SWEA1 CSE 5810 HIEx HIEx TM TM : Health Link Information : Health Link Information Exchange Exchange Review the elements of, and differences Review the elements of, and differences between health information technology and between health information technology and health information exchange health information exchange Relate the importance of HIE to primary Relate the importance of HIE to primary care physicians for both practice care physicians for both practice management and clinical information management and clinical information Develop an understanding of the Develop an understanding of the functionalities in the HIExTM system, and functionalities in the HIExTM system, and how this provides a flexible infrastructure how this provides a flexible infrastructure for a cross-disciplinary Regional Health for a cross-disciplinary Regional Health Information Organization (RHIO) Information Organization (RHIO) Excerpted from From Presentation by: Excerpted from From Presentation by: David R. Little, Katherine L. Cauley, and David R. Little, Katherine L. Cauley, and Mary M. Crimmins – Wright State Univ. Mary M. Crimmins – Wright State Univ. Medical School Medical School See: See: http://pciwg.amia.org/pmwiki/PapersAndPresentations/HomePage http://pciwg.amia.org/pmwiki/PapersAndPresentations/HomePage
Transcript
SWEA1
CSE5810
HIExHIExTMTM: Health Link Information Exchange: Health Link Information Exchange Review the elements of, and differences between Review the elements of, and differences between
health information technology and health information health information technology and health information exchangeexchange
Relate the importance of HIE to primary care Relate the importance of HIE to primary care physicians for both practice management and clinical physicians for both practice management and clinical informationinformation
Develop an understanding of the functionalities in the Develop an understanding of the functionalities in the HIExTM system, and how this provides a flexible HIExTM system, and how this provides a flexible infrastructure for a cross-disciplinary Regional Health infrastructure for a cross-disciplinary Regional Health Information Organization (RHIO)Information Organization (RHIO)
Excerpted from From Presentation by:Excerpted from From Presentation by:David R. Little, Katherine L. Cauley, and Mary M. David R. Little, Katherine L. Cauley, and Mary M. Crimmins – Wright State Univ. Medical School Crimmins – Wright State Univ. Medical School
Objectives of EffortObjectives of Effort Personal health informationPersonal health information
Continuity of care Coordination of care
Family and community Family and community informationinformation
Public Health, Public Health, EpidemiologyEpidemiology
Consultants
AncillaryProviders
Schools
Hospitals
ServiceAgencies
Demographic& Family
Data
Primary CarePhysician
Record
SWEA3
CSE5810
Overall Architecture and TechnologiesOverall Architecture and Technologies Scalable multi-tier application architectureScalable multi-tier application architecture Microsoft SQL databaseMicrosoft SQL database Supports source and time stamps and log tables to Supports source and time stamps and log tables to
assure audit functions. assure audit functions. Fully customizable role based access for each data Fully customizable role based access for each data
element.element.
SWEA4
CSE5810
Current components of HIEx™Current components of HIEx™ Demographic and individual health status informationDemographic and individual health status information Contacts module for emergency contacts, caseworkers, Contacts module for emergency contacts, caseworkers,
PC physicians, guarantors, etc.PC physicians, guarantors, etc. Electronic Medicaid and PRC applicationsElectronic Medicaid and PRC applications Referrals module with workflow historyReferrals module with workflow history Scanned documentsScanned documents Reporting on individual productivity Reporting on individual productivity Full audit trail for all transactionsFull audit trail for all transactions
Referrals module Provides TrackingReferrals module Provides Tracking Service utilization patterns are recorded Service utilization patterns are recorded
Source of referrals For example one uninsured family presents at two
hospitals The first referral for Medicaid would be recorded from
hospital A and the second from hospital B. Community Health Advocates track the progress of
each referral. The system displays the history of the progress.
Tracking Referrals for a PatientTracking Referrals for a Patient
SWEA13
CSE5810
Scanned documents module adds flexibilityScanned documents module adds flexibility Designed to capture documentation from paperDesigned to capture documentation from paper Examples include: Examples include:
Immunization records Birth certificates Driver’s license or other identity documents
Massachusetts eHealth CollaborativeMassachusetts eHealth Collaborative Presentation by David W. Bates, MD, MSc, 2005Presentation by David W. Bates, MD, MSc, 2005
Three-Fold Objective:Three-Fold Objective: Tools for Health care Incorporation into Clinical Practice Sustained Usage over Time
Pilot in Different CommunitiesPilot in Different Communities Collect ExperiencesCollect Experiences Look at Larger Scale Roll outLook at Larger Scale Roll out
Current Definition of CDSCurrent Definition of CDS Providing clinicians, patients or individuals with Providing clinicians, patients or individuals with
knowledge and person-specific or population knowledge and person-specific or population information, intelligently filtered or presented at information, intelligently filtered or presented at appropriate times to foster better health processes, appropriate times to foster better health processes, better individual patient care, and better population better individual patient care, and better population health. health.
