1. 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 8 th -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

2. Western Nebraska Health Information Exchange Project Staff Meeting Presentation: June 2007

3. 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

4. An Emerging Vision Nationally By computerizing health records, we can avoid dangerous medical mistakes, reduce costs and improve care. President Bush State of the Union, 2004

5. An Emerging Vision Nationally In 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

6. Annual Projected Savings Inpatient Savings$ 31.3 B Outpatient Savings$ 15.9 B

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

9. Misalignment of benefits – 89% of the savings go to purchases and insurers, 11% goes to providers ProvidersOthers Source: Center for Information Technology Leadership, 2003 Ambulatory Computer-based Provider Order Entry

10. Vision for a Regional Health Information Exchange VISION A sustainable system of healthcare for the region developed through collaboration and cooperation which respects the autonomy of partners. MISSION Enhance patient safety quality of care through the effective exchange of health information among all providers and partners.

11. 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

12. Funding

13. Architecture Not necessarily one big, centralized database Patient matching at the core

14. 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

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

16. 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.

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

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

19. 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