The Healthcare Safety Net

1
The Healthcare Safety Net

• A look at what patients and caregivers designed
  in Whatcom County, Washington
• Marc Pierson, MD
• Lori Nichols

2
Overview

• 1 Context
• 2 Confidentiality
• 3 Technology
• 4 Constraints
• 5 Learning
• 6 Connectivity

3

• Who is We?
• Where is Home?
• Health is broken between our organizations.

4
Healthcare Collaboration in Whatcom County

• 1990 Vision of Seamless Care
• 1994 Whatcom Integrated Delivery System
  Community Health Improvement Consortium
• 1995 SJH goes live with Community Health Record
• 1996 Whatcom Health Information Network (HInet
  Program)
• 2001 Diabetes registries, IOM report
• 2002 Pursuing Perfection Project begins
• 2006 to present Electronic Prescribing
  continues, Pursuing Perfection tenets spreading

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Current State of HIT

• Private self sustaining Health Information
  Intranet serving community
• 180 K citizens
• 1 hospital
• 400 physicians (99)
• All Skilled Nursing Facilities (9)
• Community Mental Health, Medic One, Medical
  Society, Home Health
• Over 100 locations
• Over 2700 pcs
• Over 2500 network users

6
Current State of HIT

• Hospital online robust installation of GE
  Carecast EMR accessible to all physicians
• Labs and images online
• Specialty practices importing notes GI, vascular
  lab, nephrology, echo, surgery centers
• E-mail - internet access virus spam
  protection
• Helpdesk phone and onsite service
• LAN consulting and implementation

7
Current State of IT

• Medical reference resources on line
• Up To Date
• Micromedex
• MD Consult
• Medical Journals, databases, etc in electronic
  library
• Krames Patient Education Materials
• Zynx Evidence
• 40 doc family practice using Logician EMR
• 70 doc multi-specialty group implementing Better
  Health Record EMR (selection of new EMR in
  progress)
• Integration of practice EMRs with Hospital record
  PHR
• 1200 Shared Care Plans, Personal Health Record
  in use, rollout to broader community underway via
  EMS providers
• Pilot e-prescribing project moving to
  implementation

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CONTEXT
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Health System
Organization of Health Care
Community
Clinical Information Systems
Self Management Support
Delivery System Design
Decision Support
Resources andPolicies

• Advocacy
• Resources
• Skills training
• Role adaptation

• Providers
• Roles clear
• Communication
• follow-up system

• Guidelines
• Provider education
• Specialty support
• Feedback

• Registries
• Reminders
• Measurement
• Feedback

Informed, Activated PATIENT
Prepared, Proactive Practice TEAM
Productive
Interactions
Functional and Clinical Outcomes
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P2 Participating Orgs

• Family Care Network
• Sea Mar Community Health Clinics
• North Cascade Cardiology
• St. Joseph Center for Senior Health
• St. Joseph Hospital
• Group Health Cooperative
• Community Health Plan of Washington
• AND LOTS OF PATIENTS

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Debilitating Assumptions

• Chronic care and prevention is like acute care
• Patients and old people are incompetent
• Doctors and hospitals are the center of health
  caring
• People cannot get access to the web
• Business medical records must be adopted before
  personal health records/support systems
• Everyone must adopt PHRs before they are useful
• Its OK for every business to provide a
  different personal health record

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Two Big Ideas

• Enable everyone to participate as fully in their
  health and healthcare as they can.
• Support coordination and communication across
  healthcare organizational lineson the behalf of
  individual patients.

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Whats a patient to do?

• Lots of connectivitysystems and resources on
  line for providers wheres the patient?
• Where does all the information converge?

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Distinctions

• Business Electronic Medical Records (EMRs)
• Patient Portals
• Personal Health Records (PHRs)
• Personal Health Management Systems (PHMS)

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A PERSONAL HEALTH RECORD The Shared Care Plan

• Its Their Health
• Help them take charge!

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Your Personal Health Record

• Keep track of important health information
• Medications
• Allergies
• Immunizations
• Surgeries
• Hospital visits
• Insurance providers
• Physician Family Contacts
• Advance Directives and other Documents

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The Shared Care Plan on Paper

• Your Personal Health Record
• A single place to keep your health information
• Critical information available in an emergency
• Contact and appointment information in one place

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The Shared Care Plan on the Web

• Additional Benefits
• Secure, easy access for viewing and updating
• Critical information available in an emergency
  any time, anywhere
• Advance Directives available at the touch of a
  button
• Access to health references relevant to your
  conditions and medications
• You decide what information to include and who
  has access to it
• Easy to read wallet sized summary

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Accessing The Personal Health Record
http//www.sharedcareplan.org
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Care Team
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About Me
23
Diagnoses
24
Next Steps
25
Health Log
26
Medications My Active Meds
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Comparing Meds on Record
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History My History
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Advanced Directives
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Printout Options
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Whos accessed my Plan?
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Confidentiality, Security, HIPAA, Consent

• All users have unique login
• Patients sign HIPAA consent to share info before
  populating the Shared Care Plan PHR
• Patient controls who has access to what
• Fully auditable
• Audit trail available to patient
• Community process for breach investigation in
  place

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Technology, Hardware, Software

• Application web based, current version html,
  Congrals new version asp.net 2.0 with AJAX
• Can be hosted centrally or locally
• End user only requires web browser, no client
• Database MS SQL server 2003
• Web based admin tools
• Web services and interfaces for data exchange

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Constraints /Opportunities

• Debilitating assumptions / change them
• Cultural barriers / users design it
• Time for initial population of data / help them
• Not everyone is computer literate or has home
  computer / use someone elses
• Creating trust / conversations
• Community support infrastructure needed /YOU

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Concerns, What Would We Do Differently?

• Always involve patients in design and partnership
  from the beginning!
• Recognize that a PHR can bridge the continuum of
  care far more quickly and easily than waiting for
  EMR interoperability
• Avoid the first mover problem make it
  community property

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Interfaces

• Application supports
• Web Services data exchange interfaces
• Messaging e-mail, SMS
• Workflow, state recognition
• Currently in Whatcom County
• Interface to hospital system for
• Identity match on online registration
• Notification that PHR exists
• Link to Patients PHR from hospital system
• Display/import of meds, allergies, immunizations
• Link to community eRx software for display/import
• Links to Healthwise (and soon Krames) patient ed

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Its not just about technology

• Technology should facilitate
• Conversations understanding
• Coordination of care
• Improving processes access to information
• Making care safe, effective, efficient,
  equitable, timely, and
• patient-centered
• Creating community