• Incentivize patients to use PHR’s through

education, social networking, points and rewards for daily healthcare involvement

• Improve clinical decision support for providers• Create workflows that make sense

Project Goals

• Create interfaces for home devices that input vitals into the PHR to the HIE and are viewable in the EHR for the provider

• Enhance or replace current efforts with an improved model of payers and employers plans to keep patients healthy and educated. “Well at Work” programs and disease management programs etc.

Measurables • EHR Installation For Free Clinics• Rural Hospital HIE Connectivity• Tribal Services • HIE Connection• Rural Clinic EHR Adoption• VLER Potential HIE Connection• Enhanced CCD • CapabilityOpen Source PHR with HRASocial Networking Surround• Points Store For Health Related Purchases• Lower Aggregate Health Care Costs• Lower Hospital Readmissions • Lower Unnecessary ED Visits• Lower Unnecessary Hospitalizations

Measurables• Quality of Life Assessment CAHPSHRA and Calculated Health Age• Lifestyle Decision Support for Patients• CHF Management, DM Management, andCOPD Management • Smoking Cessation• Alcohol Usage• Health Age• Pneumovax Influenza Mammogram PSA Lipid Panels Compliance• Interface Sharing • Knowledge Base Sharing• Report Exchange within HIE • Condition Surveillance

Move over Batman

EHR/HIE Finish Line

• Create patient accountability in their care and a viable medical home model

• Disease management and public health initiatives

• Health as a daily function of our lives

• Tear down the walls that create transitions of care

• Reduce overall healthcare expenditures