Why?

Between 44,000 – 98,000 people die each year in the United States as the result of medical errors.

This exceeds the number attributable to the 8th-leading cause of death.

More deaths that are attributable to: Motor vehicle accidents (43,458)

Breast cancer (42,297) AIDS (16,516)

Source: Building a Safer Health System, Institute of Medicine To Err is Human

Western Nebraska Health Information Exchange Project

Staff Meeting Presentation: June 2007

What isn’t working now?

Almost 1/3 of the $1.6 trillion the US spends on healthcare goes to care that is:

Duplicative Fails to improve patient health May even make it worse

Source: Building a Safer Health System, Institute of Medicine To Err is Human

An Emerging Vision Nationally

By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care.

President BushState of the Union,

2004

An Emerging Vision NationallyIn the 20th Century, bricks and mortar constituted the

basic infrastructure of the healthcare delivery system. To deliver care in the 21st Century, the system must be based upon a health information and communications technology infrastructure that is accessible to all patients and providers.

Institute of Medicine,Foster Rapid Advances

in Health Care, 2002

Annual Projected Savings

Inpatient Savings $ 31.3 BOutpatient Savings $ 15.9 B

Source: Healthcare Financial Management Association. (2006, February). Overcoming Barriers to Electronic Health Record Adoption. Westchester, IL: Author.

Misalignment of benefits – 89% of the savings go to purchases and insurers, 11% goes to providers

% of Savings Captured by

89% 11% ProvidersOthers

Source: Center for Information Technology Leadership, 2003

Ambulatory Computer-based Provider Order Entry

Vision for a Regional Health Information Exchange

VISIONA sustainable system of healthcare for the region developed through collaboration and cooperation which respects the autonomy of

partners.

MISSIONEnhance patient safety quality of care through

the effective exchange of health information among all providers and partners.

Rural Nebraska Healthcare Network and its members

Box Butte General Hospital Chadron Community Hospital Garden County Health Services Gordon Memorial Hospital Kimball Health Services Memorial Health Center Morrill County Community

Hospital Perkins County Health Services Regional West Medical Center

Panhandle Community Services Health Clinic

Panhandle Mental Health Center Panhandle Public Health District

Partners

FundingRND – Longterm care, clinics, FQHC, public health

Vendor-based Solution

Legal & Governance

Capacity-building

AHRQ – Hospital-centric

Architecture

Not necessarily one big, centralized database

Patient matching at the core

Technological

Widely varying levels of sophistication and of products!

Regional West Medical Center – McKesson Most Wired Rural Hospital (2003, 2004)

3 hospitals - No EHRs, no computers at key work sites, no functional network.

1 Physician-designed – not interoperable

Clinic-only EHR

1- CPSI 1 - Dairyland

Hammond, W.E. (2005). The making and adoption of health standards. Health Affairs, 24, 1205-1213.

Privacy, Security, Confidentiality Complex issues and regulations

HIPAA State law Electronic vs. “physical” security Opting in or out of EMRs/HIEs Access to information is a hiring and training issue!

In a recent Harris Poll, 48 percent of adults said that EHRs' benefits to patients and society outweighed the risks, while 47 percent said the opposite (1)

(1) Westin, A.F. (2005, February). Public attitudes toward electronic health records. Privacy & American Business. Vol. 12(2), 1-5.

Rogers, E.M. (1995). Diffusion of Innovations, 4th ed. P.163.

Diffusion Model

Venkatesh, V., Morris, M.G., Davis, G.B, & Davis, F.D. (2003). User acceptance of information technology. MIS Quarterly, 27, 425-478.

Keerun’s Public Health Survey Communicable Disease HIV/AIDS Nebraska Newborn Screening Program Newborn Hearing Screening Chronic Disease Nebraska Cancer Registry Nebraska Trauma Registry Immunization