Bringing Health Information Exchanges and Public Health Together: The Indiana Perspective Shaun Grannis, MD MS FAAFP Medical Informatics Research Scientist, Regenstrief Institute Assistant Professor of Family Medicine, I. U. School of Medicine
Overview: What We’ll Cover § Current Status of Public Health HIE Activity in Indiana § Future Directions § HIE impact on Patient Care and PH outcomes © 2008 Regenstrief Institute, Inc.
Why Health Information Exchange? © 2008 Regenstrief Institute, Inc.
RHIO =HIE
NHIN – A Nationwide Vision
The Indiana Network for Patient Care (INPC) An operational community wide electronic medical record
Silos of Information Immunization Registry Data delivered to immunization registry Data delivered to EMR Electronic Medical Record System Jane Receives Immunizations @ Health Department and other care (measurements, labs, diagnoses, etc) @ Clinical Practice
Silos of Information Immunization Registry Web Interface EMR Interface Electronic Medical Record System ? ? ?
Aggregating Patient Data Immunization Registry Electronic Medical Record System Jane Doe’s 123 LMNOP Patient ID: Immunizations: Name: Jane Doe 3/1/04 Dip. Teta. Pur 30936 -9 DOB: 01/01/04 30938 -5 3/1/04 Hem. Inf. B SSN: N/A 33555 -4 3/1/04 555 Johnson Road Address: Polio. Vir 30937 -7 3/1/04 Hepa. B City: Indianapolis State: Indiana ZIP: 46202 Patient ID: Doe’s Shots: Jane Ellen 6789 XYZ Name: Jane Ellen Doe DOB: 01/01/04 5/1/04 DTa. P Imm 30936 -9 30938 -5 SSN: 123 -45 -6789 5/1/04 HIB Imm 33555 -4 Address: IPV Imm 5/1/04 555 Johnson Road City: Indianapolis 7/9/04 DTa. P Imm 30936 -9 33555 -4 State: Indiana 7/9/04 IPV Imm ZIP: 46202 DTa. P Dose Count: HIB Dose Count: IPV Dose Count: VZV Dose Count: MMR Dose Count: Hep. B Dose Count: 30936 -9 30938 -5 33555 -4 30943 -5 30940 -1 30937 -7 Global Patient Index Global ID: 45678 Name: Jane Ellen Doe Lots of Demographics. . MRF 1 ID: OU 81247 MRF 2 ID: 4564356 PH MRF ID: 123 LMNOP Concept MRF 3 ID: 6789 XYZ Dictionary
Regional Health Information. Data Exchange Aggregating Patient Hospital A MRF Hospital C MRF Global Patient Index Immunization Registry Public Health MRF Global Patient Index Electronic Medical Record System IUMG MRF Concept Dictionary Hospital D MRF Concept Dictionary Hospital B MRF
Data Reuse Data Management Data Access & Use Hospitals Hospital Payers Health Information Exchange Physicians Labs Negotiated Access. Labs Data Repository • • • Results delivery Secure document transfer Shared EMR Credentialing Eligibility checking • • • Results delivery Secure document transfer Shared EMR CPOE Credentialing Eligibility checking • Results delivery Network Applications Public Health Physician Office • Surveillance • Reportable conditions • Results delivery Payer Outpatient RX • Secure document transfer Researchers • De-identified, longitudinal clinical data Public Health Ambulatory Centers
Current PH-HIE Activities § Automated Electronic Laboratory Reporting § Syndromic Surveillance / Situational Awareness § Results Delivery / Broadcast Messaging § Newborn Screening Prototype © 2008 Regenstrief Institute, Inc.
Automatic Electronic Laboratory Reporting
Notifiable Condition Detector Realtime Inbound Message Compare to Dwyer I Potentially Reportable Record Count as denominator Abnormal flag, Organism name in Dwyer II, Value above threshold Reportable Condition E-mail Summar y Daily Batch To Public Health Reportable Conditions Databases Print Reports To Infection Control
ELR Completeness 4, 785 total reportable cases INPC– 4, 625 (97%) Health Dept – 905 (19%) Hospitals – 1, 142 (24%)
Syndromic Surveillance Situational Awareness © 2008 Regenstrief Institute, Inc.
Current PHESS Hospitals (n=76) 6, 500 – 7, 000 visits per day ~ 15 MB data per day
Results Delivery: Connections to Healthcare Providers and Public Health © 2008 Regenstrief Institute, Inc.
© 2008 Regenstrief Institute, Inc.
© 2008 Regenstrief Institute, Inc.
Enhancing Newborn Screening Follow-Up © 2008 Regenstrief Institute, Inc.
Registration Test present? NBS Yes/No INPC Clinical Reminders
Future Directions § Refine/Expand PH-HIE data sharing processes § § § Expanded interactions/roles for PH and clinical health care § § Augment existing information (patient, doctor, conditions) Provide access to additional information (in both directions) Immunization decision support Notifiable reporting reminders (e. g. , STD’s) Clinical treatment reminders (e. g. , stool cultures during Shigella outbreak) Expanded Dialog between PH and HIE to better align growth/avoid redundancies © 2008 Regenstrief Institute, Inc.
Bringing Health Information Exchanges and Public Health Together: The Indiana Perspective Shaun Grannis, MD MS FAAFP Medical Informatics Research Scientist, Regenstrief Institute Assistant Professor of Family Medicine, I. U. School of Medicine
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