Patient Health Record Card (PHRC) Project: The Illinois State Initiative MED INFO 403—Spring 2009

1. Patient Health Record Card (PHRC) Project: The Illinois State Initiative MED INFO 403—Spring 2009 Anjana Santos Bashar Attar Cathy Whaley Dawn L. Rex Imran Khan Lemuel Dizon

2. Patient Health Record Card(PHRC) • What is the PHRC? • Why in healthcare? • Who uses the PHRC?

3. PHRC—Purpose • Simple • Cost-effective • Basic medical profile • Low tech • Smart card technology • Portability • Access

4. PHRC—Purpose • Better efficiency • Improved accuracy • Response time Clinicians work smarter, not harder Effective medical treatment Accurate medical diagnosis Quality Patient Care

5. PHRC—How is it used? • Emergency/Trauma • Office Visit • Hospital Admission

6. PHRC—Global Model • Germany: electronische Gesundheitskarte (eGK) • France: Sesam Vitale • Taiwan: National Health Insurance

7. PHRC—U.S. Initiative • Regional Focused • NYC: HealthSmart Network • Omaha, NE: Health Data Card • UPMC: Health Care Passport

8. PHRC—Project Outline • Significance • Scope • Challenges/Obstacles • Implementation • Processing • Technology • Timelines for Illinois PHRC Implementation • Demonstration

9. PHRC—What is theSignificance? • Institute of Medicine (IOM) 6 AIMS • Safety • Timeliness • Effectiveness • Efficiency • Patient-centered • Equitability Committee on Quality of Health Care in America, Institute of Medicine Washington, DC, USA: National Academies Press; 2001

10. PHRC—Significance • Patient Empowerment • Harmonization of Patient Management • Better Satisfaction of Patients and Healthcare Providers • The card is the logic way for portable clinical data repository • Health Card will lead to Cost Savings • Ability to maintain confidentiality, HIPAA Compliance • Life Saver? The card is the future passport to healthcare

11. PHRC—What information isstored on the card? • Health problem list • Emergency data • Prior hospitalizations • Allergy information • Vaccination • Pregnancy records • Laboratory data • Electronic prescription • Insurance information • Current and prior treatments • Organ donor status • Power of Attorney for Healthcare • Emergency contact information

12. PHRC—Scope • State Based Implementation of PHRC • Rapid identification of patients; improved treatment • Convenient way to carry data between systems or to sites without systems • Reduction of records maintenance costs

13. PHRC—Benefits • Convenient to patients • Size • Current medical data housed on card • Access authenticated by provider PIN • Encrypting technology employed to preserve data integrity • Technology employed for security • PIN (provider, patient & other pre-designated people) • Lockdown after unsuccessful PIN entry • Audit trails to identify who accessed by tracking PIN, date/time and location of access http://www.bmj.com/cgi/content/full/314/7080/573

14. PHRC—Challenges and Resolutions • Failure rate of the chips in the cards • House each card in a “card enclosure” for protection. • Deficiency of standards surrounding the performance & security of smart cards • The Berlin Group, project: ERIDANE • Develop “functional & security framework for smart card based Point of Interaction equipment” http://en.wikipedia.org/wiki/Smart_card#Health_care_.28Medical.29 (accessed 4/25/09) http://en.wikipedia.org/wiki/Card_enclosure (accessed 4/25/09)

15. PHRC—Processing ClinicalData e-Health: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bioinformatics to the edge. Editors: B. Blobel et al. IOS Press, 2008 Implementing an Electronic Health Record System. Editors: J.M.Walker et.al. Springer, 2005 • The architecture of electronic clinical data applications required for the smart card depends largely on where they are deployed. • Generally they can be divided into two groups: • Ambulatory systems • Hospital-based enterprise systems

16. PHRC—Processing Outpatient Data Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003 • Electronic data systems intended for use in outpatient settings are usually composed of two major components: • The underlying database: is based on the relational model and consists of tables organized around common medical records concepts. • The user interface. • Typical table groups would be laboratory, diagnosis, medications, demographics, referrals, etc. • Outpatient electronic data should be stand-alone systems and have relatively simple external interfaces (EKG, clinical laboratory downloads, practice management system). This permits the design of the database component to remain uncomplicated.

