1. Shaun Grannis, MD MS FAAFP
Bringing Health Information Exchanges and Public Health Together: The Indiana Perspective
Shaun Grannis, MD MS FAAFP
Medical Informatics Research Scientist, Regenstrief Institute
Assistant Professor of Family Medicine, I.U. School of Medicine

2. Overview: What We’ll Cover
Current Status of Public Health HIE Activity in Indiana
Future Directions
HIE impact on Patient Care and PH outcomes
The 3rd bullet, although discussed to be third, really needs to lead the other two. The 3rd bullet is the goal/missioin/vision/etc.

3. Why Health Information Exchange?

4. RHIO
The dots represent the home addresses of individuals seen on Indianapolis ED’s.
For the Indianapolis patient that visits Lake County ED for asthma, their Indianapolis provider currently has little chance of securing encounter information.
LOCAL → REGIONAL → NATIONAL
“A Network of Networks”
=HIE

5. NHIN – A Nationwide Vision
NHII SCHEMATIC
LHII’s/RHII’s combine to form national infrastructure
Emphasize the local nature of the system and the importance of information exchange standards (HL7, LOINC, etc.) to transfer information between Local and Regional exchanges.
“A network of networks”

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

7. Silos of Information Jane Receives Immunizations @ Health Department
Data delivered to immunization registry
Immunization Registry
Jane Receives Health Department
Jane Receives Immunizations and other care (measurements, labs, diagnoses, Clinical Practice
Data delivered to EMR
Electronic Medical Record System

8. Silos of Information ??????????? Registry Web Interface
Immunization Registry
???????????
EMR Interface
Electronic Medical Record System

9. Aggregating Patient Data
Patient ID: 123LMNOP
Name: Jane Doe
DOB: 01/01/04
SSN: N/A
Address: 555 Johnson Road
City: Indianapolis
State: Indiana
ZIP: 46202
Jane Doe’s Immunizations:
3/1/04 DipTetaPur
3/1/04 HemInfB
3/1/04 PolioVir
3/1/04 HepaB
DTaP Dose Count:
HIB Dose Count:
IPV Dose Count:
VZV Dose Count:
MMR Dose Count:
HepB Dose Count:
Immunization Registry
Global Patient Index
Jane Ellen Doe’s Shots:
5/1/04 DTaP Imm
5/1/04 HIB Imm
5/1/04 IPV Imm
7/9/04 DTaP Imm
7/9/04 IPV Imm
Patient ID: 6789XYZ
Name: Jane Ellen Doe
DOB: 01/01/04
SSN:
Address: 555 Johnson Road
City: Indianapolis
State: Indiana
ZIP: 46202
Global ID: 45678
Name: Jane Ellen Doe
Lots of Demographics..
MRF1 ID: OU81247
MRF2 ID:
PH MRF ID: 123LMNOP
MRF3 ID: 6789XYZ
Concept Dictionary
Electronic Medical Record System

10. Aggregating Patient Data
Regional Health Information Exchange
Aggregating Patient Data
Hospital A MRF
Hospital C MRF
Immunization Registry
Global Patient Index
Global Patient Index
Concept Dictionary
Public Health MRF
Hospital D MRF
Concept Dictionary
Electronic Medical Record System
IUMG MRF
Hospital B MRF

11. Health Information Exchange
Data Reuse
Data Management
Data Access & Use
Hospitals
Physicians
Labs
Public
Health
Payer
Results delivery
Secure document transfer
Shared EMR
Credentialing
Eligibility checking
CPOE
Surveillance
Reportable conditions
De-identified, longitudinal clinical data
Researchers
Hospital
Data Repository
Health Information Exchange
Network Applications
Payers
Labs
Outpatient RX
Physician Office
Ambulatory Centers
Public Health
Negotiated Access

12. Current PH-HIE Activities
Automated Electronic Laboratory Reporting
Syndromic Surveillance / Situational Awareness
Results Delivery / Broadcast Messaging
Newborn Screening Prototype

13. Automatic Electronic Laboratory Reporting

14. Notifiable Condition Detector
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
Message
Potentially
Reportable
Reportable
Condition
To Infection
Control
Generalize what is on the right
What is on the left is difficult to generalize because it has to be integrated with and optimized for performance
Record Count
as denominator
Print
Reports

15. ELR Completeness 4,785 total reportable cases INPC– 4,625 (97%)
System is far from perfect, but these findings suggest that automated ELR may substantially improve case reporting completeness
NEXT STEPS: rewriting NCD, improving critiics, administrative pieces
4,785 total reportable cases
INPC– 4,625 (97%)
Health Dept – 905 (19%)
Hospitals – 1,142 (24%)

16. Syndromic Surveillance Situational Awareness

17. Current PHESS Hospitals (n=76)
6,500 – 7,000 visits per day
~ 15 MB data per day

18. Results Delivery: Connections to Healthcare Providers and Public Health

19. 19

20. Broadcast messaging
Forms messaging
Shigella/Syphillis alerting 20

21. Enhancing Newborn Screening Follow-Up

22. Registration
Test present?
INPC
NBS
Yes/No
Clinical Reminders

23. Future Directions Refine/Expand PH-HIE data sharing processes
Augment existing information (patient, doctor, conditions)
Provide access to additional information (in both directions)
Expanded interactions/roles for PH and clinical health care
Immunization decision support
Notifiable reporting reminders (e.g., STD’s)
Clinical treatment reminders (e.g., stool cultures during Shigella outbreak)
Expanded Dialog between PH and HIE to better align growth/avoid redundancies

24. Shaun Grannis, MD MS FAAFP
Bringing Health Information Exchanges and Public Health Together: The Indiana Perspective
Shaun Grannis, MD MS FAAFP
Medical Informatics Research Scientist, Regenstrief Institute
Assistant Professor of Family Medicine, I.U. School of Medicine