Regional Health Information Organizations

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• Regional Health Information Organizations
• An Argument for Central Implementation

Ken Geoly, M.D. Clinical Informatics
Consultant BIO-IT Coalition May 4 2006
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Current Problem
Data from Clinics MD Offices OP Radiology OP
Labs OP Pharmacy
Encounter 1 Clinical Data
Encounter 2 Clinical Data
Are Lost in the Continuum
Health Care Information System
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Why?
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OP Labs
MD Offices If any
Multiple Outpatient Data Sources
Rx
OP Radiology
Healthcare Information Systems
OP Pharmacy
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Dont Talk to Each Other!!
OP Labs
MD Offices If any
Healthcare Information Systems
OP Radiology
Rx
OP Pharmacy
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Because.....
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1
3
No Unique Patient Identifier
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No Central Repository
Most MDs Dont Digitize Their Records
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No Single Source of a Continuous Patient Record
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Two Possible Ways to Implement a CDR
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Distributed Database

• Would require that all data elements be stored
  and accessed at the site at which they were
  generated
• Requires that ALL MD offices be automated and
  that their systems are on all the time for
  universal access
• Require the use of a central coordinating system
  to acquire the data from each requisite source
• Issues with applying an EMPI

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Distributed Database
OP Labs
All MDs Dont Digitize Their Data And Cant Be
Counted On To Have Their Systems On 24x7
Coordinating System
Healthcare Information Systems
OP Radiology
Rx
OP Pharmacy
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Central RepositoryElements
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2
1
Database - Web Based - Populated by
Multiple Sources
Unique Patient Identifier - Ultimately HIPAA
Required - Multiple Programs Available
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Full Time Administration
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Proper Security
Connectivity - Internet
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And...
Cooperation
Result...
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CDR
OP Labs
MD Offices If any
WWW
Healthcare Information Systems
OP Radiology
Rx
OP Pharmacy
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Instead of....
Data from Clinics MD Offices OP Radiology OP
Labs OP Pharmacy
Encounter 1 Clinical Data
Encounter 2 Clinical Data
Are Lost in the Continuum
Health Care Information System
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Rx
MD Offices
OP Labs
OP Radiology
OP Pharmacy
Encounter 1 Clinical Data
Encounter 2 Clinical Data
CDR
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Access to the CDRwith Proper Security
Payors
Patients
Health Care Providers -with or w/o EMRs -From
Hospitals
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Contributors
Miners
CDR
Hosp Data
MD Offices with and w/o Elec Med Recs
Reference Laboratories
Physician Office Data - Labs, Notes,
Immunizations, etc
Patients
WWW
Payers
Reference Radiology
Rx
OP Pharmacy
Healthcare Systems
Insurance Data
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Security of Data
Patient KEY
Physician KEY
Safety Deposit Box
Patient KEY
Patient KEY
Once accessed, the data could then be
stored electronically (if there was a physician
based EMR) or printed for a paper record
Safety Deposit Box
CDR
Miners KEY
Other Potential Data Miners
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Unique Patient Identifier - Enterprise Master
Patient Identifier
May be mandated by Federal Law Most difficult
aspect of the HIPAA regulation to implement
A number of identifiers used to insure
accuracy Name, DOB, SSN, Address, Mother MN, etc.
Newer EMPI Programs using a series of identifiers
Would be essential for an accurate CDR
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Issues with a Unique Patient Identifier
Privacy - Already a Concern
Technical Issues - Accuracy - Implementation
Community Issues - Acceptance
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Issues c EMPI - CDR

• Constructive
• Universal Availability of Medical Data
• Simplification of patient care
• Improved through-put

• Restrictive
• Patient Confidentiality
• Patient Agreement
• Accuracy
• Will be Mandated by HIPAA

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Health Care Role
Participate in the Process
Utilize the unique identifier
Contribute and Utilize the Data
Participate in Securing the Data
Participate in Education of the Community
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Patient Role
Participate in the Process
Understand the Benefit
Contribute, Access and Utilize the Data
Understand and be comfortable with the Security
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Industry Role
Technical Expertise - Database Maintenance
Education and Encouragement of Employees
Staff Contribution
Validate Security
Financial Support
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Government Role
Administration
Financial Support
Community Awareness and Education
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Present Advantages

• Regional Database with secured universal access
  by
• Clinicians
• Enhanced Throughput
• Reduced Cost (lack of unnecessary duplication)
• Payers
• Demographic Verification
• Improved Utilization
• Patients
• Direct access to individual patient record
• Portability of the patient record
• Digitally or Printed

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Future Advantages

• Template for Regional Health Record Keeping - for
  large metropolitan areas
• Ultimate Portability of Patient Records from
  location to location
• Productize the Model