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From Electronic Medical Records to the Florida Health Information Network


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Title: From Electronic Medical Records to the Florida Health Information Network

From Electronic Medical Records to the Florida
Health Information Network
The First Central Florida Electronic Medical
Records Conference Saturday, October 20, 2007
The Florida Health Information Network
  • The statewide Florida Health Information Network
    (FHIN) is being built from the local community
  • The FHIN is a collaboration of Regional Health
    Information Networks (RHIOs) in Florida.
  • Each RHIO is responsible for developing a health
    information exchange and working with local
    providers to accept the exchange of medical
    records through the RHIO portal.

The FHIN Begins at the Local Level
  • AHCAs strategic plan for the adoption of EMRs is
    to empower local stakeholder collaborations
    focused on health information exchange.
  • The driver of this plan is the FHIN Grants
    Program for RHIOs to build health information
  • AHCA Legislative Goal Fund the FHIN Grants
    Program for 6.8 million in 2008-2009 to leverage
    ongoing RHIO development.

What is a RHIO?
FHIN Grants Program, 2007-2008
Projected 2007-2008 Operational Metrics
No. Metrics Description Target 10/2007 12/2007 Target 01/2008- 03/2008 Target 4/2008 06/2008 TOTAL PROJECTIONS
1 Number of hospitals, clinics, or other facilities authorized to use the network (attach list) 16 27 54 97
2 Number of hospitals, clinics, or other facilities sharing data within the network (attach list) 10 27 59 96
3a Number of physician offices authorized to use the network (attach list) 112 432 610 1,154
3b Number of clinicians authorized to use network 220 595 916 1,731
4 Number of patients participating in the network 563,564 95,364 172,714 831,642
5 Number of queries to the network from facilities or physician offices 12,250 32,250 50,848 95,348
6 Number of queries from facilities or physician offices returning results 3,250 6,550 19,761 29,561

Why Connect to a RHIO?
  • The nature of modern health care requires the
    involvement of multiple medical providers to
    effectively diagnose and treat many of the
    medical conditions affecting individuals.
  • Effective coordination is largely dependent upon
    the communication of information between
    providers about a patients medical condition but
    the mechanisms used to exchange patient data
    depend on the transmission of facsimile copies of

Why Connect to a RHIO?
  • Better coordination between referring physicians
    and specialists increases physician satisfaction
    with specialty care and enhances referral
  • Christopher B. Forrest, MD, PhD, et al. (2000)
    Coordination of Specialty Referrals and Physician
    Satisfaction With Referral Care. Archives of
    Pediatric Adolescent Medicine.
  • 68 of specialists report that they received no
    information from the primary care physician prior
    to specific referral visits.
  • Four weeks after specific referral visits, 25
    of PCPs had still not received any information
    from specialists.
  • Tejal K. Gandhi, (2000). Communication
    Breakdown in the Outpatient Referral Process.
    Journal of General Internal Medicine, Volume 15,
    Number 9, September.

Why Connect to a RHIO?
  • The RHIOs provide a secure, real-time exchange of
    medical records that guarantees the efficient
    delivery of patient data to the authorized
  • The following examples will demonstrate how two
    Florida RHIOs are implementing health information

Palm Beach County Community Health Alliance
Western Palm Beach County Health Information
Infrastructure Operations and Evaluation Project
The Glades Community
  • 28 uninsured rate
  • Glades General Hospital is only Acute Care
  • 17,753 ER visits 1,900 Medicaid discharges in
  • Prevent duplication between hospital and clinics

AllCare Participants
  • 2007 2008
  • 3 Dept of Health Clinics Bethesda Hospital
  • Boca Raton Community Hospital
  • Delray MC
  • Good Samaritan MC
  • Jupiter MC
  • Palm Beach Gardens MC
  • St. Marys Hospital
  • Wellington Regional
  • West Boca MC
  • 2006 2007
  • Glades General
  • FAU Wellness Centers
  • Caridad Clinic
  • Samaritan Gardens
  • Carelink Clinic
  • Project Access
  • End of June 2007
  • Columbia MC
  • JFK MC
  • Palms West MC

AllCare Shared Health Record
  • County wide shared electronic health record for
    uninsured and Medicaid patients with health data
    from all existing safety net providers.
  • Results
  • Access to longitudinal patient records
  • Improved clinical care,
  • Reduction of duplicate tests/procedures,
  • Reduction of errors, and
  • Valuable source of aggregate data for planning
    and evaluation.

PBCCHA All-Care Shared Health Record
  • Real-time electronic interface to existing data
    systems used by hospitals, clinics, and other
    safety net providers.
  • Shared summary records created for all uninsured/
    Medicaid/other patients.
  • No duplicate data entry.
  • Free clinics, Federally Qualified Health Centers,
    PBCMS Project Access and key competitor safety
    net hospitals are participating.
  • Viewable via the Web - after patients have signed

All-Care Clinical Data List
  • Date of Visit and Encounter Type
  • Clinic and Provider Names
  • Diagnosis and CPT codes
  • (Hospital) Discharge code
  • Prescribed and Filled drugs
  • Lab results
  • Radiology Results

All-Care Login Page
All-Care Patient Locator
All-Care Patient Demographics
All-Care Patient Encounter Page
All-Care Medication History Page
Big Bend RHIO
Big Bend RHIO RHIN Architecture
pMAN Connectivity Dedicated fiber-based Private
Medical Area Network VPN gateway
Small organizations can connect either directly
to the RHIN or through a VPN gateway
Organizations can connect bi-directly to feed
their data and receive data directly into their
In the early Phases CHP, CRMC TMH will provide
a one way feed of their data. They have the
largest repositories and the priority is to make
their data available ASAP
Current RHIN Services
  • Core RHIN Platform
  • Data Sharing Patient demographic and clinical
    data feeds.
  • RHIN Web Portal Secure web interface for
  • User Access Audit Control Detailed audit logs
    across the entire system.
  • Disaster Recovery Business Continuity
  • RHIN Applications
  • e-Prescribing
  • Document Imaging
  • Patient Portal Web interface for electronic
    patient registration form and Personal Health
    Record (PHR).

Health Information Exchange Services
  • Big Bend RHIO will establish a community
    repository for the storage and retrieval of
  • Demographic/encounter data
  • Medication claims data and e-prescribing
  • Document viewer including lab/radiology
  • Secure messaging
  • Disaster recovery
  • Remote data backup outside service area

Production - RHIN Platform
RHIN Web Portal patient search
Secure Internet Access
Clinical data display including labs, radiology
reports, allergies, problems, providers, and
medication history
Production - RHIN Apps
Patient Portal (PHR)
Document Imaging
Long Term Plan for Sharing Electronic Health
  • Continue the FHIN Grants Program
  • Sustainability of RHIOs
  • Health Information Technology Committee
  • Health Information Security and Privacy
  • Create Pilot Projects for Adoption of EMRs
  • Create clinical repository within RHIOs to
    support both EHRs and PHRs

Vision for the Florida Health Information Network
  • The Florida Health Information Network vision
    will integrate clinical health information
    exchange in Florida through a network
    architecture that will empower physicians to
    access timely and accurate medical records in
    order to deliver high quality medical care for
    their patients.

Christopher B. Sullivan, Ph.D. Agency for Health
Care Administration Florida Center for Health
Information and Policy Analysis Office of Health
Information Technology 2727 Mahan
Drive Tallahassee, FL 32308