1. Midwestern Grandparents on Vacation
TUESDAY, 10:00 – 10:50AM
Midwestern Grandparents on Vacation
Communities Working Together to Improve Quality, Safety and Efficiency Using the NHIN
Rodney Cain, Chief Information Officer, HealthBridge
Joyce Beck, Chief Executive Officer, Thayer County Health Services
Will Ross, Chief Operating Officer, Redwood MedNet

2. 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
HIMSS 2010

3. TUESDAY, 10:00 – 10:50AM
Rodney Cain, CIO

4. 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
HIMSS 2010

5. 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
HIMSS 2010

6. 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.
HIMSS 2010

7. HealthBridge NHIN Architecture
Independent. Labs, Imaging & Diagnostic Centers
Independent Practices
Health System
Exchange with NHIN,
Other HIEs
Ambul. EHR
Push & Pull Capability
Use Case Specific
Data
Stores
Community Patient / Provider Index
Integration Layer
NHIN Gateway
Adapter APIs / Web Service API
Inpt EHR
PMS, EHR
LIS, RIS, etc
Quality Reporting
Results /
Orders / Summary Record
Summary Record Exchange
Results
Delivery
Registry
eRx
Basic ASP EHR
Modular EHR
Exchange Services
Public Health Reporting
Order Entry
Applications
NHIN
Other Providers - Pharmacies, Nursing Homes, etc.
Inbound / Outbound Interfaces
Patient Discovery
Document
Query
/ Retrieve
Consumer
Preferences
HIMSS 2010

8. HealthBridge Use of NHIN
Center for Medicare and Medicaid Services
CARE–Health Information Exchange Project (C-HIEP)
Social Security Administration
Disability Benefits Determination
HIMSS 2010

9. Cross Country Data Exchange Demonstration
Midwestern Grandparents on Vacation
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
HIMSS 2010

10. Midwestern Grandparents on Vacation
CBC & CMP tests
Upper GI Test
Rx history
Cardiac Enzymes
EKG
Stress Test
HIMSS 2010

11. Summary Record View from ER at HealthBridge
HealthBridge Demonstration – Lab Report
HIMSS 2010

12. Will Ross, COO Launching Redwood MedNet Policy Themes
TUESDAY, 10:00AM – 10:50AM
Will Ross, COO
Launching Redwood MedNet
Policy Themes
CONNECT Demonstrations

13. California Redwood MedNet HIE Home Region
Pacific Ocean
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
HIMSS 2010

14. Redwood MedNet Startup Funding
Since 2005
$1.2 Million in Grants
About $100,000 in contracts or revenue
HIMSS 2010

15. 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
HIMSS 2010

16. 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
HIMSS 2010

17. 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
HIMSS 2010

18. 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
HIMSS 2010

20. 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 Internet in 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
HIMSS 2010

23. 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
HIMSS 2010

24. 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
HIMSS 2010

25. 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
HIMSS 2010

26. 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
HIMSS 2010

27. 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
HIMSS 2010

29. CONNECT v2.0 Demonstration in 2009
HIMSS 2010

30. Summary Record View from Redwood MedNet
HIMSS 2010

31. Joyce Beck, MS, CEO NHIN Connectivity Through The Eyes Of A Patient
TUESDAY, 10:00 – 10:50AM
Joyce Beck, MS, CEO
NHIN Connectivity Through The Eyes Of A Patient
How Connectivity Improves Patient Care
Southeast Nebraska Health Information Exchange (SENHIE)

32. 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
HIMSS 2010

33. 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
HIMSS 2010

34. 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 USB bracelet at patient request
HIMSS 2010

35. 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
HIMSS 2010

36. 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
HIMSS 2010

37. Summary Record View from Thayer County
HIMSS 2010

38. Midwestern Grandparents on Vacation
HealthBridge Rodney Cain, CIO Redwood MedNet Will Ross, COO Thayer County Health Services Joyce Beck, CEO
HIMSS 2010

39. Thank You
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.