Connecting to the Future: The Use of Electronic Health Information Exchange to Reduce Health Disparities

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Connecting to the FutureThe Use of Electronic
Health Information Exchange to Reduce Health
Disparities
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SMRTNETSecure Medical Records Transfer Network

• An Expandable Health Information Exchange for
  Treatment Providers and Their Support Systems

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• Where Are Your Health Records?
• Physician(s)
• Hospital(s)
• Specialist(s)
• Pharmacy (local, chain, mail in)
• Indigent clinic
• FQHC
• Laboratories
• Native American facility
• Veterans Administration
• Public health

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• Who Has Scattered Records?
• Hospital and ED use
• Uninsured
• Moved
• Change Insurance
• Change provider
• Health Department
• Community health center
• VA
• Native American
• Elderly
• Specialist use

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Here is Enrico, our patient
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Chronic Headaches
Diagnosed With Asthma 5-27-99
Prescribed medication for Elevated LDL
Cholesterol 12-22-05
Diagnosed With Depression 4-29-06
Diagnosed with IBS 9-30-02
Diagnosed With Arthritis 4-29-06
Foot Surgery 1-15-02 Bone Spur removal
Enrico has disconnected healthcare providers,
records, timeframes
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Chronic Headaches
Diagnosed With Asthma 5-27-99
Prescribed medication for Elevated LDL
Cholesterol 12-22-05
Diagnosed With Depression 4-29-06
Diagnosed with IBS 9-30-02
Diagnosed With Arthritis 4-29-06
Foot Surgery 1-15-02 Bone Spur removal
SMRTnet brings them together.
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Why This is So Important

• Our medical records are scattered. This costs
  lives, injuries, and significant money
• Our medical system is largely paper based.
  Paper Kills

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Three county area

• 24.1 families under poverty level
• 33.5 Native American
• Median family income
• Area 28,320
• State 35,313
• US 42,409

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An Inclusive Safety Net Project

• One of the most inclusive exchanges in the
  country
• Data exchange agreement being used by HHS to help
  them resolve issues at the national level
• 1.5 million AHRQ Transforming Healthcare
  Quality through Information Technology
  (5-UC1-HS016131-02), 1.9 million local sources

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One of Every Provider Institution

• Public Health Oklahoma State Department of
  Health
• Mental Health Oklahoma Department of Mental
  Health and Substance Abuse Services
• Hospital Tahlequah City Hospital
• Native American Tribe Cherokee Nation Health
  Services
• University Northeastern State University
• Indian Health Service Hastings Indian Medical
  Center
• Community Health Center NEO Comm. Health Center

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Types of eRecords

• Community record
• Eprescribing
• Personal health record

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Data to be SharedBased on Continuity of Care
Record

• Demographics
• Allergies and Reactions
• Diagnosis
• Pharmacy
• Laboratory results
• Immunization
• History/visits
• Providers
• Five health risk factors as defined by prevention
  science taskforce, aspirin use, cholesterol,
  blood pressure, alcohol abuse, tobacco
• Social history
• Insurance
• Advanced directives
• Plan of Care

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Types of Providers

• Hospitals
• Community Health Centers
• Public Health
• Mental Health and Drug Abuse
• University
• Tribal Health
• Indian Health Service

• Physicians
• Dentists
• Pharmacies
• Chiropractors

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Benefits of Community Record

• Accurate history from all sources in the network.
  
