Enhancing Public Health, Health Care System, and Clinician Preparedness: Strategies to Promote Coordination and Communication

1
Enhancing Public Health, Health Care System, and
Clinician Preparedness Strategies to Promote
Coordination and Communication

• Marc Overhage, M.D., Ph.D.
• Associate Professor of Medicine and Investigator
• Regenstrief Institute for Health Care
• Indiana University School of Medicine

The Indiana Network for Patient Care An
operational community-wide electronic medical
record
2
(No Transcript)
3
INPC database organization
St. Vincents
Community Hospitals
VA
Global Patient Index
Global Doctor File
Dictionary
Winona
Clarian Health
St. Francis
Reportable Conditions
Wishard
MCHD
LabCorp
4
(No Transcript)
5
Minimum data set

• Emergency Department visits
• Hospital Discharges
• Laboratory Results

6
Expanded data set

• Minimum data set plus
• Admission notes/Discharge summaries
• Operative Reports
• Radiology Reports
• Surgical Pathology Reports
• Inpatient Medications
• Tumor Registry

7
Electronic reporting flow
Reportable Condition Processor
Reportable Condition Database
Interface Engine
Lab System
Other Hospital Systems
Hospital Fire Wall
8
Reportable condition processor
E-mail Summary
Abnormal flag, Organism name in Dwyer II, Value
above threshold
Compare to Dwyer I
Realtime
Daily Batch
To Public Health
Reportable Conditions Databases
Inbound HL7
Potentially Reportable
Reportable Condition
To Infection Control
Record Count as denominator
Print Reports
9
Provider to Public Health Communications

• Doubled reporting completeness
• Reduced reporting time lags
• Potential for syndromic surveillance

10
Clinical Information Standards

• Health Level 7 (HL7)
• Digital Imaging and Communications in Medicine
  (DICOM)
• Logical Object Identifier and Numerical Code
  (LONIC)

11
Public health to provider communication

• Screening reminders
• Syphillis screening for high-risk patients
• Stool cultures for patients with diarrhea during
  outbreaks
• Outbreak alerting

12
Barriers encountered

• Obtaining cooperation
• Sustaining focus
• Inconsistency of data representation
• Modifying workflow

13
INPC timeline
14
Creating cooperation

• Shared vision
• Trust
• Neutral party

15
Security/Confidentiality

• Agent of State Department of Health under
  Memorandum of Understanding (MOU)
• Private network (moving to Virtual Private
  Network)
• Encrypted file transfer
• Controlled database access
• Location linked IP address
• User name/password

16
Support

• Funding from Federal agencies
• National Library of Medicine
• Agency for Healthcare Research and Quality
• In-kind support from hospitals