1. Creating Health Information Exchanges: The Indiana Network for Patient Care Shaun Grannis, MD, MS Research Scientist Regenstrief Institute / IU School of Medicine

2. The Challenge: Silos of Information

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

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

5. INPC - Humble Beginnings  Regenstrief tasked in 1972 to “stitch” these silos of information together -> the Regenstrief Medical Record System (RMRS/Wishard)  In 1994, began stitching together information across institutions (INPC/Indianapolis)  In 2003, working towards stitching the state together (INPC/Indiana)

6. Consolidating the Silos Immunization Registry Electronic Medical Record System Patient ID: 123LMNOP Name: Jane Doe DOB: 01/01/04 SSN: N/A Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Patient ID: 6789XYZ Name: Jane Ellen Doe DOB: 01/01/04 SSN:123-45-6789 Address: 555 Johnson Road City: Indianapolis State: Indiana ZIP: 46202 Global Patient Index Concept Dictionary Global ID:45678 Name: Jane Ellen Doe Lots of Demographics.. MRF1 ID: OU81247 MRF2 ID: 4564356 PH MRF ID: 123LMNOP MRF3 ID:6789XYZ DTaP Dose Count:30936-9 HIB Dose Count:30938-5 IPV Dose Count:33555-4 VZV Dose Count:30943-5 MMR Dose Count:30940-1 HepB Dose Count:30937-7 Jane Doe’s Immunizations: 3/1/04DipTetaPur 3/1/04HemInfB 3/1/04PolioVir 3/1/04HepaB Jane Ellen Doe’s Shots: 5/1/04DTaP Imm 5/1/04HIB Imm 5/1/04IPV Imm 7/9/04DTaP Imm 7/9/04IPV Imm 30936-9 30938-5 33555-4 30937-7 30936-9 30938-5 33555-4 30936-9 33555-4

7. Consolidating the Silos Immunization Registry Electronic Medical Record System Global Patient Index Concept Dictionary St. Vincent MRF Clarian MRF Wishard MRF Community MRF Public Health MRF Global Patient Index IUMG MRF Concept Dictionary The Indiana Network for Patient Care

8. INPC System Design  Separate medical record vault per institution  Each vault in separate physical files, but centrally located  Standardized data structure – All use same software and observation codes  Patient demographics linking via global registry  Combine on the fly when needed

9. INPC – Participants  Includes 17 hospitals from the 5 major Indianapolis hospital systems (95% of non- office care)  National and regional laboratories  Includes county and state public health departments  35% of outpatient practices  Both major cardiology referral centers  Four homeless care centers

10. INPC hospital participants Health Department Practice/Clinic Hospital LabCorp Quest MCHD Rx data In progress Heart Center of Indiana The Indiana Heart Hospital

11. A “Big” Repository by US Standards  In the system: -1.3 million patients, 5 million registration “events” -24 million orders -660 million coded results -12 million dictated reports -8.8 million radiology reports -25 million prescriptions -480,000 EKG tracings -45 million radiology images  Added Per Year: -600,000 ambulatory encounters -50,000 inpatient encounters

12. Docs4Docs - Links to office practices  Results delivery service (Docs4Docs)  Results flow through INPC central to Docs4Docs and are routed to MD in-boxes  All hospitals send reports through same mechanism  Improved office efficiency and convenience  Eliminates mail and (almost) fax costs

13. Current status  280 practices from 3 Hospital systems (about 1800 MDs)  Indiana Health Information Exchange (IHIE) is Regenstrief’s corporate partner  Scheduled for whole city by end of 2005 through IHIE  Uses same data streams as structured EMR – but simpler structure  Will provide links to all MDs for other purposes

16. Founding Members  Hospital systems -Clarian Health Partners -St. Francis Hospitals and Health System -St. Vincent Health Care -Wishard Health Services -Community Hospitals of Indiana  Government -City of Indianapolis  Public Health -State Department of Health -Marion County Health Department  Research -IU School of Medicine -Regenstrief Institute  Medical societies -Indianapolis Medical Society -Indiana State Medical Association  Economic development -BioCrossroads / Central Indiana Corporate Partnership

17. Benefits Accrue to Stakeholders Across System Annual economic value ($M) Patients Physicians Hospitals Labs Physicians Hospitals Patients Physicians Hospitals Payors Patients Physicians Hospitals Payors Employers Patients Physicians Hospitals Public health Payors Employers Beneficiaries 1 Patients Hospitals Labs Public health Patients Researchers Investigators Pharma companies (1)Includes quality of care/other non-economic beneficiaries as well Source:BCG Analysis & Estimates LONG-TERM ECONOMIC BENEFIT TO CENTRAL INDIANA WILL EXCEED $120M ANNUALLY LONG-TERM ECONOMIC BENEFIT TO CENTRAL INDIANA WILL EXCEED $120M ANNUALLY

18. Achieving full value requires structured data Percent Capture electronic ally Connect & interface Standardi ze and store data 76% 5% 19% C!TL, BCG calculations

19. Questions / Discussion Shaun Grannis, MD, MS Research Scientist Regenstrief Institute / IU School of Medicine sgrannis@regenstrief.org