View
213
Download
0
Category
Tags:
Preview:
Citation preview
April 2013Adel A. Al-Marshad, MD
Emergency MedicineUC San Diego Health Sciences
“ Information should follow the patient, and artificial barriers – technical, business-related, bureaucratic – should not get in the way ”
– David Blumenthal, MD, Former Director, ONC
Technology, Innovations and Emergency Medicine – Where is the Value?
• Providers in the ED: Full picture of the patients, including access to previous tests, becomes available real time
• Providers in the ambulatory setting: Understanding of when their patients end up in the ED due to an exacerbation – could it have been avoided?
• Providers out in the field (EMS): Close alignment with hospital if acute action is required – long term potential to generate hot-spotting data.
3
Overview• Funded by ARRA HITECH Act administered by
the Office of the National Coordinator for Health Information Technology
• $15 million over three years to use health IT to improve health care delivery in San Diego as model for nation
• Transition from a grant-funded initiative to an self-sustaining independent organization providing services to the health care community
4
• No dominant health care entity (Scripps, Sharp, Kaiser, Rady, UCSD)
• 24% of all 30-day readmissions occurs at a different hospital than the first admission (nearly 30% for Medi-Cal patients)
• 15% of all ED patients and 69% of “frequent fliers” were seen in multiple hospitals
San Diego
Cardiovascular Disease Childhood ImmunizationsSyndromic Surveillance
Redundant TestsED/hospital Readmissions
San Diego Beacon
• Build and Strengthen Health IT• Community Health Information Exchange
• 3 Part Aim
• Test Innovative Approaches
Kaiser
SD VA/DOD
EMS
County PH
Clinics
Others
Hospitals
Initiatives
Meaningful Use
• Improve Quality, Population Health, Costs
Cardiovascular Disease Childhood ImmunizationsSyndromic Surveillance
Redundant TestsED/hospital Readmissions
San Diego Beacon
Improve Cost, Quality, andPopulation Health
10
www.sandiegobeacon.org
Health IT
• Two recent studies indicate significant cost savings, reduction in testing in EDs with access to community HIE
HIE: Quality & Cost
• Patients seek care at different systems– Lack of timely patient information at point-of-care
• Care not coordinated among providers– Medical errors– Risks of unneeded evaluation
• Increased Costs– Repeat testing– Redundant evaluations
Care Transitions Initiative
• Collaboration between San Diego County HHSA and San Diego Beacon Community
• Reduce 30 d readmissions for high-risk population by connecting these patients to social services in the community
• 460 pts enrolled from 3 sites: UCSD-Hillcrest, Scripps-Mercy, Sharp Memorial
San Diego County ED patients and visits by type of user: 2008-2010.
Patients Total Visits^
Type of User* N % N %
Infrequent User (<6 visits) 895,489 96.73 1,592,453 78.97Frequent User (6-20 visits) 28,569 3.09 333,648 16.55Super User (>=21 visits) 1,661 0.18 90,436 4.48
Total 925,719 100.0 2,016,537 100.0
*Based on number of visits in a one year period of time between January 2008 and December 2010.
^Includes all visits between January 2008 and December 2010.
ED Visits in San Diego
Care Transitions Initiative
• Initial Results: 18% baseline 30d readmission rate reduced to 13%
Other Initiatives
• Real-time reporting for Public Health Meaningful Use
• EMS Hub: Transmit & track EMS data• Targeted readmissions reduction efforts• Messaging & notification to providers, health
plans, and payers • CRM Device data and other innovation
initiatives
Test Innovative Approaches
• Frequent Fliers / Hot Spots– 1% of SD population generates over 10% of 911
EMS calls– Disproportionately consume acute, emergency,
and safety net healthcare resources– Care provided is often mismatched with need
creating a recurring cycle
19
San Diego Beacon Community• The EMS hub is an active real-time information exchange between pre-
hospital providers and hospitals in San Diego. The system currently serves the entire San Diego City EMS region (1.7million) and 3 receiving hospitals, with expansion plans to all area hospitals.– Since launching 6 months ago, over 40,000 prehospital records have been
sent electronically to hospitals including field 12-lead ECGs; reducing false activations of the cardiac catheterization lab, improving resource utilization and reducing costs.
