1. NHII Operating in a Community J. Marc Overhage, MD, PhD Regenstrief Institute June 30, 2003 NATIONAL HEALTH INFORMATION INFRASTRUCTURE 2003 DEVELOPING A NATIONAL ACTION AGENDA FOR NHII

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

5. Indiana Network for Patient Care

7. I Indiana IAIMS Initiative

8. Regenstrief Institute

9. Initial RMRS Aims Eliminate the logistic problems associated with the paper record Standardize the care process. Deliver information in a more organized and useful way. Actively process this record and provide decision support to clinicians. Analyze and understand the data to improve the health of populations

10. INPC Project Goal Demonstrate the feasibility and benefit of a community wide electronic medical record system in acute care situations.

11. Resistance is futile! You will be assimilated INPC Project Motto

12. INPC Hospital Geographic Coverage

13. INPC Users Most central Indiana med/surg hospital EDs Hospital based providers (expanding) Primary Care (85 providers/20 locations) Homeless care network Public school clinics Marion County Health Department Indiana State Department of Health

14. INPC functions Results retrieval Clinical messaging/document delivery Data entry Reporting Clinical decision support Public health surveillance Medical reference access

15. INPC database organization St. Vincent’s Community Hospitals Wishard Clarian Health Global Patient Index Dictionary MCHD Global Doctor File St. Francis VA LabCorp IU Medical Group 16 Practices Statewide Data entry

16. DatumCoveragePenetration Chief ComplaintIndianapolis MSA98% Lab ordersIndianapolis MSA30% IP DiagnosesIndianapolis MSA98% (179K/yr) OP DiagnosesIndianapolis MSA10% Laboratory ResultsIndianapolis MSA90% (46.5M/yr) IP MedicationsIndianapolis MSA95% (48.2M/yr) Radiology reportsIndianapolis MSA90% (1.3M/yr) Outpatient Prescriptions Indianapolis70-80% OTC MedicationsIndiana10% Nurse hotlineIndianapolis MSA10%

17. Patient: John Doe MRN: 123-0 Diagnosis: 410.0 WBC: 14,000/cm 3 Patient: John Doe MRN: 123-0 Diagnosis: 410.0 WBC: 14,000/cm 3 Current –HL7 messages for most as the envelope –DICOM messages for images as the envelope –LOINC for laboratory results content –CPT-4 for procedures content –ICD-9 for diagnoses content –NDC and RxNorm for medications content Anticipated –Organisms for microbiology content Clinical Data Standards

19. Patient Linkage When data is returned from multiple sites, it will need to be combined and linked. For example, if “John Doe” is seen for various aspects of his colon cancer at different institutions, the data must be aggregated: Diagnostic Studies Treatment Data Outcome Data ED

20. Patient linkage approach Create global registry –One record per assigned patient number per institution Create logical links between each of these records Match on social security number, patient name, birth date and gender Use Sideli/Friedman algorithm 1 for near name matches Sideli RV 1992

21. Global Patient Registry Assigning Authority Global #Local Pat #Patient NameBirthdate Sex Hospital A99-1231456Sinkwell, Ralph J12-2-59 M Hospital B123-0A47239Sinkwell, RJ2-12-59 M Hospital A99-11032115Sinkwell, Ralph12-2-59 Hospital C101-0A3276Fredrick, Alice4-14-78 F Hospital A101-02314590Fredrick, Alyce4-14-78 F

23. INPC - Confidentiality While numerous measures in in place to protect confidentiality of patient’s data, the provider has to know who the patient is. –Secure physical network –Encryption –Authentication –Agreements –Device controls

24. INPC Data Access

29. Patient Name Details Report Image

38. Data reuse Clinical care –Emergency room –Primary care –Inpatient Public health (state and local HD) –Immunization registry –Reportable conditions –Surveillance Health services research Clinical research Accreditation reports

39. To Infection Control To Infection Control Reportable condition processor InboundHL7InboundHL7 Potentially Reportable Potentially Reportable Condition Reportable Condition To Public Health To Public Health Reportable Conditions Databases Reportable Conditions Databases Abnormal flag, Organism name in Dwyer II, Value above threshold Compare to Dwyer I Record Count as denominator E-mail Summar y Realtime Daily Batch Print Reports

40. Shigella Outbreak: Timeline Dr. MD

41. Integrating Non-traditional Data The sales of OTC Electrolytes are a result of two outbreaks: RSV (in gold) and Rotavirus (in pink)

42. Links to knowledge sources PraxisMD Links to knowledge sources