1. RHIOs: CHINs or Champs? Health TechNet
October 21, 2005
Robert Steffel, Executive Director
HealthBridge

2. Greater Cincinnati Demographics
2.2 million population
14 county tri-state area (OH, KY, IN)
25 hospitals / $4 billion annual expenses
3 dominate private health plans
Approximately 4,000 active physicians
Engaged employers / Low reimbursement
History of collaborative activities
This is an overview of the HealthBridge service area. Note that 18 of the 25 total hospitals are participating in HealthBridge and 17 are actively sending their results through the Clinical Messaging system. The 18 HealthBridge participating hospitals account for about $3.5 billion in annual expenses.
We think that the nature and mechanics of collaboration may be very different in communities that are much smaller or larger than ours.

3. HealthBridge Timeline
1997: Funded by 5 Health Systems & 2 Insurers
Began service as a community-wide MD portal
A true multi-stakeholder collaborative
2000: Purchased Axolotl Clinical Messaging
Community license funded by “content providers”
2003: Public health/physician alerts added
2004: Syndromic Surveillance added
2005: Ambulatory Order Entry (In Process)

4. The HealthBridge Portal Homepage

5. HealthBridge Clinical Messaging System Overview
Health Systems – 17 Hospitals
Lab Results, Radiology Reports, Transcribed Reports, ADT Transactions
Mercy Health
Partners
Health Alliance
TriHealth
St. Elizabeth
Cincinnati
Children’s
Ancillary
Data Feeds
LabOne
Community Standards
Physician Access to Clinical Results
MD Dictation
-Data Feeds (HL-7)
-MD Directory
-Patient Index
-HIPAA Access Audit
Public Health
Clinical Messaging Servers
Health Alerts
RODS
Lab
Syndromic
Surveillance
MD EMRs
Fax
Electronic
Mail

6. Awaiting Action Inbox HealthBridge Clinical “Inbox”
Clinical Messaging Electronic “Inbox”
Note lab, radiology & transcribed reports from several hospitals for a two physician office
Awaiting Action Inbox
-This view shows all results that need to be dealt with in the physician office
-Before Clinical Messaging this would be a pile of paper on fax machines, envelopes from each lab, Med Records, Radiology dept. at each hospital a physician uses
-You can sort for abnormal values, by location for rounds
-Note that there is a “final view” which is everything that has been sent to a practice organized by patient. This is very useful to cut down on calls for resending of results.
-If you click on a results like this CBC you get this (flip to next slide).

7. HealthBridge Clinical “Inbox”
Inbox by Abnormal View
Results sorted by abnormal lab values

8. Community Standard CBC Result
Sample of a Clinical Messaging CBC Result
Community Standard CBC Result
Community Standard CBC Result
-This is the standard format of a CBC. It is the exact data sent by the hospital with no interpretation or normalization by HealthBridge
-Physicians of record show each physician that was sent the result
-Patient demographic information like phone number and address is also displayed
-Note that physicians can annotate and forward results as well as view cumulative results of a particular test regardless of where the test originated
-The next slide shows an MRI report

9. Final View = “EMR Light”
Final View- Used To Access All Electronic Results for a Practice
Final View = “EMR Light”

10. Community Patient Index

11. Public Health Alert

12. Sept 2005 – Results Sent

13. Typical Physician Office (before HealthBridge)
Paper to Electronic
Typical Physician Office (before HealthBridge)
Physician Office
With electronic “inbox”

14. Results Per Envelope

15. Before & After Daily Printing

16. Problems, Choices & Lessons Learned

17. Key Issues We Had To Address
Respond to pressure to start a CHIN
Fund and form a collaborative network
Offer content/services that deliver value
Build trust, collaboration & utilization
Show value of stakeholder participation