San Diego Beacon:San Diego Regional Health Information Exchange

James Killeen, MDSD Beacon Technical LeadProfessor of Clinical Emergency MedicineUCSD School of Medicine

“These pioneering communities are going to lead the way in bringing smarter, lower-cost health care to all Americans through use of electronic health records”

Vice President Joseph Biden, May 2010 White House Announcement of Beacon Community

Awardees

Beacon Community Program

Overview

• Funded by ARRA HITECH Act administered by the Office of the National Coordinator for Health Information Technology

• $15 million over three years to use health IT to improve health care delivery in San Diego as model for nation

• Transition from a grant-funded initiative to an self-sustaining independent organization providing services to the health care community

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ARRA & HITECH Act

• HITECH Priority Grant Programs nationwide meaningful use – Medicare and Medicaid Meaningful Use Incentive

Payments– Health IT Regional Extension Center Program– Grants to states and state-designated entities for Health

Information Exchange (HIE)• $20b in Health HIT

– electronic health records– e-prescribing, e-care and telemedicine– community health initiatives– foster private sector investment in innovation

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Build and strengthen health IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years.

Improve cost, quality, and population health - translating investments in health IT in the short run to measureable improvements in the 3-part aim.

Test innovative approaches to performance measurement, technology integration, and care delivery - accelerating evidence generation for new approaches.

ONC’s Beacon Community Program – where HITECH comes to life

• Beacon Communities funded to:

17 Beacon Communities

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Hawaii County Beacon Community

Hilo, HI

Southeast Michigan Beacon Community

Detroit, MI

Crescent City Beacon CommunityNew Orleans, LA

Delta BLUES Beacon Community

Stoneville, MS

Keystone Beacon Community Danville, PA

Utah Beacon Community

Salt Lake City, UT

Beacon Community of Inland Northwest

Spokane, WA

Great Tulsa Health Access Network Beacon

CommunityTulsa, OK

Southeastern Minnesota Beacon Community

Rochester, MN

Rhode Island Beacon Community

Providence, RI

Greater Cincinnati Beacon Community

Cincinnati, OH

Southern Piedmont Beacon Community

Concord, NCSan Diego Beacon Community

San Diego, CA

Western New York Beacon Community

Buffalo, NY

Colorado Beacon Community

Grand Junction, CO

Bangor Beacon CommunityBrewer, ME

Central Indiana Beacon Community

Indianapolis, IN

San Diego Beacon

• Connecting ambulances to emergency rooms• Patient event notification to providers and

payors• Wireless cardiac device pilot• Community Health Information Exchange

• Patient information available to providers across systems at the point-of-care

• Accessible in ED, hospital, clinic• Reporting (Immunizations, Public Health)

San Diego

Beacon

CDC

Community A

VA/DOD

State/Local Government

Community B

ClinicsEMS

County PH

SD VA/DOD

Build and Strengthen Health IT

Kaiser

SD VA/DOD

EMS

County PH

Clinics

Others

Hospitals

Suite of Services

• Pre-hospital data available to hospitals electronically– Pre-hospital record– ECG, Images– Search capability into the HIE

• Immunization– Optimize vaccine administration strategies– Import data from non-traditional settings– Add Immunization Forecasting

• Syndromic Surveillance– Enhance reporting capabilities

• Radiology Imaging• Import Medical Device Data

– Implantable devices– Wireless Devices

HIE Construction

Clinical

Pre-Hospital & 911

Population & Public Health

San Diego Beacon

• Improve Quality, Population Health, Costs

Cardiovascular Dz Childhood IZSyndromic Surveillance

Redundant TestsED/hospital Readmits

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Integrated Clinical Experience

Integrated Solution

Immunizations

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• More than 700,000 Lives• UCSD, Sharp, Rady, Scripps, & Medical Groups within San Diego

ImmunizationsSDB Hosting Immunization Server

Provides routing of ADT and MU Reporting messages to SDIR and SD County

Lab Data Normalization and ELR

Syndromic Surveillance: ADT messages

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Verbal Report

Written Report

ECG

Prehospital HIE

• Prehospital data available to hospitals electronically– Prehospital record– Electrocardiograms & Images– HIE also back to field providers

• EMS Application Partners– SD City EMS– AMR (Initiated)– Fieldsaver (Initiated)

San Diego

• 2010 OSHPD Data: – 24% (nearly one in four) of all 30-day readmissions

occurs at a different hospital (excluding VA, NMCSD)

• 15% of all ED patients and 69% of “frequent fliers” were seen in multiple hospitals

eRAP

Messaging

• Event notification for ED Visit, Admit or Discharge– Providers– Payors– Health Systems– Federal Partners

Project 25

• ED visits and charges reduced substantially in 6 month pre/post comparison for enrollees

Financial Impact

EMS EMR vendor

EMS HubSan Diego

San Diego, CA

Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 20120

10

20

30

40

50

33.3

15.8

7.7

0.0

Performance on false positives STEMI incidents, by Quarter

False positive STEMI incidents

Perc

ent

Smart Analytics AlgorithmsIdentifying Patients with In-Home Difficulties

Smart Analytics AlgorithmsIdentifying Patients with Substance Abuse Issues

Smart Analytics AlgorithmsIdentifying Patients with Psychiatric/Behavioral Problems

59 y/o Serial Inebriate Patient

Serial Inebriate Patient

RAP Trigger=SIP counselor sent to ED

40 y/o Post Traumatic Brain Injury

40 y/o Post Traumatic Brain Injury

40 y/o Post Traumatic Brain Injury

Arrested

Released from Jail

P25

Alerts to P25

“ Information should follow the patient, and artificial barriers – technical, business-related, bureaucratic – should not get in the way ”

– David Blumenthal, MD, Former Director, ONC

www.sandiegobeacon.org

San Diego Beacon

Questions?