A San Diego Health Information Exchange

1. A San Diego Health Information Exchange Jami Young, MPA San Diego Beacon Project Manager San Diego Health Care Association April 26th, 2012

2. Office of the National Coordinator for Health Information Technology (IT) Health Information Technology Extension Program (Meaningful Use adoption) Strategic Health IT Advanced Research Projects (SHARP) Program State Health Information Exchange Cooperative Agreement Program Education programs (curricula development at community colleges and universities) Beacon Community Program

3. Beacon community program priorities • I. Health IT and Exchange Infrastructure • II. Integration of Health IT into Care Delivery • Instituting clinically relevant decision supports • Improving medication management • Improving care coordination • Engaging patients and families • III. Evaluation, Monitoring and Feedback • Establishing systems for measurement and feedback of health systems quality, safety, and costs relevant to project goals

4. 17 Beacon communities

5. http://sandiegobeacon.org

6. San Diego-specific components Reduce hospital readmissions by sharing patient health information (health information exchange) Reduce STEMI field-to-intervention time Increase childhood immunizations via texting Transmit cardiac device information through a single interface Reduce repeat radiology use

7. Exchange architectural model Hospital Master Patient Index Facility A Point Click Care Facility B ResCare

8. Exchange Architectural Model Master Patient Index (AG|A=AG|B) Facility A (clinical data) Facility B (clinical data) AG AG

9. Master patient index • Demographic information • Highly depending on the data collected by partner organizations • Inappropriate matching and lack of appropriate matching are both bad

10. Exchange Architectural Model Master Patient Index User Directory Facility A (clinical data) Facility B (clinical data)

11. User directory • Who can access the information? • Front desk • Nurses • Providers • Authentication • Expiration and renewal

12. Exchange Architectural Model Master Patient Index User Directory Consent and Auditing Facility A (clinical data) Facility B (clinical data)

13. Consent and auditing • All-or-none • Consent types • Changing consent status • Determining if a privacy breach occurred

14. Exchange Architectural Model Immunization Registry Public Health Reporting Master Patient Index User Directory Consent and Auditing Facility A (clinical data) Facility B (clinical data)

15. Value case for Skilled Nursing Facilities • Access to recent patient health information from other care settings-

16. Data types shared • ADT information • Problems • Medications and allergies • Lab results • Radiology reports • Immunizations • Clinical documents (e.g., discharge summaries)

17. Value case for Skilled Nursing Facilities • Access to more patient health information • Notification about care transitions-

18. Outside the exchange • Use ADT messages to determine if a patient has been admitted or discharged from a facility • Notify other members of the care team about the care transition using secure email (DIRECT)

19. Value Case for Skilled Nursing Facilities • to ensure care continuity especially in regards to e-prescribing • Promote person centered care and culture change initiatives • Prevent medical errors and diagnostic testing redundancy

20. Next steps • Connecting medical centers, medical groups and skilled nursing facilities to the Exchange • Using messaging to notify providers about patients undergoing care transitions • Establishing an independent governance structure and sustainability model • Expanding HIE network to encompass all care providers in region

21. Questions?