1. CIMI - FHIR Russ Leftwich August 11, 2015

2. Clinicians and Interoperability The universe of clinicians State of interoperability … most places The clinician as input device Engaging clinicians in transformation

3. The future is here – it’s just not evenly distributed. ~ William Gibson

4. The future clinician is here – they’re just not evenly distributed. ~ Russ Leftwich

5. Remember the Game of Telephone?

6. average Medicare beneficiary: 7 providers in 4 different organizations in one year

7. How many of those 7 providers know who the other 6 are and how to get in touch with them?

8. When a patient in the US first sees their primary care provider after a stay in the hospital, 75% of the time that PCP does not yet have the discharge summary

9. 5 antihypertensive medications 3 antidepressant medications 2 oral hypoglycemics Nashville got second CT scan No such thing as MRI No ACE inhibitors No angioplasty No statins When I trained in the 1980’s

11. Physician Office Living at Home CBS Outpt. Rehab Home Health Adult Day Care PACE Assist Living Nursing Home SNF LTACH IRF Acute Care Hospital Emergency Department Urgent Care Psych Hospital Hospice Facility Home Hospice Outpt. Behav. Health Acuity of Illness Intensity of Care Adapted from Derr and Wolf, 2012 Low High Outpatient Testing/Pharmacy/DME 11 The Spectrum of Care has become Increasingly Complex

12. Clinician/Patient Observations Allergy/Intolerance list example – 1960’s Clinical model – Missing data attributes/detail – 91 % drug-allergy alert override rate Smoking history 44 places in database Applying models to clinician input – Questionnaire/questionnaire response

13. Clinician Recruitment & Engagement Marketing: sell the problem, then solution HL7 Health Professional membership Specialty society organizational members HL7 User Groups Organizational collaborations – AMIA – AMDIS – MD EpiNet