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NHII Operating in a Community

NATIONAL HEALTH INFORMATION INFRASTRUCTURE 2003 DEVELOPING A NATIONAL ACTION AGENDA FOR NHII. NHII Operating in a Community. J. Marc Overhage, MD, PhD Regenstrief Institute June 30, 2003. The Indiana Network for Patient Care (INPC). An operational community wide electronic medical record.

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NHII Operating in a Community

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  1. NATIONAL HEALTH INFORMATION INFRASTRUCTURE 2003DEVELOPING A NATIONALACTION AGENDA FOR NHII NHII Operating in a Community J. Marc Overhage, MD, PhD Regenstrief Institute June 30, 2003

  2. The Indiana Network for Patient Care (INPC) An operational community wide electronic medical record

  3. Indiana Network for Patient Care INPC

  4. I Indiana IAIMS Initiative 3

  5. Regenstrief Institute

  6. Initial RMRS Aims • Eliminate the logistic problems associated with the paper record • Standardize the care process. Deliver information in a more organized and useful way. Actively process this record and provide decision support to clinicians. • Analyze and understand the data to improve the health of populations

  7. INPC Project Goal Demonstrate the feasibility and benefit of a community wide electronic medical record system in acute care situations.

  8. INPC Project Motto Resistance is futile! You will be assimilated

  9. INPC Hospital Geographic Coverage

  10. INPC Users • Most central Indiana med/surg hospital EDs • Hospital based providers (expanding) • Primary Care (85 providers/20 locations) • Homeless care network • Public school clinics • Marion County Health Department • Indiana State Department of Health

  11. INPC functions • Results retrieval • Clinical messaging/document delivery • Data entry • Reporting • Clinical decision support • Public health surveillance • Medical reference access

  12. INPC database organization 16 Practices St. Vincent’s Community Hospitals VA Global Patient Index Global Doctor File IU Medical Group Dictionary Clarian Health St. Francis Wishard MCHD LabCorp Data entry Data entry Statewide

  13. Patient: John Doe MRN: 123-0 Diagnosis: 410.0 WBC: 14,000/cm3 Clinical Data Standards • Current • HL7 messages for most as the envelope • DICOM messages for images as the envelope • LOINC for laboratory results content • CPT-4 for procedures content • ICD-9 for diagnoses content • NDC and RxNorm for medications content • Anticipated • Organisms for microbiology content

  14. Diagnostic Studies Outcome Data Treatment Data Patient Linkage • When data is returned from multiple sites, it will need to be combined and linked. • For example, if “John Doe” is seen for various aspects of his colon cancer at different institutions, the data must be aggregated: ED

  15. Patient linkage approach • Create global registry • One record per assigned patient number per institution • Create logical links between each of these records • Match on social security number, patient name, birth date and gender • Use Sideli/Friedman algorithm1 for near name matches Sideli RV 1992

  16. Global Patient Registry Assigning Authority Global #Local Pat #Patient NameBirthdateSex Hospital A 99-1 231456 Sinkwell, Ralph J 12-2-59 M Hospital B 123-0 A47239 Sinkwell, RJ 2-12-59 M Hospital A 99-1 1032115 Sinkwell, Ralph 12-2-59 Hospital C 101-0 A3276 Fredrick, Alice 4-14-78 F Hospital A 101-0 2314590 Fredrick, Alyce 4-14-78 F

  17. INPC - Confidentiality • While numerous measures in in place to protect confidentiality of patient’s data, the provider has to know who the patient is. • Secure physical network • Encryption • Authentication • Agreements • Device controls

  18. INPC Data Access

  19. Patient Name Details Report Image

  20. Data reuse • Clinical care • Emergency room • Primary care • Inpatient • Public health (state and local HD) • Immunization registry • Reportable conditions • Surveillance • Health services research • Clinical research • Accreditation reports

  21. Reportable condition processor E-mail Summary Abnormal flag, Organism name in Dwyer II, Value above threshold Realtime Compare to Dwyer I Daily Batch To Public Health Reportable Conditions Databases Inbound HL7 Potentially Reportable Reportable Condition To Infection Control Record Count as denominator Print Reports

  22. Dr. MD Shigella Outbreak: Timeline

  23. Integrating Non-traditional Data The sales of OTC Electrolytes are a result of two outbreaks: RSV (in gold) and Rotavirus (in pink)

  24. PraxisMD Links to knowledge sources Links to knowledge sources

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