– During the first 6 months of the project, total field cardiac catheterization lab activations were reduced for the 3 area hospitals compared to the period before the intervention
20
• eRAP– Utilize 911/EMS data to identify FF (name), HS
(location), or key word– Trigger alerts to EMS case manager– Case manager coordinates with healthcare
providers, social services, law enforcement to get the right care for the individual
• Senior services, Housing, Treatment, other resources
21
Test Innovative Approaches
• Alerts & Actions
22
Test Innovative Approaches
Specific PatientsProject 25
Specific Neighborhood Hot Spots
ImageTrend MN
EMS HubSan Diego
San Diego, CA
eRAP
• eRAP alerts to EMS Case Manager initiated in October 2011
• Decrease in repeat visits to ED and subsequent admissions
UCSD Visits by eRAP patients
eRAP Alerts & P-25 Program
• Project 25 Example– eRAP alerts created for Project 25 clientele– Project 25 – Homeless clients identified by high
911 usage. Clients enrolled in housing and social support program funded by the United Way
– eRAP alerts case manager real-time when Project 25 client accesses 911
• Field Electronic Record & NLP Alerts
26
Test Innovative Approaches
27
Test Innovative Approaches
Elderly patient with frequent falls, 911 access, ED/hospital visitsElectronic alert fired on APS text in pre-hospital recordCase manager evaluated patient in field, contacted Adult Protective Services and directed patient to appropriate social services support
eRAP Alerts & P-25 Program
• P-25 Impact at UCSD– Comparison of ED visits by P-25 clients 6 months
before and 6 months after enrollment
Financial Impact
Ambulance ECG Transmission• Reduced false-positive catheterization activations at
San Diego hospitals with significant cost savings
• UCSD, Rady, Navy, Sharp live on EMS Hub
Public Health Reporting
• Over 700,000 lives covered to meet Meaningful Use Stage 1 reporting requirements for Immunization Reporting (participants include UCSD, Rady, Sharp, Council of Community Clinics)
• SDB to have SDIR mirror server to meet MU Stage 2 requirements
• Testing for Syndromic Surveillance reporting
Bangor Beacon Community• The value of exchange: Medical records are shared through our statewide
health information exchange – HealthInfoNet. Right now, 22 hospitals and several ambulatory practices across the state are participating.– Early results for “high risk/high cost patients” who are actively being case
managed (note: interventions include more than access to HIE, n = 721, comparing baseline to 6 months):
• Patients with at least one ED visit: 26.5% down to 17.7%• Patients with at least one non-urgent care visit: 19.9% down to 12.8%• Patients with at least one hospitalization: 25.7% down to 14.2%
31
Greater Cincinnati Beacon Collaboration
• The value of ED alert systems to patients, families and providers: 69 Beacon physician practices are currently receiving alerts, 18 to go. Participating hospitals include Mercy Health, TriHealth, UC Health, Cincinnati Children’s, St Elizabeth Health Center, The Christ Hospital– The practice transformation has begun when the team is learning how to best
respond to the alert and “pulling the patient in for care” rather than expecting the patients to call after an ED visit of hospitalization.
– Around 60% of the time, the patient had X-ray done while at the ED. Practice outreach to that family has made them aware of open access scheduling in the practice and helped coach the family on how to handle episodes in the future.