• Improve diagnostic speed
• Decrease repeat tests and rule out need for other
  tests
• Improve quality from seeing activities that have
  occurred elsewhere
• Coordinate care as all provider share the same
  record
• Track clients between ED and other health
  facilities

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Benefits of ePrescribing

• Improve patient safety
• Right drug
• Least expensive drug
• Right spelling
• Right dosage
• Up to date pharmacy science
• Eliminate drug interaction
• Catch drug abusers
• Prescriptions sent electronically, fax, or
  printed out, no handwriting
• Can see if patient is refilling prescription

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Benefits of Personal Health Record

• Allows patient to see their health information in
  an understandable way
• Can add information such as herbals, allergies
  and reactions
• Allows patient to audit chart use

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How A Health Information Network Can Improve
Health Disparities
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Gather Data from Many Sources for Quality
Improvement and Research

• Special populations use many providers
• Only aggregated data will give enough information
  over time to establish comprehensive health facts
• Data is standardized in measurement systems
• Data is current

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Lower cost of Care for the Uninsured

• Recent SMRTNET Oklahoma City ten hospital study
• ED reductions from network
• 1,714,000
• Reduced lab 351,002
• Reduced inpatient and observations
• 7,439,713
• Total of 9,504,762

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Common Science Based Prevention

• Research group chaired by David Satcher, National
  Commission on Prevention Priorities
• Ranked 25 leading prevention measures based on
  best science available
• Based on effectiveness and cost effectiveness
• Published American Journal of Preventative
  Medicine 2006
• www.prevent.org/content/view/46/96/

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Oklahoma Health Rankings

• Conditions OK US
• Heart Disease 307.1 240.8
• Stroke 66.4 56
• Smokers 26.0 20.8
• High bp 28.0 24.8
• High chol. 32.0 33.1
• Binge drinking 13.0 14.9

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Measures Selected

• Intervention CPBCE Score
• 1) Discuss Benefits of daily aspirin use 10
• 2) Measure blood pressure and treat 8
• 3) Screen for lipid disorders and treat 7
• 4) Screen adults for tobacco use,
• provide brief counseling, offer
• pharmacotherapy 10
• 5) Screen those at risk for problem 8
• drinking and provide counseling
• and follow-up

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Geographic Pockets Can Be Identified for More
Intense Efforts

• Sometimes health problems are more intense in
  pockets, such as injuries, communicable diseases,
  and environmental influences
• These areas can them be more focused for
  intervention

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Customized Algorithms Can Be Developed

• Different populations may need different
  algorithms
• System can be programmed to provide alerts

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Build an Electronic Health Record for the
Uninsured

• If we are not going to insure people then we need
  to at least provide them with a portable
  electronic health record
• Can be accomplished by creating a phantom
  insurance company and submitting claims to it

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Improve Funding Environment

• Grants are available based on data
• Special population health data can help qualify
  an area for these grants
• Health centers can be established through some of
  these grants
• Opportunities for intervention care research

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Cost to Oklahomans from Disconnected Health
Records

• 1.2 billion in healthcare costs of 20.1
  billion health care expenditures in Oklahoma
• This is a minimum of 6 of all health
  expenditures
• 1,139 potential lost lives
• Estimate based in U.S. Center for
  Medicare and Medicaid Services 2004 and medical
  inflation at 6.65 through 2007. 1.7 billion
  projected by 2011 against medical costs of 25.8
  billion.

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Overview of Cost Savings for Statewide Adoption
of SMRTNET

• Year All Oklahoma State Govt. Medicaid
  Deaths Avoided
• 2007 100.6 million 20.1 million 10.1
  million 101
• 2008 205.1 million 41.0 million 19.8
  million 172
• 2009 349.7 million 69.9 million 32.3
  million 247
• 2010 539.8 million 107.9 million 48.2
  million 325
• 2011 784.8 million 156.9 million 67.7
  million 407

Total Cost Based on Percentage of Providers Using
System
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Cost Benefits Based on Statewide SMRTNET
Initiative

• Prescription Savings and Fraud and Abuse are the
  largest areas for potential savings

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In summary, HIE can help reduce health
disparities by

• Gather data from many sources for treatment,
  quality improvement and research
• Lower costs for the uninsured
• Customize algorithms for special populations
• Identify pockets and address those specifically
• Build an electronic health record for the
  uninsured
• Improve funding by providing special population
  data