San Diego Beacon: San Diego Regional Health Information Exchange James Killeen, MD SD Beacon Technical Lead Professor of Clinical Emergency Medicine UCSD School of Medicine

These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records Vice President Joseph Biden, May 2010 White House Announcement of Beacon Community Awardees Beacon Community Program

Overview Funded by ARRA HITECH Act administered by the Office of the National Coordinator for Health Information Technology $15 million over three years to use health IT to improve health care delivery in San Diego as model for nation Transition from a grant-funded initiative to an self-sustaining independent organization providing services to the health care community 4

ARRA & HITECH Act HITECH Priority Grant Programs nationwide meaningful use – Medicare and Medicaid Meaningful Use Incentive Payments – Health IT Regional Extension Center Program – Grants to states and state-designated entities for Health Information Exchange (HIE) $20b in Health HIT – electronic health records – e-prescribing, e-care and telemedicine – community health initiatives – foster private sector investment in innovation 5

Build and strengthen health IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years. Improve cost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim. Test innovative approaches to performance measurement, technology integration, and care delivery - accelerating evidence generation for new approaches. ONCs Beacon Community Program – where HITECH comes to life Beacon Communities funded to:

17 Beacon Communities 7 Hawaii County Beacon Community Hilo, HI Hawaii County Beacon Community Hilo, HI Southeast Michigan Beacon Community Detroit, MI Southeast Michigan Beacon Community Detroit, MI Crescent City Beacon Community New Orleans, LA Crescent City Beacon Community New Orleans, LA Delta BLUES Beacon Community Stoneville, MS Delta BLUES Beacon Community Stoneville, MS Keystone Beacon Community Danville, PA Keystone Beacon Community Danville, PA Utah Beacon Community Salt Lake City, UT Utah Beacon Community Salt Lake City, UT Beacon Community of Inland Northwest Spokane, WA Great Tulsa Health Access Network Beacon Community Tulsa, OK Great Tulsa Health Access Network Beacon Community Tulsa, OK Southeastern Minnesota Beacon Community Rochester, MN Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Rhode Island Beacon Community Providence, RI Greater Cincinnati Beacon Community Cincinnati, OH Greater Cincinnati Beacon Community Cincinnati, OH Southern Piedmont Beacon Community Concord, NC Southern Piedmont Beacon Community Concord, NC San Diego Beacon Community San Diego, CA San Diego Beacon Community San Diego, CA Western New York Beacon Community Buffalo, NY Western New York Beacon Community Buffalo, NY Colorado Beacon Community Grand Junction, CO Colorado Beacon Community Grand Junction, CO Bangor Beacon Community Brewer, ME Central Indiana Beacon Community Indianapolis, IN Central Indiana Beacon Community Indianapolis, IN

San Diego Beacon Connecting ambulances to emergency rooms Patient event notification to providers and payors Wireless cardiac device pilot Community Health Information Exchange Patient information available to providers across systems at the point-of-care Accessible in ED, hospital, clinic Reporting (Immunizations, Public Health)

CDC Community A VA/DOD State/Local Government Community B ClinicsEMS County PH SD VA/DOD

Build and Strengthen Health IT Kaiser SD VA/DOD EMS County PH Clinics Others Hospitals

Suite of Services Pre-hospital data available to hospitals electronically – Pre-hospital record – ECG, Images – Search capability into the HIE Immunization – Optimize vaccine administration strategies – Import data from non-traditional settings – Add Immunization Forecasting Syndromic Surveillance – Enhance reporting capabilities Radiology Imaging Import Medical Device Data – Implantable devices – Wireless Devices

HIE Construction Clinical Pre-Hospital & 911 Population & Public Health

San Diego Beacon Improve Quality, Population Health, Costs Cardiovascular Dz Childhood IZ Syndromic Surveillance Redundant Tests ED/hospital Readmits

14 Integrated Clinical Experience Integrated Solution

Immunizations 15 More than 700,000 Lives UCSD, Sharp, Rady, Scripps, & Medical Groups within San Diego

Immunizations SDB Hosting Immunization Server Provides routing of ADT and MU Reporting messages to SDIR and SD County

Lab Data Normalization and ELR

Syndromic Surveillance: ADT messages 18

Verbal Report Written Report ECG

Prehospital HIE Prehospital data available to hospitals electronically – Prehospital record – Electrocardiograms & Images – HIE also back to field providers EMS Application Partners – SD City EMS – AMR (Initiated) – Fieldsaver (Initiated)

San Diego 2010 OSHPD Data: – 24% (nearly one in four) of all 30-day readmissions occurs at a different hospital (excluding VA, NMCSD) 15% of all ED patients and 69% of frequent fliers were seen in multiple hospitals

eRAP

Messaging Event notification for ED Visit, Admit or Discharge – Providers – Payors – Health Systems – Federal Partners

Project 25 ED visits and charges reduced substantially in 6 month pre/post comparison for enrollees Financial Impact

EMS EMR vendor EMS Hub San Diego San Diego, CA

Smart Analytics Algorithms Identifying Patients with In-Home Difficulties

Smart Analytics Algorithms Identifying Patients with Substance Abuse Issues

Smart Analytics Algorithms Identifying Patients with Psychiatric/Behavioral Problems

59 y/o Serial Inebriate Patient

Serial Inebriate Patient RAP Trigger=SIP counselor sent to ED

40 y/o Post Traumatic Brain Injury

Arrested Released from Jail P25 Alerts to P25

Community Governance Independent entity established Initial board slate with representation from major healthcare providers in San Diego Dan GrossSharp COORob Smith, MDVA CMO Albert OriolRady CIOT. GehringCEO, SDCMS David Guss, MDUCSD DEM ChairN. MacchioneHHSA Director Bill SpoonerSharp CIOL. FerrariAnthem/BC Joe Traube, MDScripps CMIOJ. Burritt, RNKaiser S. EscobozaCEO, HASDICN. DiazCEO, CHG S. OKaneCEO, CCCR. BrownCEO, Scripps Green

Information should follow the patient, and artificial barriers – technical, business-related, bureaucratic – should not get in the way – David Blumenthal, MD, Former Director, ONC

San Diego Beacon

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