This is part 2 of the Central Illinois HIE Summit: Patient Care & Connectivity, held Sept. 21, 2011 in East Peoria, Illinois. Joy Duling, Interim Executive Director of the Central Illinois Health Information Exchanges, explains how a Health Information Exchange works. Duling is introduced by Dr. Gail Amundson, President and CEO of Quality Quest for Health of Illinois.

1. How HIE Works September 21, 2011 Joy Duling Interim Executive Director Central Illinois HIE www.cihie.org

3. Countless Similar Stories My Story What We Heard in Our Planning Process

4. In a 2010 National Survey The average number of doctors seen for all survey participants was 18.7. For 18-24 year olds, the average was 8.3. For patients over 65, the average was 28.4. Women reported having seen more doctors on average (20.6) than men (16.7). Patients with income under $20,000 a year reported seeing more doctors on average (22.4) than the patients with incomes over $75,000 a year (18.1).

5. As high as the numbers from the survey are, if you looked at ALL clinicians that these patients have seen, the numbers probably would have been much higher. Anesthesiologists Radiologists Pathologists Physicians assistants Nurse practitioners Chiropractors Physical therapists Etc.

6. So, What Happens When Clinicians Encounter Pieces? We Fax Things Around. We Mail Things Around. We Call to Get Details. We Ask Patients to Recount Their Treatment From Memory. We Re-Order Tests that May Have Already Been Completed. We Log Into Different Hospital Portals to See What Information Exists. Each Clinician is Their Own Island, Making Decisions Based on What He/She Personally Knows.

7. The HIE Vision “The right information at the right time” SECURE PORTABLE ACCESSIBLE CONTEXTUAL

8. “If You’ve Seen One HIE, You’ve Seen One HIE” The eHealth Initiative has been tracking the progress of health information exchange initiatives for seven years. In 2010, eHIidentified 234 active health information exchange initiatives across the country. Clearly, the desire to connect all our disparate medical information is stronger than ever.

9. 50 percent of respondents reported a reduction in cost of clerical administration time from 2009 to 2010; 30 percent saw a reduction in lab and radiology staff time; 75 percent reported a reduction in redundant tests; 78 percent realized a reduction in medical errors; and 133 percent reported a reduction in write-offs or accounts receivables for providers. Respondents also indicated that they were better able to fulfill provisions of the American Recovery and Reinvestment Act (ARRA) that tie incentive payments to the meaningful use of EHRs.

10. Goals for HIE in Central IL By bringing information together into a more complete picture, we aim to: Improve care coordination Decrease duplicate tests & services Reduce medical errors Provide better information to patients Improve overall health in our communities

11. How Does HIE Do All This? Whenever there’s a sea of information that makes it difficult to find exactly what you’re looking for, a technology emerges to help people make sense of that information. Websites Google Travel options Expedia Sports Scores Stats.com Global News CNN

12. Show Me Information on Gardening!

13. Show Me Information on Travel to New York

14. Health Information Exchange (HIE) Software Show Me Information on Jane Miller

15. Top Uses for HIE Emergency Department Scenario 1: A patient presents to a hospital Emergency Department with an acute condition and is able to provide only sketchy details on previous care or conditions. Current Perspective: No info available in hospital’s EHR With HIE: Search of the HIE reveals lab results and reports from other HIE-participating hospitals and clinics

16. Emergency Department Scenario Two: A patient has been seen by his Primary Care Physician (PCP) on the previous day and now presents to a hospital Emergency Department for care related to that encounter. Current Perspective: PCP may not be connected to or using the hospital EHR. With HIE: Search of the HIE provides encounter and treatment plan from the patient’s PCP.

17. Hospital Acute Care Scenario One: A hospitalist is working with an unaccompanied, confused patient who is new to the hospital. Current Perspective: Patient is new to hospital, so no history is found in the hospital EHR. With HIE: Search of the HIE provides a problem list, medication list and a documentation of the patient’s recent visits with his PCP.

18. Hospital Acute Care Scenario Two: A discharge planner has identified a patient who may be at risk for failure to follow through on appointments and obtain necessary care for chronic conditions. Current Perspective: Discharge planner may not be notified that a patient has failed to show for follow-up appointments. With HIE: Search of the HIE provides documentation of the follow-up visit and allows the discharge planner to track progress.

19. Ambulatory Care Scenario One: A patient arrives for a scheduled follow-up appointment after hospital discharge. Current Perspective: The hospital discharge report may not have been received yet. With HIE: Search of the HIE provides immediate access to hospital record, including labs, procedures, tests and discharge summary.

20. Ambulatory Care Scenario Two: A patient requires a referral to a specialist. Current Perspective: Specialist needs last office visit documentation including relevant tests and procedures that have been performed. PCP requires consultation note after the visit. With HIE: Through the HIE, patient documentation can be sent to the specialist with confirmation of receipt and reminders can be created for referral tracking.

21. Health Information Manager Scenario One: A patient requests that her information be sent to another facility or provider. Current Perspective: Release of information form must be signed; patient information must be printed and faxed to facility or provider. With HIE: Through the HIE, patient documentation can be sent instantly and securely to the facility with automatic confirmation of receipt.

22. What About Patient Privacy? In the original HHS privacy rule, a core component of HIPAA’s purpose was the ability to protect patient privacy while at the same time allowing the sharing of personal health information to facilitate patient care.

23. The Three A’s of Security Authenticate– validate identity of the user seeking access to data; Authorize– determine user role as the framework for allowing access; Audit– trigger an examination of the system and all user activities, including data collection and audit reporting.

25. Where is Health Information Technology Headed? “Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system. Physicians and institutions trying to practice highest-quality medicine without HIT are like Olympians trying to perform with a failing heart.” David Blumenthal, M.D., M.P.P. Office of National Coordinator for HIT December 2009

26. HIE, the Future and YOU As a clinician As a health information professional As a consumer As a member of our community

27. Q&A Dr. Gail Amundson President / CEO Quality Quest for Health of Illinois Joy Duling Interim Executive Director Central Illinois HIE