32
CCTP
• Community-based Care Transitions Program
• $15m grant over 3 years• Partnership between the HHSA/AIS, Palomar
Health, Scripps, Sharp and UCSD -11 hospitals with 13 campuses
• Targets 21,000 Medicare SD lives for case management and care coordination
• Goal to reduce 30day readmissions rate
Community HIE• Patients seek care at different system - Lack of
timely information • Lower Quality - care not coordinated among
providers • Increased Costs – repeat testing, evaluations• Providers access patient information during
treatment encounter– Summary information (meds, allergies,
problem lists)– Documents (DC summaries, notes, procedures)– Images (radiology, ECGs, etc)
Long-term Vision
• Clinical benefit and improved care– Patients, providers, organizations
• ROI for all participants– Patients see personal health value– Care delivery efficiency gains, lower costs– Support new care models (case management,
coordination, ACOs)– Federal funding for providers connecting to other
organizations electronically
35
EMR/HIEDevices - Geneva Healthcare
SummarizedHistory
At-a-glanceDashboard
Heart FailureMonitor
Latest EpisodeInfo
EMRIntegration
In-ERInterrogation
Upload
ExpandableEP Window
IDCO ProfileData
EmbeddedEKG
NSF 1237174, Information & Intelligent Systems – Project Dates: 2012-2016
DELPHI• Develop a platform to enable integrated access
to, analysis and use of all data relevant to health – medical record, genomic, behavioral, environment (built/natural)
• Overall vision is to develop and pilot a local “ecosystem” with low barriers of entry to mobile device and app developers of all kinds
• Partners: Qualcomm, SD Beacon Community, SD County, SANDAG, CONNECT
PI: K. Patrick; Co-PI’s: C. Baru, T. Chan, S. Dasgupta, B. Griswold, J. Huang,
L. Ohno-Machado, Y. Papakonstantinau
DELPHI
Multiple sources of health data• Webified hospital
medical record systems• Personal health data
(weigh-ins, run info on apps, meals…)
• Genomic data(mutations, …)
• “Environmental” data(pollution, food deserts…)
• Online research troves(journals, some data)
41
SAND
AG
Messaging/Notification• System can utilize ADT moment or patient index
list to generate message/notification and recipient– Secure direct email addresses available
• Limited clinical data to reduce risks– Consent vs HIPAA requirements
• Utility for providers, plans, payors, others– In development with CHG, Molina– Interest from UHG, P25, others
42
Messaging/Notification• Real-time patient event notifications• ED visit, hospital admission/discharge• Secure delivery of event information to interested
parties (secure email or website posting)
43
Relevant components of ADT Registration Message
MSH|DATETIME|REGISTRATION EVENTPID|MRN^LOCATION|LNAME^FNAME^MNAME|DOB|SEX|ADDRESS|PHONE NUMBER|PV1|INTERNAL PROVIDER ID^PROVIDER NAME^PROVIDER LOCATION^PROVIDER TYPEDG1|DIAGNOSIS|
Community Governance
45
• Independent entity established• Initial board slate with representation from
major healthcare providers in San Diego
Dan Gross Sharp COO Rob Smith, MD VA CMO
Albert Oriol Rady CIO T. Gehring CEO, SDCMS
David Guss, MD UCSD DEM Chair N. Macchione HHSA Director
Bill Spooner Sharp CIO L. Ferrari Anthem/BC
Joe Traube, MD Scripps CMIO J. Burritt, RN Kaiser
S. Escoboza CEO, HASDIC N. Diaz CEO, CHG
S. O’Kane CEO, CCC R. Brown CEO, Scripps Green
PHI Security
• Each participating organization maintains its own consent policy around sharing health information
• No clinical data are stored centrally• Data storage and transmission protocols
adhere to the most recent security guidelines
Long-term Vision
• Clinical benefit and improved care– Patients, providers, organizations
• ROI for all participants– Care delivery efficiency gains, lower costs– Support new care models (case management,
coordination, ACOs)– Federal funding for providers connecting to other
organizations electronically
47
Questions?
Adel A. Al-Marshad, MDaalmarshad@ucsd.edu
Recommended