Rodney Cain, Chief Information Officer, HealthBridge

Joyce Beck, Chief Executive Officer, Thayer County Health Services

Will Ross, Chief Operating Officer, Redwood MedNet

Midwestern Grandparents on Vacation

Communities Working Together to Improve Quality, Safety and Efficiency Using the NHIN

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TUESDAY, 10:00 – 10:50AM

Midwestern Grandparents on Vacation

HealthBridge• Located in Cincinnati, Ohio• Represented by Rodney Cain, CIO

Redwood MedNet• Located in Ukiah, California• Represented by Will Ross, COO

Thayer County Health Services• Located in Hebron, Nebraska• Represented by Joyce Beck, CEO

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Rodney Cain, CIO

TUESDAY, 10:00 – 10:50AM

HealthBridge Background

» In operation since 1997

» Provides secure, real-time electronic health information exchange for Southwestern Ohio, Northern Kentucky and Southeastern Indiana

» One of only a handful of HIE/RHIOs nationwide with cash-positive, sustainable business model

• 97% of revenue from fees; <3% from grants

• 5-8% annual return for last five years

» HIT Regional Extension Center Awardee, February 2010

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HealthBridge Network

» Includes:

• 24 local hospitals in Kentucky, Ohio and Indiana

• 5000+ physicians and other professionals at hundreds of sites

• 17 local health departments

• Large commercial, hospital, & physician office labs

• Diagnostic centers

• Delivered 2.9 million clinical results in December 2009; more than 30 million total results in 2009

» EMR Feeds to 28 different vendors, 60+ versions

» 47 hospital information system connections for 10 different organizations

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Collaborative HIE Network

HealthLINC is a community-based organization leading the health information exchange (HIE) effort on behalf of healthcare stakeholders in Monroe and surrounding counties in South Central Indiana.

CCHIE was founded in 2007 as a multi-stakeholder non-profit community-wide health information exchange for the benefit of the medical community in Springfield, Ohio and surrounding areas.

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HealthBridge NHIN Architecture

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Independent. Labs, Imaging &

Diagnostic Centers

Independent Practices

Health System Exchange with NHIN,Other HIEs

Exchange with NHIN,Other HIEsAmbul. EHRAmbul. EHR

Push & Pull Capability

Push & Pull Capability

Use Case SpecificData

Stores

Use Case SpecificData

Stores

Community Patient / Provider

Index

Community Patient / Provider

Index

Inpt EHR Inpt EHR

PMS, EHRPMS, EHR

LIS, RIS, etc LIS, RIS, etc

Quality Reporting

Results / Orders /

Summary Record

Results / Orders /

Summary Record

Summary Record

Exchange

Summary Record

Exchange

ResultsDeliveryResultsDeliveryRegistryRegistryeRxeRxBasic ASP

EHR Basic ASP

EHR

Modular EHRModular EHR Exchange ServicesExchange Services

Public Health Reporting

Order EntryOrder Entry

ApplicationsApplications

Other Providers - Pharmacies, Nursing

Homes, etc.

Inbound / Outbound Interfaces

Inbound / Outbound Interfaces

ResultsResults

Patient Discovery

Patient Discovery

DocumentQuery

/ Retrieve

DocumentQuery

/ Retrieve

ConsumerPreferencesConsumer

Preferences

HealthBridge Use of NHIN

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Center for Medicare and

Medicaid Services

CARE–Health Information Exchange

Project (C-HIEP)

Social Security Administration

Disability Benefits Determination

Cross Country Data Exchange Demonstration

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Mr. & Mrs. Gordon Fakepatient

•Residents of Hebron Nebraska

•Visit daughter in Cincinnati

•Visit grandsons in California

Privacy & Security Posture

•Patient consents to provider exchange of data for treatment

Midwestern Grandparents on Vacation

Midwestern Grandparents on Vacation

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• CBC & CMP tests• Upper GI Test• Rx history

• Cardiac Enzymes• EKG

• EKG• Stress Test

Summary Record View from ER at HealthBridge

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HealthBridge Demonstration – Lab Report

Will Ross, COO1.Launching Redwood MedNet

2.Policy Themes

3.CONNECT Demonstrations

TUESDAY, 10:00AM – 10:50AM

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Redwood MedNet

HIE Home Region• 7,000 Square Miles in

Northern California (larger than Connecticut)

• 600,000 population

• 1 to 4 hours north of San Francisco

• 14 hospitals (5 Critical Access) with 1,200 beds

• 10 FQHCs, 12 RHCs, 4 Tribal Clinics, 1 VA Satellite Clinic

CaliforniaPacifi

c Ocean

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Redwood MedNet Startup Funding

Since 2005$1.2 Million in Grants

About $100,000 in contracts or revenue

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Redwood MedNet HIE Project Plan

Health Policy• Start from the Connecting for Health “Common Framework”• Harmonize with State and Federal privacy & security requirements

Business Operations• Focus on clinical data, not billing data• Focus on site level workflow from the perspective of an individual user (adaptive

business rules rather than imposed rules)• Make clinical data agile, with or without EHRs• Leverage open source software to disrupt legacy software lock in and incompatible

data silos• Build HIE services incrementally

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Redwood MedNet HIE Business Plan

Startup from 2005 to 2010• Grant funded HIE operations startup• Develop open source software as appropriate• Build enterprise health data exchange services• Transition from grants to paid services

