1. Plenary Session #1 “What Technology is currently available to support care in the home for older adults?” Medical / Personal Records SPRY NATIONAL CONFERENCE "Computer-Based Technology and Caregiving for Older Adults“ October 2–3, 2003 NIH Campus/Natcher Conference Center Bethesda, Maryland www.ptsafety.org

2. PATIENT SAFETY INSTITUTE OpportunityOpportunity …access to a timely, accurate, consolidated patient-centric view of critical clinical information. Solving one of the major problems of care coordination…

3. PATIENT SAFETY INSTITUTE ProblemProblem Every year preventable medical errors cause: Death to approximately 100,000 hospitalized Americans (more than breast cancer, traffic accidents and AIDS) Injury to one million more hospitalized Americans Indirect tax (cost) of $29B to the nation Healthcare cost escalation is out of control 2003 health premiums increased 13%, largest increase in decade In 2002, 20% of states' budgets was for Medicaid, creating fiscal crisis in many states One in seven Americans are without health insurance

4. PATIENT SAFETY INSTITUTE SolutionSolution Studies have indicated that well over half of all preventable deaths and over $40B in annual cost could be saved if clinicians had current clinical information at the point of care or decision. National Medical Information Exchange

5. PATIENT SAFETY INSTITUTE Patient Safety Institute Is PSI is an industry represented non- profit organization focused on BUILDING a secure, "trusted" national, medical information exchange network. PSI provides (with patient permission) real time access to critical patient information at the point of treatment or decision similar to the way VISA ® provides real time financial information at the point of service. PSI completes missing connectivity, replacing nothing and joining relevant electronic clinical data within and outside the community.

6. PATIENT SAFETY INSTITUTE Requirements for National Medical Information Exchange "Trusted" cross-industry representative governance Non-profit Core mission of patient privacy, security and choice Open, non-proprietary, scalable infrastructure architecture National design while community driven –Connectivity to national data sources –Single membership model rather than peer to peer contract model Single focus on healthcare network access for all (like VISA® for financial information) States

7. PATIENT SAFETY INSTITUTE The Board of Directors includes nine representatives drawn equally from national leaders in the patient, physician and hospital communities. This composition ensures the safety and security needs of each group are being met as PSI delivers its solution to the marketplace. –Chair and President: Dr. Jack Lewin, CEO of the California Medical Association –Vice Chair: Don Black, President of the Child Health Corporation of America –Secretary/Treasurer: Dr. Jane Delgado, President and CEO of the National Alliance for Hispanic Health –Twila Brase, RN, PHN, President of Citizens’ Council on Health Care –Dr. Richard F. Corlin, past President, American Medical Association –Sister Karin DuFault, Ph.D.,RN, Vice-President, Providence Health System (former Board Chair) and Trustee of Catholic Health Association –Linda Golodner, President of the National Consumers League –Dr. William Jessee, President of the Medical Group Management Association –Dr. Daniel H. Winship, Petersdorf Scholar in Residence, Association of American Medical Colleges (former Vice Chancellor for Health Affairs and CEO, Univ. of Missouri Health Care) The Board is advised by Dee Hock, Founder and CEO Emeritus of VISA ® in areas of governance and structure. PSI Governance

8. PATIENT SAFETY INSTITUTE PSI – Technical Overview PSI Hub Physician Patient Community Labs Community Pharmacies Hosp./Clinic B Hosp./Clinic A 1 1 Physician requests information using a PDA or Browser. The request is transmitted to the PSI Hub 1 2 2 2 2 The PSI Hub sends a request/response message to retrieve the local “Basic Safety Data,” or “BSD” 2 3 3 The PSI Hub gathers and formats the BSD. The BSD is then transmitted to the requestor, formatted to the appropriate device footprint 3 Pharmacist Patient

9. PATIENT SAFETY INSTITUTE Patient Portal (of patient’s choice) Caregiver Physicians Services Research, Treatment & Clinical Trial Information Hosp./Clinic Community Labs Community Pharmacies PSI – Patient Connectivity PSI Hub Physician Patient Review Append Contribute Communicate Patient Pharmacist Patient

10. PATIENT SAFETY INSTITUTE PSI National Hub* State Y Model State X Model Patient Portals National Patient Verification & Supplemental Data Insurers National Diagnosis Meds, Immunizations & Enrollment Lab Co’s National Labs PBMs & Pharmacies National Meds & Allergies State Programs Immunizations & Other State Registries Medicaid, SCHIP State-Funded Indigent Care Head Start WIC Community Health Centers Workers’ Compensation EMS Correction Facilities Food Stamps Etc. Physician Data Integrators Physician Portals, ASPs and large clinics * State Public Policy & Academic Research* Hospitals & Other Providers Basic Safety Data * Individual Physicians Via State Designee (State Medical Society or Licensing Board) * * w/Patient Permission State Z Model PSI Core with State Specific Functionality PSI National/State Community Approach Medicare & Employers Claims Data & Enrollment

11. PATIENT SAFETY INSTITUTE Additional Information

12. PATIENT SAFETY INSTITUTE  Participation must be equitably open to all individuals and organizations that materially affect patient health and safety.  Deliberations must be conducted, and decisions made, by bodies and methods that reasonably represent all such parties, controlled or dominated by none.  Individually identified data must remain the property of that individual and must not be disclosed or disseminated to others without that individual's consent.  All participation shall be voluntary with the right to withdraw.  Any data accessed for the development of improved health or patient safety must be de-identified and remain under the control of PSI.  PSI operation will only be funded by those means which do not compromise the above principles.  PSI will be designed and will function to enable and enhance community-based collaboration for improved health and patient safety. PSI Principles

13. PATIENT SAFETY INSTITUTE  Improve healthcare quality  Reduce medical errors  Lower the cost of health care  Strengthen the privacy and security of patients, physicians, and hospitals  Enhance the patient-physician and hospital- physician-patient relationships PSI Goals

14. Thank You QUESTIONS?