A San Diego Health Information Exchange San Diego Health Care Association April 26 th, 2012 Jami Young, MPA San Diego Beacon Project Manager

Office of the National Coordinator for Health Information Technology (IT) Beacon Community Program State Health Information Exchange Cooperative Agreement Program Health Information Technology Extension Program (Meaningful Use adoption) Strategic Health IT Advanced Research Projects (SHARP) Program Education programs (curricula development at community colleges and universities)

I. Health IT and Exchange Infrastructure II. Integration of Health IT into Care Delivery Instituting clinically relevant decision supports Improving medication management Improving care coordination Engaging patients and families III. Evaluation, Monitoring and Feedback Establishing systems for measurement and feedback of health systems quality, safety, and costs relevant to project goals Beacon community program priorities

17 Beacon communities

Reduce hospital readmissions by sharing patient health information (health information exchange) Reduce STEMI field-to-intervention time Increase childhood immunizations via texting Transmit cardiac device information through a single interface Reduce repeat radiology use San Diego-specific components

Exchange architectural model Master Patient Index Facility A Point Click Care Facility B ResCare Hospital

Master Patient Index (AG|A=AG|B) Facility A (clinical data) Facility B (clinical data) Exchange Architectural Model AG

Master patient index Demographic information Highly depending on the data collected by partner organizations Inappropriate matching and lack of appropriate matching are both bad

Exchange Architectural Model Master Patient Index User Directory Facility A (clinical data) Facility B (clinical data)

User directory Who can access the information? – Front desk – Nurses – Providers Authentication Expiration and renewal

Exchange Architectural Model Master Patient Index User Directory Consent and Auditing Facility A (clinical data) Facility B (clinical data)

Consent and auditing All-or-none Consent types Changing consent status Determining if a privacy breach occurred

Exchange Architectural Model Master Patient Index User Directory Consent and Auditing Facility A (clinical data) Facility B (clinical data) Immunization Registry Public Health Reporting

Value case for Skilled Nursing Facilities Access to recent patient health information from other care settings-

Data types shared ADT information Problems Medications and allergies Lab results Radiology reports Immunizations Clinical documents (e.g., discharge summaries)

Value case for Skilled Nursing Facilities Access to more patient health information Notification about care transitions-

Outside the exchange Use ADT messages to determine if a patient has been admitted or discharged from a facility Notify other members of the care team about the care transition using secure (DIRECT)

Value Case for Skilled Nursing Facilities to ensure care continuity especially in regards to e-prescribing Promote person centered care and culture change initiatives Prevent medical errors and diagnostic testing redundancy

Next steps Connecting medical centers, medical groups and skilled nursing facilities to the Exchange Using messaging to notify providers about patients undergoing care transitions Establishing an independent governance structure and sustainability model Expanding HIE network to encompass all care providers in region

Questions?