Creating Health Information Exchanges: The Indiana Network for Patient Care

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Creating Health Information Exchanges The
Indiana Network for Patient Care

• Shaun Grannis, MD, MS
• Research Scientist
• Regenstrief Institute / IU School of Medicine

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The Challenge Silos of Information
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Silos of Information
Data delivered to immunization registry
Jane Receives Immunizations _at_ Health Department
Jane Receives Immunizations and other care
(measurements, labs, diagnoses, etc) _at_ Clinical
Practice
Immunization Registry
Data delivered to EMR
Electronic Medical Record System
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Silos of Information
Registry Web Interface
???????????
Immunization Registry
EMR Interface
Electronic Medical Record System
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INPC - Humble Beginnings

• Regenstrief tasked in 1972 to stitch these
  silos of information together - the Regenstrief
  Medical Record System (RMRS/Wishard)
• In 1994, began stitching together information
  across institutions (INPC/Indianapolis)
• In 2003, working towards stitching the state
  together (INPC/Indiana)

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Consolidating the Silos
Patient ID 123LMNOP Name Jane Doe DOB
01/01/04 SSN N/A Address 555 Johnson
Road City Indianapolis State Indiana ZIP 46202
Jane Does Immunizations 3/1/04 DipTetaPur 3/1/0
4 HemInfB 3/1/04 PolioVir 3/1/04 HepaB
DTaP Dose Count 30936-9 HIB Dose
Count 30938-5 IPV Dose Count 33555-4 VZV Dose
Count 30943-5 MMR Dose Count 30940-1 HepB Dose
Count 30937-7
30936-9 30938-5 33555-4 30937-7
Global Patient Index
Immunization Registry
Global ID 45678 Name Jane Ellen Doe Lots of
Demographics.. MRF1 ID OU81247 MRF2 ID
4564356 PH MRF ID 123LMNOP MRF3 ID 6789XYZ
Patient ID 6789XYZ Name Jane Ellen Doe DOB
01/01/04 SSN123-45-6789 Address 555 Johnson
Road City Indianapolis State Indiana ZIP 46202
Jane Ellen Does Shots 5/1/04 DTaP
Imm 5/1/04 HIB Imm 5/1/04 IPV Imm 7/9/04 DTaP
Imm 7/9/04 IPV Imm
30936-9 30938-5 33555-4 30936-9 33555-4
Concept Dictionary
Electronic Medical Record System
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Consolidating the Silos
The Indiana Network for Patient Care
Clarian MRF
St. Vincent MRF
Global Patient Index
Immunization Registry
Global Patient Index
Concept Dictionary
Public Health MRF
Wishard MRF
Concept Dictionary
Electronic Medical Record System
Community MRF
IUMG MRF
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INPC System Design

• Separate medical record vault per institution
• Each vault in separate physical files, but
  centrally located
• Standardized data structure All use same
  software and observation codes
• Patient demographics linking via global registry
• Combine on the fly when needed

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INPC Participants

• Includes 17 hospitals from the 5 major
  Indianapolis hospital systems (95 of non-office
  care)
• National and regional laboratories
• Includes county and state public health
  departments
• 35 of outpatient practices
• Both major cardiology
• referral centers
• Four homeless care centers

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INPC hospital participants
Heart Center of Indiana
Rx data
The Indiana Heart Hospital
In progress
MCHD
Quest
LabCorp
Health Department Practice/Clinic Hospital
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A Big Repository by US Standards

• In the system
• 1.3 million patients, 5 million registration
  events
• 24 million orders
• 660 million coded results
• 12 million dictated reports
• 8.8 million radiology reports
• 25 million prescriptions
• 480,000 EKG tracings
• 45 million radiology images
• Added Per Year
• 600,000 ambulatory encounters
• 50,000 inpatient encounters

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Docs4Docs - Links to office practices

• Results delivery service (Docs4Docs)
• Results flow through INPC central to Docs4Docs
  and are routed to MD in-boxes
• All hospitals send reports through same mechanism
• Improved office efficiency and convenience
• Eliminates mail and (almost) fax costs

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Current status

• 280 practices from 3 Hospital systems (about 1800
  MDs)
• Indiana Health Information Exchange (IHIE) is
  Regenstriefs corporate partner
• Scheduled for whole city by end of 2005 through
  IHIE
• Uses same data streams as structured EMR but
  simpler structure
• Will provide links to all MDs for other purposes

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Founding Members

• Hospital systems
• Clarian Health Partners
• St. Francis Hospitals and Health System
• St. Vincent Health Care
• Wishard Health Services
• Community Hospitals of Indiana
• Government
• City of Indianapolis
• Public Health
• State Department of Health
• Marion County Health Department
• Research
• IU School of Medicine
• Regenstrief Institute
• Medical societies
• Indianapolis Medical Society
• Indiana State Medical Association
• Economic development
• BioCrossroads / Central Indiana

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Benefits Accrue to Stakeholders Across System
Annual economic value (M)
LONG-TERM ECONOMIC BENEFIT TO CENTRAL INDIANA
WILL EXCEED 120M ANNUALLY

• Patients
• Physicians
• Hospitals
• Labs

• Physicians
• Hospitals

• Patients
• Physicians
• Hospitals
• Payors

• Patients
• Physicians
• Hospitals
• Payors
• Employers

• Patients
• Physicians
• Hospitals
• Public health
• Payors
• Employers

Beneficiaries1

• Patients
• Hospitals
• Labs
• Public health

• Patients
• Researchers
• Investigators
• Pharma companies

(1) Includes quality of care/other non-economic
beneficiaries as well Source BCG Analysis
Estimates
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Achieving full value requires structured data
Percent
76
5
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Capture electronically
Connect interface
Standardize and store data
C!TL, BCG calculations
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Questions / Discussion

• Shaun Grannis, MD, MS
• Research Scientist
• Regenstrief Institute / IU School of Medicine
• sgrannis_at_regenstrief.org