From Electronic Medical Records to the Florida Health Information Network

1. From Electronic Medical Records to the Florida Health Information Network The First Central Florida Electronic Medical Records Conference Saturday, October 20, 2007

2. The Florida Health Information Network • The statewide Florida Health Information Network (FHIN) is being built from the local community up. • The FHIN is a collaboration of Regional Health Information Networks (RHIOs) in Florida. • Each RHIO is responsible for developing a health information exchange and working with local providers to accept the exchange of medical records through the RHIO portal.

3. The FHIN Begins at the Local Level • AHCA’s strategic plan for the adoption of EMRs is to empower local stakeholder collaborations focused on health information exchange. • The driver of this plan is the FHIN Grants Program for RHIOs to build health information exchanges. • AHCA Legislative Goal: Fund the FHIN Grants Program for $6.8 million in 2008-2009 to leverage ongoing RHIO development.

4. What is a RHIO?

5. FHIN Grants Program, 2007-2008

6. Projected 2007-2008 Operational Metrics

7. Why Connect to a RHIO? • The nature of modern health care requires the involvement of multiple medical providers to effectively diagnose and treat many of the medical conditions affecting individuals. • Effective coordination is largely dependent upon the communication of information between providers about a patient’s medical condition but the mechanisms used to exchange patient data depend on the transmission of facsimile copies of records.

8. Why Connect to a RHIO? • “Better coordination between referring physicians and specialists increases physician satisfaction with specialty care and enhances referral completion.” • Christopher B. Forrest, MD, PhD, et al. (2000) Coordination of Specialty Referrals and Physician Satisfaction With Referral Care. Archives of Pediatric Adolescent Medicine. • “68% of specialists report that they received no information from the primary care physician prior to specific referral visits.” • “Four weeks after specific referral visits, 25% of PCPs had still not received any information from specialists.” • Tejal K. Gandhi, et.al. (2000). Communication Breakdown in the Outpatient Referral Process. Journal of General Internal Medicine, Volume 15, Number 9, September.

9. Why Connect to a RHIO? • The RHIOs provide a secure, real-time exchange of medical records that guarantees the efficient delivery of patient data to the authorized physician. • The following examples will demonstrate how two Florida RHIOs are implementing health information exchange

10. Partners Public Funders Free Clinics Private Funders Health Dept. Social Services Hospitals PBC Community Health Alliance (An Alliance of Funders and Providers Serving Health Care Consumers) Collaborative Projects Care Expansion Language Access Project Access Shared EHR Common Eligibility Palm Beach County Community Health Alliance (PBCCHA)

11. Western Palm Beach County Health Information Infrastructure Operations and Evaluation Project The Glades Community • 28% uninsured rate • Glades General Hospital is only Acute Care facility • 17,753 ER visits; 1,900 Medicaid discharges in 2002 • Prevent duplication between hospital and clinics

12. AllCare Participants 2007 – 2008 • 3 Dept of Health Clinics Bethesda Hospital • Boca Raton Community Hospital • Delray MC • Good Samaritan MC • Jupiter MC • Palm Beach Gardens MC • St. Mary’s Hospital • Wellington Regional • West Boca MC 2006 – 2007 • Glades General • FAU Wellness Centers • Caridad Clinic • Samaritan Gardens • Carelink Clinic • Project Access End of June 2007 • Columbia MC • JFK MC • Palms West MC

13. AllCare Shared Health Record • County wide shared electronic health record for uninsured and Medicaid patients with health data from all existing safety net providers. • Results: • Access to longitudinal patient records • Improved clinical care, • Reduction of duplicate tests/procedures, • Reduction of errors, and • Valuable source of aggregate data for planning and evaluation.

14. PBCCHA All-Care Shared Health Record • Real-time electronic interface to existing data systems used by hospitals, clinics, and other safety net providers. • Shared summary records created for all uninsured/ Medicaid/other patients. • No duplicate data entry. • Free clinics, Federally Qualified Health Centers, PBCMS Project Access and key competitor safety net hospitals are participating. • Viewable via the Web - after patients have signed authorizations.

15. All-Care Clinical Data List • Date of Visit and Encounter Type • Clinic and Provider Names • Diagnosis and CPT codes • (Hospital) Discharge code • Prescribed and Filled drugs • Lab results • Radiology Results

16. All-Care Login Page

17. All-Care Patient Locator

18. All-Care Patient Demographics

19. All-Care Patient Encounter Page

20. All-Care Medication History Page

21. Big Bend RHIO

22. Big Bend RHIO RHIN Architecture pMAN Connectivity – Dedicated fiber-based Private Medical Area Network & VPN gateway VPN Small organizations can connect either directly to the RHIN or through a VPN gateway Organizations can connect bi-directly to feed their data and receive data directly into their EMR In the early Phases CHP, CRMC & TMH will provide a one way feed of their data. They have the largest repositories and the priority is to make their data available ASAP

23. Current RHIN Services Core RHIN Platform • Data Sharing – Patient demographic and clinical data feeds. • RHIN Web Portal – Secure web interface for clinicians. • User Access & Audit Control – Detailed audit logs across the entire system. • Disaster Recovery& Business Continuity RHIN Applications • e-Prescribing • Document Imaging • Patient Portal – Web interface for electronic patient registration form and Personal Health Record (PHR).

24. Health Information Exchange Services • Big Bend RHIO will establish a community repository for the storage and retrieval of: • Demographic/encounter data • Medication claims data and e-prescribing • Document viewer including lab/radiology • Secure messaging • Disaster recovery • Remote data backup outside service area

25. Production - RHIN Platform RHIN Web Portal patient search Secure Internet Access Clinical data display including: labs, radiology reports, allergies, problems, providers, and medication history

26. Production - RHIN Apps Patient Portal (PHR) eRx Document Imaging

27. Long Term Plan for Sharing Electronic Health Records • Continue the FHIN Grants Program • Sustainability of RHIOs • Health Information Technology Committee • Health Information Security and Privacy Collaboration • Create Pilot Projects for Adoption of EMRs • Create clinical repository within RHIOs to support both EHRs and PHRs

28. Vision for the Florida Health Information Network • The Florida Health Information Network vision will integrate clinical health information exchange in Florida through a network architecture that will empower physicians to access timely and accurate medical records in order to deliver high quality medical care for their patients.

29. Christopher B. Sullivan, Ph.D. Agency for Health Care Administration Florida Center for Health Information and Policy Analysis Office of Health Information Technology 2727 Mahan Drive Tallahassee, FL 32308