Establishing a Recovery Health Information Network to Improve Care for Displaced Populations

1. Establishing a Recovery Health Information Network to Improve Care for Displaced Populations National Emergency Management Summit New Orleans March 6, 2007 Tony Sun, MD, MBA, FACP Bill Hineman, MBA Chief Medical Director Director of Recovery Initiatives

2. Today’s Agenda • The problem • Storms destroy health care infrastructure and the connections between patients and providers • The solution • Secure PHI infrastructure for interim providers • Create a network of interim providers • Enable patients to reconnect to established systems • Other uses

3. Initial Catastrophe • 1 million people evacuated, few with any medical records • >300,000 homes uninhabitable • 11 major hospitals lost, including two of the largest in LA • Patients and providers scattered in different directions. 465 physicians and 874 nurses state wide net loss.

4. The Ongoing Problem • Many FEMA residents have few tools to resettle • Many are low-income with little access to health care • Most have little or no medical history, medication or treatment plan information for their interim providers • Interim providers were unaware of each other’s activities - even with the patients they share

5. The Solution:Recovery Health Information Network

6. The RHIN Demonstration:Objectives The RHIN Demonstration:Objectives • Help ensure that displaced residents in FEMA trailer parks receive the right care at the right time every time • Work with stakeholders to define, develop and operate a support infrastructure that meets their needs while meeting Object 1

7. The RHIN Demonstration:Scope • Location: Baton Rouge-area FEMA trailer villages • Number of residents: 2200+ • Number of providers: 4 • Timeframe: August 2006 through November 2007. • Authority: Under auspices of our Medicare QIO contract with CMS

8. The RHIN Demonstration: Solution Requirements • Web-based, to allow access to and sharing of information among providers • Serve as the primary medical record • Offer relevant decision support • Quick to deploy • Easy to use – little opportunity to train • Secure • Enable referrals • Patient records must be portable: hard copy, disc, thumb drive, email, etc.

9. The RHIN Demonstration:Development • Secured limited funding from Centers for Medicare & Medicaid Services • Issued an ITB to vendors of EHRs and DM platforms: Small, large, local (LA), national • Very limited interest • Formed a steering committee of providers and coordinators of care for target population • Key players are Capital Area Human Services District, Department of Health and Hospitals, Excelth, Inc. and Southern University School of Nursing, OLOL

10. The RHIN Demonstration:Development II • Steering Committee selected DGL • Work sessions with providers and DGL • Software customization • Conversion of paper charts • Data entered meds, labs, vitals • Provider training • Rollout

11. The RHIN Demonstration:In Full Use by Providers • From their mobile units at the FEMA villages, providers can: • Access their own patients’ records • Access records of the patients they share with other on-site providers • Make electronic referrals containing relevant clinical information

12. The RHIN Demonstration:Full Capability for Patients • With Web access, patients can: • View their own records • Grant access to other providers • Add/update information in segregated fields

13. The RHIN Demonstration:Results • Demonstration to run until November 2007 • High provider satisfaction: • Average provider training: 45-60 minutes • Opening access to providers’ fixed locations

14. The RHIN Demonstration:Results II • Expected outcomes: • Decreased duplication of services by multiple providers • Reduced errors in patient care • Reduced opportunities for Medication fraud

15. The RHIN: Additional Benefits • Built-in ability to: • Monitoring of patients over time • Customize and track quality indicators by: • Individual, location, condition, etc. • Disease surveillance • Provider- and site-level reporting support improved management of scarce health care resources • HL7 compliant for interoperability

16. Why the RHIN Works • Web-based solution for the gaps in communications infrastructure that have interfered with delivery of high quality care • Providers identified the gaps and helped design the solution • The RHIN’s methods of gathering, storing and sharing PHI are highly intuitive and far superior than the systems the RHIN replaces • Very willing vendor

17. RHIN Hardware Requirements • CMS has funded laptops for providers: • Dell Latitude D620 laptop with Cingular G3 Card • Windows XP and Internet Explorer • Digital cameras to add patient photo to medical record for security

18. Other Uses for the RHIN • Evacuee shelters after any disaster or civic disruption • Triage facilities for disease outbreaks • Pre-populated personal medical record for fragile populations: e.g. Dialysis, nursing home, multiple chronic disease, etc.

19. Who We Are • Louisiana Health Care Review is a business division of Integrated Health Management Solutions. • Integrated Health provides: • Tools and strategies to integrate patients, providers and payers • HIT consulting • Quality improvement and utilization management for Medicare and Medicaid clients • Tony Sun, MD, MBA, FACPChief Medical Directortsun@lhcr.org • Bill Hineman, MBADirector of Recovery Initiativesbhineman@lhcr.org • (225)926-6353

20. Maslow's Hierarchy of Needs • Physiological: hunger, thirst, bodily comforts, etc.; • Safety/security: out of danger; • Belongingness and Love: affiliate with others, be accepted; and • Esteem: to achieve, be competent, gain approval and recognition.