17. PHRC—Processing Inpatient Data Electronic Health Records. Editor J.H. Carter. ACP Press, 2008 Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003 • Inpatient clinical data are more complex in design and have at their core clinical data repositories (CDR). • These electronic data systems consolidate data from a variety of clinical sources to present a unified view of a single patient. • It is optimized to allow clinicians to retrieve data for a single patient rather than to identify a population of patients with common characteristics or to facilitate the management of a specific clinical department.

18. PHRC—ProcessingInpatient Data e-Health: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bioinformatics to the edge. Editors: B. Blobel et al. IOS Press, 2008 Implementing an Electronic Health Record System. Editors: J.M.Walker et.al. Springer, 2005 • Typical data types that are often found within core clinical data repositories (CDR) include: • clinical laboratory test results • patient demographics • pharmacy information • radiology reports and images • pathology reports • hospital admissions/discharges/transfers • ICD-9 codes, discharge summaries • For the smart card purposes, progress notes, radiology images will be excluded.

19. PHRC—How clinical data iscaptured? Electronic Health Records. Editor J.H. Carter. ACP Press, 2008 • Dictation and transcription of clinical notes • Uploading these documents require indexing by the transcriptionist based on a unique patient identifier, the date of dictation, and type of report. • Scanning • Should be reserved as an adjunct for entry of clinical data that is deemed of value to the longitudinal patient record (e.g., discharge summary, results of tests or procedures, operation reports). • Indexing of documents • Requires hiring competent staff who will be responsible for indexing, proofreading and editing the OCR’d documents to avoid content errors.

20. PHRC—Data Entry Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003 • There is growing number of modalities to support data entry. • Interfaces with systems such as laboratories, pharmacy, diagnostic imaging, and point –of-care equipment can result more efficient, less manual data entry. • The most common message standards are HL7, ASTM, and DICOM. Electronic forms can be customized to display and capture required data such as problem list documentation. • Smart cards may not only be used to describe important clinical conditions but also can be proactive in nature, initiating clinical alerts and health maintenance reminders.

21. PHRC—TechnologyEmployed • Digital World • CCHIT Certified EMR having CCR/CCD functionality • Central Server • Health Smart Card Reader with USB cable • Barcode Scanner? • Analog World • Optical Character Recognition Technology (OCR) for scanning paper charts

22. PHRC

23. PHRC—Continuity of CareRecord/Document (CCR/CCD) • Existing standard that packages summary documents that may include: • Allergies, Medications, Problems List, Immunizations • Procedures, Results, Health Care Providers, Plans • Demographics, Insurance information etc

24. PHRC—Break Glass Patient Sensitive Information: • Addiction Medicine • HIV Testing • Psychological Treatment

25. PHRC—Syncing and EditingHealth Records EMS (Ambulances) Home Health Doctor’s Office Hospitals

26. Scan paper forms, and digitally parse data –Process called “Optical Character Recognition” (OCR) –Store data as text, with image data archived •Analog workflow with digital data capability Paper World—Using OCRTechnology

27. Form ID Identifies form: Discharge Summary from CCR / CCD Sample Form Excerpt—Form Identification • Form Number • Uniquely identifies the document, incl. page, i.e. • “Page 2 of Discharge form for MRN # 983345443.”

28. Sample Form Excerpt—Document Scanned

29. Sample Form Excerpt—Fields and Data Identified

31. PHRC—Illinois Initiative

32. PHRC—Process for ILResidents Obtaining PHRC • Go to Secretary of State’s office, bring with: • Driver’s License, State ID, other photo ID • Proof of residency – two forms • Insurance card, Medicare/Medicaid information • Residency will be verified • Photograph will be taken • PHRC created • Card activated • Demographic and insurance/payor information downloaded to card • Secure PIN established • Resident leaves with card in hand

33. Demonstration of the PHRC in action Link to Demonstration