Sustainability Model• Estimated breakeven point = 400 providers using the service• At current pace 400 providers should be on the system in 2011• 400 providers will require expansion beyond startup territory of

Mendocino, Lake and Sonoma Counties

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Redwood MedNet Timeline

2004 Steering Committee with members from local Medical Society, County Public Health and Community Clinic consortium

2005 Established an independent 501(c)(3) nonprofit corporation

2007 Pilot test new open source software for HIE operations

2008 Began production laboratory test result delivery in April

2009 Demonstrated CONNECT gateway in June; Began production radiology report delivery in September

2010 Live use of CONNECT gateway in February; Scheduled to begin e-Prescribing services in third quarter

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HIMSS 2010 19

EHR Adoption Reality Check

“Four percent of physicians reported having an extensive, fully functional electronic records system, and 13% reported having a basic system.”

DesRoches, Campbell, et al.

July 2008

New England Journal of Medicine

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Redwood MedNet EHR Adoption Survey, 2009

• 8% of providers use EHR

• 5% of providers receive lab results in their EHR

• 90% of providers have broadband Internetin their office

• 59% of providers can access their office network from offsite

• 13% of providers say EHR is ready for broad adoption

• 30% of providers plan to implement EHR in the next 2 years

• 55% of providers do not plan to implement EHR in the next 2 years

HIMSS 2010 21

Health Information Liquidity

“EHRs are necessary but not sufficient for interoperability”

Penfield, Anderson, Edmunds & Belanger

January 2009

Booz Allen Hamlilton

HIMSS 2010 22

Crossing the Health Care IT Chasm

“Providers will appropriately be drawn to IT only if, where and when it can be shown to enable them to do their jobs more effectively.”

Stead & Lin

February 2009

National Academies Press

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Making Smart Health Care IT Investments

“We need to have more of an ‘enterprise’ approach to health IT implementation, but most of the health care industry isn’t part of an enterprise.”

Halamka

March-April 2009

Health Affairs

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Deciding When to Pursue and EHR

“Rushing to the EHR solely to optimize the amount of incentive funding is a recipe for disaster.”

Rishel

September 2009

Gartner Industry Research

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The Business Case for Interoperability

“Labs may decide it does not make business sense for them to send electronic results to physicians who do not represent enough business.”

Frohlich

October 2009

Testimony to HIT Standards Implementatation Workgroup

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Avoid Silos of Disconnected Information

“Exchange within business groups will not be sufficient. The goal is to have information flow seamlessly and effortlessly to every nook and cranny of our health system, when and where it is needed.”

Blumenthal

November 2009

ONC Email

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Are EHRs Helpful For Care Coordination?

“There is a gap between policy-makers’ expectation of current EMRs’ role in the coordination of care and clinicians’ real-world experience with them.”

O’Malley, Grossman, et al.

December 2009

Center for Studying Health System Change

HIMSS 2010 28

CONNECT v2.0 Demonstration in 2009

CONNECT v2.0 Demonstration in 2009

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Summary Record View from Redwood MedNet

Joyce Beck, MS, CEONHIN Connectivity Through The Eyes Of A Patient

How Connectivity Improves Patient Care

Southeast Nebraska Health Information Exchange (SENHIE)

TUESDAY, 10:00 – 10:50AM

Reason for Demonstration

• Test Data had only been sent on the NHIN between facilities

• Information Technology said it would work

• There were doubts from other HIE’s in Nebraska about NHIN

• If NHIN was to be endorsed I had to see it myself

• If our actions do not help a patient than all is for nothing

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Wellness Check Began at Thayer County Health Services in Hebron, Nebraska

• Dr. Bryan Hubl ordered lab test in Hebron for wellness check

• Lab results obtained and placed in EHR in Hebron

• Lab results then made available to Redwood Mednet in California for actual wellness exam

• Information also available on USB to fulfill meaningful use

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Second Step of Trip was Travel to Healdsburg, California for Wellness and Radiology Exam

• Wellness exam completed by Dr. Jeff Meckler at Alliance Medical Center, Healdsburg, California

• Lab results and patient visit summary from Thayer County retrieved by Redwood MedNet via CONNECT gateway

• Results of labs and x-ray of left hip taken in Healdsburg placed in Alliance Medical Center EHR

• Results could be placed on USBbracelet at patient request

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Final Step

• Returned to Thayer County Health Services to be seen by Dr. Hubl

• Wellness exam as well as results of x-ray was available to Dr. Hubl via the NHIN therefore no duplication of testing necessary

• Dr. Hubl was able to recommend treatment based on information gathered in both Hebron, Nebraska and Healdsburg, California

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Conclusion

• Information flowed from one facility to another without difficulty

• Duplication of testing was avoided due to availability of information via the NHIN and patient USB device

• Ease of availability of medical information provided better patient care

• The NHIN is functioning, provides patients with the information needed

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Summary Record View from Thayer County

HIMSS 2010 37

Midwestern Grandparents on Vacation

HealthBridgeRodney Cain, CIO

rcain@healthbridge.org

Redwood MedNet

Will Ross, COO

wross@redwoodmednet.org

Thayer County Health Services

Joyce Beck, CEO

jbeck@tchsne.org

HIMSS 2010 38

Thank You

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The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase

does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal

Health Architecture or the Department of Health and Human Services.