Community Meeting 2

1. Community Meeting 2 1 February 2012

2. Agenda

3. Service Areas for Inclusion Lyman Dennis Organizer & Facilitator

4. Approach • Looked at Dartmouth Atlas data • Uses two Medicare referral types • Major cardiovascular surgery • Neurosurgery to aggregate 3,436 hospital service areas into 306 hospital referral regions • Counties are split • Diagram: to nearest county

6. Conclusions • Sacramento is the center of a separate service area • Yolo is closely related to Sacramento for Medicare patients • Yolo is part of PHC and is involved in the Medi-Cal systems of care with the other PHC counties • Communicare uses Redwood Community Health Network in Sonoma for its eCW EHR • Recommendation • Omit Sacramento • Retain Yolo

7. Discussion

8. Health Information Exchange • What’s in it for Patients? • A Physician’s Perspective • By Dr Peter Mathews • Kaiser Permanente Napa • 02/01/12

9. Definition of Health Information Exchange • Secure, Standardized Electronic Transfer of Health Information • Among Health Care Organizations (hospitals, office, labs, pharmacies, the patient, SNF,etc) • For improving Health (Quality), improving Experience of Care, and reducing Cost

10. Key Attributes of High Performing Health Care Organizations • Organization wide focus on the needs of the patient • Strong organizational and clinical leadership • Access to info to support EFFICIENT, COORDINATED CARE • Timely access to care • Emphasis on Prevention, Wellness and Healthy behaviors

11. Enabling New Patient Centric Models of Care • Better telephone and e-visits enabled because of presence of clinical information • Teledermatology • Telemedicine • Population management • Better preventive care (paps, Mammos, etc) • Better chronic disease management (Diabetes) • Reduced rate of hospital readmission

12. Who Needs the Info • The Patient • Primary Care Physician Offices • Specialist Physician Offices • Lab, Pharmacies and Radiology • Health Plans • Long Term Care Facilities • Hospitals/Emergency Departments

13. What Information is the most Clinically Important to Exchange? • Problems • Meds • Allergies • Immunizations • Problem List • Screening • Advance Directive • Recent Discharge Summaries/H&P/Op Note

14. Scenario 1 – ED to Physician office • 60 yo man is seen at Local Emergency department with Chest Pain. Is evaluated there and discharged home. Comes to his doctors office 2 days later. Need for ED Visit record and EKG from the ED

15. Scenario 2 Doctors Office to Hospital • 88 yo lives at home with is wife. He has previous filled out an Advanced Directive stating he wishes no heroic measures. This is at his doctor’s office. He collapses at home, is found by a neighbor, and he is intubated and has a prolonged hospitalization

16. Scenario 3 Hand off Between primary care and specialty care • 45 yo female develops arthritic symptoms. Xray and blood tests for arthritis are done – patient is referred to Specialist - Results are not available. Studies are repeated. Patient was allergic to one of the drugs prescribed. Was in family doctors records but patinet forgot to tell this to the specialist.

17. Scenario 4 • 45 year old woman previous had care at the local community clinic and states she had a mammogram in the last year. It turns out it’s been 3 years. Mammogram not ordered. Patient presents with advanced breast cancer.

18. Exchanging Clinical Information • Where do we start? • What has been our experience in Kaiser Permanente?

19. What we did First • Lab • Medications • Radiology online • Soon thereafter • Allergies • Problem List

20. Next • Discharge Summaries (transcriptions) • Next we implemented an Ambulatory Electronic Health Record (Epic) • Next we implemented an Inpatient Electronic Health Record (EpicCare Inpatient)

21. And the last lap • We implemented Secure Messaging to our Members • In the last 6 months we turned on • Care Epic • The ability to View Records on Kaiser Patients from other Kaiser regions (e.g. Southern California) • We scan in Advanced Directives

22. SNAPSHOT (SUMMARY CLINICAL RECORD)

24. Allergies

25. Medications

26. Status on Preventive Tests(pap smear, mammo, colon ca screening, etc)

27. Immunizations

28. Lab results (and or trend) note prior Vital Signs (weight, bp)

29. Last Cardiac Studies (EKG as an example)

30. Advance Directive

31. Scan of Advance Directive

32. Kaiser Example of Health Information Exchange (WITHIN Kaiser regions) • CARE EPIC • Almost the entire record - but VIEW only • Following slides • How the care team pulls up the record • What the record looks like once pulled up

33. CARE EPIC (requesting a view only record from another Kaiser region)

34. Requesting Record (slide 2)

35. Viewing Record

36. Viewing Record (part 2)

37. Viewing record (part 3)

38. Exchange of Clinical Information is Important • It promotes Quality Health Care • Preventing harm to patient from adverse reactions • Preventing over utilization of narcotics • Insuring patients are up to date on preventive care and chronic disease lab monitoring

39. Reducing Cost • It prevents duplication of tests • It ensures good communication and coordination of care among different members of the health care team • It enables new models of care • Teledmedicine, population management,

40. Begin at the Beginning • Meds • Labs • Pharmacy • Problem List • Allergies • Then Transcriptions/ ED visits/Discharge summaries - the journey begins!

41. Discussion

42. Vision Statements H. Martin Malin, PhD, MA, MFT Interim Mental Health Services Act Coordinator Solano County Health and Social Services Tim Wilson, PhD Epidemiologist Yolo County Health Department

43. To Improve Individual Health Outcomes in the NE Bay Area • Support continuity of care • Promote appropriate clinical decision making at the point of service • Make information available and useful • Improve patient safety • Improve and enhance the patient/clinician experience • Support achievement of systematic goals such as • Clinical analytics, • Population health management & • Implementation of best practices

44. Reduce adverse outcomes and costs associated with • Treatment decisions made based on incomplete or patient-recall data when better data is available • Lack of patient engagement in their own healthcare due to lack of understanding of key health drivers and test trends

45. Provide connector technology that • Reliably exchanges • Physical health • Mental health and • Alcohol and substance use information among providers • Rapidly provides requested data • Anticipates connection with other HIEs regionally and nationally

46. Discussion

47. What do we wantthe group to accomplish? Lyman Dennis Organizer & Facilitator

48. Why HIE?Rationalize medical care • Allow continuity of care across providers • Provide more (all) clinical data at point of care • Support evidence-based medicine by allowing review of more (all) information about each case • Reduce duplicate analytical studies • Support ACO reimbursement incentives

49. Options for the Community Group • Do nothing. Disband. • Set up a full HIE organization and business. • Set up an organization to contract for HIE services. • Set up a collaborative to coordinate the contracting for services.

50. 1. Do nothing. • HIE will develop chaotically and without plan for integration. • Analogous to unplanned ER services. Competition for victims or no ambulance when needed. • Likely to be • More expensive • Contain gaps • Have unlinked HIE service silos