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San Diego Beacon Community

San Diego Beacon Community. Ted Chan, MD Anupam Goel, MD Principal Investigators. Overview. National perspective ONC, ARRA & HITECH Act Beacon Communities Program Local perspective San Diego Beacon Community Beacon and the Right Care Initiative. 2. ARRA HITECH Priority Grant Programs.

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San Diego Beacon Community

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  1. San Diego Beacon Community Ted Chan, MD Anupam Goel, MD Principal Investigators

  2. Overview • National perspective • ONC, ARRA & HITECH Act • Beacon Communities Program • Local perspective • San Diego Beacon Community • Beacon and the Right Care Initiative 2

  3. ARRA HITECH Priority Grant Programs • Medicare and Medicaid Meaningful Use Incentive Payments • Health IT Regional Extension Center Program • Grants to states and state-designated entities for Health Information Exchange (HIE) • Beacon Community Program • $250m in funding to strengthen the health IT infrastructure and health information exchange • Pilot communities to health IT to make marked & sustainable improvements in health care quality, safety, and efficiency 3

  4. Beacon Community Program “These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records.” Vice President Joseph Biden, May 2010 White House Announcement of Beacon Community Awardees

  5. Local Perspective: San Diego Beacon Community

  6. San Diego Beacon Community • Build Regional HIE Infrastructure • Target Improvements in Specific Clinical Outcomes • Integrate Health IT into Care Delivery 7

  7. San Diego Beacon Community • Build Regional HIE Infrastructure • Benefits of community exchange • Challenges and obstacles • Proposed structure and plan • Target Improvements in Specific Clinical Outcomes • Integrate Health IT into Care Delivery 8

  8. Health Information Exchange • Improve ability to integrate data across EHR platforms • Ability to view clinical information from other providers and health systems • Access to and sharing patient data improves healthcare quality and reduces errors • Enhances clinical decision making to change health care outcomes • Achieve cost-efficient care by reducing redundant imaging, ED visits, re-admissions

  9. Health Information Exchange • Clinical data for patients who obtain care at multiple institutions (e.g., DOD, VA, CMS patients) • Aggregate information across San Diego for population and public health initiatives • Immunizations • Other public health initiatives • Assist providers, medical groups and centers • Achieve Meaningful Use and other Federal incentive/requirement programs • Better position for other future potential healthcare reforms (Primary Care Medical Home, Accountable Care Organizations, etc.)

  10. HIE Challenges & Obstacles • Technical • Diverse EHR systems, capabilities amongst providers • Agreement on standards, security, architecture • Non-Technical • Highly competitive provider organizations • Coordination of data sharing • Agreement on operational policies (e.g., consent, governance, liability)

  11. Precedents for sharing data in San Diego • SD VA-Kaiser Pilot Program • National Health Information Network (NHIN) protocol with a subset of patients • Data elements include patient demographics, treating provider, problem list, medications/allergies, immunizations • Other local efforts • San Diego Immunization Registry • ED-Community Clinic linkages • CDC Biosense 12

  12. SD Beacon Approach • Local Agreement on HIE Architecture • Working Groups • Technical, Clinical and Privacy Working Groups • Representatives include UCSD, VA, Navy, Scripps Health System, Sharp Health System, Palomar-Pomerado Health System, City EMS, County Human and Health Services Agency, Council of Community Clinics, others • Coordination with State and Federal Organizations • Cal eConnect, CalOHI, HRSA/ONC

  13. Proposed HIE Infrastructure • Hybrid Federated Model • NHIN-compliant (VA, DOD) • SD Beacon Hub to allow greater flexibility for providers, and more utility with links to SD City EMS, County PH, SDIR • Compliance with state and national standards • Consolidated view of patient’s care • Web portal for those providers without an electronic medical record • Can also be embedded with electronic medical records • No Clinical Data Repository 14

  14. State/Local Government Community B NHIN VA/DOD County PH San Diego Beacon CDC Community A SD VA/DOD EMS Clinics

  15. San Diego Beacon Community • Build Regional HIE Infrastructure • Target Improvements in Specific Clinical Outcomes • Quality goals • Population health goals • Cost-efficiency goals • Integrate Health IT into Care Delivery 16

  16. Specific Outcome Targets • Quality: Cardiovascular & Cerebrovascular disease • Prevention: Risk factor control with statin and ACE-inhibitor use among high-risk patients • Acute care: EKG transmission from EMS to STEMI-receiving centers, reduce field-to-balloon times • Chronic care: Improve care transitions to reduce 30 day re-admissions • Population Health • Immunization rates for children & at-risk adults • Syndromic surveillance • Cost Efficiency • Reduce repeat ED visits and hospital admissions • Reduce repeat imaging tests 17

  17. San Diego Beacon Community • Build Regional HIE Infrastructure • Target Improvements in Specific Clinical Outcomes • Integrate Health IT into Care Delivery • Coordinate clinical efforts • Evaluate success in achieving clinical targets 18

  18. Health IT & Care Delivery • Examples from SD Beacon partners • UCSD/Rady’s coordinating CDS prompts for influenza vaccination in children • NMCSD primary care home audit/feedback for lipid, BP screening and management • UCSD CDS for lipid screening and management • Resources available for other initiatives • HIE-related Initiatives • Discharge planning and notification to primary care • Tracking immunization rates with SDIR connectivity • Ordering fewer imaging tests with data exchange

  19. Beacon Resources & RCI Opportunities: Data Reporting • Medical Groups • Routine data reporting to state agencies and plans, instead of auditor-approved transaction (fewer costs) • More frequent performance evaluation, audit/feedback with peer comparisons • Health Plans • Facilitate quality measure data reporting and evaluation • Consider altering payment structure to allow for payment based on all tracked patients instead of just the managed care population

  20. Opportunity for San Diego • One of only 17 communities chosen to lead HIT innovation in the nation • Funding to build and expand regional HIT infrastructure over next three years • Benefits • Patient care with more complete information • Meet Meaningful Use criteria and other reform efforts • Payors (e.g., Medicare, MediCal) may require HIE participation in the future • Framework to deliver interventions to improve the community’s health

  21. Questions?

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