From:From:
A Roadmap for National Action on Clinical Decision A Roadmap for National Action on Clinical Decision SupportSupport
Optimize Decision MakingOptimize Decision Making Optimize choices available (drug formulary) Improve compliance with guideline Improve compliance complex protocols (Cancer) Optimize treatment chronic conditions over time
Rationale For The Use of CDSRationale For The Use of CDS Mixed overall results – improving with timeMixed overall results – improving with time CDS effective with other interventionsCDS effective with other interventions
studies Most improved prescribing Some decreased hospital length of stay and cost
HIT effects on Quality most with adherence guideline HIT effects on Quality most with adherence guideline care, surveillance and monitoring and decreased care, surveillance and monitoring and decreased medication errors. (Chaudry)medication errors. (Chaudry)
ReferencesReferences Bates DW et al. Ten Commandments for Effective Clinical Decision Support: Making the Practice of Bates DW et al. Ten Commandments for Effective Clinical Decision Support: Making the Practice of
Evidence Based Medicine a Reality. J Am Med Inform Assoc. 10:523-530, 2003.Evidence Based Medicine a Reality. J Am Med Inform Assoc. 10:523-530, 2003. Chaudry B, et al. Systematic review: Impact of Heath Information Technology on Quality, Efficiency and Chaudry B, et al. Systematic review: Impact of Heath Information Technology on Quality, Efficiency and
Cost of Medical Care. Ann of Int Med. 144(10): 742-752, 2006Cost of Medical Care. Ann of Int Med. 144(10): 742-752, 2006 Classen DC. Clinical Decision Support Systems to Improve Clinical Practice and Quality of Care. JAMA. Classen DC. Clinical Decision Support Systems to Improve Clinical Practice and Quality of Care. JAMA.
280(15)1360-1361, 1998.280(15)1360-1361, 1998. Garg AX et al. Effects of Computerized Clinical Decision Support Systems on Physician Performance and Garg AX et al. Effects of Computerized Clinical Decision Support Systems on Physician Performance and
Patient Outcomes. JAMA 293(10)1223-1238, 2005.Patient Outcomes. JAMA 293(10)1223-1238, 2005. Hunt DL et al. Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Hunt DL et al. Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and
Patient Outcomes. JAMA 290(15)1339-1346, 1998.Patient Outcomes. JAMA 290(15)1339-1346, 1998. Hunt DL et al. Patient-specific evidence-based care recommendations for diabetes mellitus: development and Hunt DL et al. Patient-specific evidence-based care recommendations for diabetes mellitus: development and
initial clinic experience with a computerized decision support system. Int J Med Inform. 51(2-3):127-135, initial clinic experience with a computerized decision support system. Int J Med Inform. 51(2-3):127-135, 1998.1998.
Judge J et al. Prescribers' responses to alerts during medication ordering in the long term care setting. J Am Judge J et al. Prescribers' responses to alerts during medication ordering in the long term care setting. J Am Med Inform Assoc. 13(4):385-90, 2006.Med Inform Assoc. 13(4):385-90, 2006.
Nagykaldi Z, Mold J. J Am Board of Family Medicine 2007; 20: 188-195Nagykaldi Z, Mold J. J Am Board of Family Medicine 2007; 20: 188-195 Mcglynn E, Asch S, et al. The Quality of Health Care Delivered to Adults in the United States. NEJM. Mcglynn E, Asch S, et al. The Quality of Health Care Delivered to Adults in the United States. NEJM.
348(26):2635-45. 2003. 348(26):2635-45. 2003. Miller RA et al. Clinical Decision Support and Electronic Prescribing Systems: A Time for Responsible Miller RA et al. Clinical Decision Support and Electronic Prescribing Systems: A Time for Responsible
Thought and Action. J Am Med Inform Assoc. 12:403-409, 2005.Thought and Action. J Am Med Inform Assoc. 12:403-409, 2005. Osheroff J, et al. A Roadmap for National Action on Clinical Decision SupportOsheroff J, et al. A Roadmap for National Action on Clinical Decision Support
Accessed at http://www.amia.org/inside/initiatives/cds/ on November 26,2006 Osheroff J, et al. Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. Healthcare Osheroff J, et al. Improving Outcomes with Clinical Decision Support: An Implementer’s Guide. Healthcare
Information Management Systems Society. Chicago 2005Information Management Systems Society. Chicago 2005 Sequist TD et al. A Randomized Trial of Electronic Clinical Reminders to Improve Quality of Care for Sequist TD et al. A Randomized Trial of Electronic Clinical Reminders to Improve Quality of Care for
Diabetes and Coronary Artery Disease. J Am Med Inform Assoc. 12:431-437, 2005.Diabetes and Coronary Artery Disease. J Am Med Inform Assoc. 12:431-437, 2005.
