“For Better or Worse, in Sickness and in
Health”… Making the HIE Marriage Work
OACIS User Group Meeting
Toronto , Ontario
June 7, 2011
…and wouldn’t it be nice to add:
• For richer or poorer
• And I PROMISE to SERVE and
OBEY
But it’s not always perfect
Serious Business
Who we are:
• Four health systems w/ 1500+ beds
• Area of approx 600K residents
• 11 Emergency Departments
Like any good relationship…
• The Courtship
• The Dating Game
• The Prenuptials
• The Marriage
• The Celebrations
The Courtship
The Courtship
Roper / St.
Francis
Roper/St. West
Francis Ashley ED Trident
Downtown Hospital ED
ED
Viewer
East Cooper Summerville
ED Medical ED
MUSC
MUSC ART Pediatric
ED ED
MUSC
Main ED
The Courtship
The Duke Endowment
The Dating Game
The Charleston-area ED
directors agree that ED-
alerts will improve the
, , and
of Patient
Care in the Charleston
Healthcare Community!
Dating Game: Anticipated Benefits
• Reduced ED length of stay
• Avoid redundant testing – saving money and
reducing patient risks
• Improved access to patient historical information
• Higher clinician throughput (decreased time waiting
for records from outside hospital)
• Increased quality of care/decreased medical errors
• Improved patient satisfaction from decreased LOS
• Information exchange to Public Health
• Improved regional disaster preparedness
The Dating Game
The Parents: Governance Board
Alliance Oversight
The Dating Game
The Extended Family
Clinical Group Privacy & Security Group
• Meet 2 to 3 times monthly in 1Qtr • Meet 2 times a month in 1Qtr
• Meet monthly thereafter • Use models for starting point
• Finalize data recommendations • Recommendations to Clinical and
Technical by 3rd month
for viewing
Financial & Legal Technical Group
• Use models to begin • Meet 2 to 3 times monthly in 1Qtr
• Integrate with Clinical & Technical • Meet monthly thereafter
by 3rd month • Determine data sources,
• Recommendations to Leadership transfer capabilities
by end of 1st Qtr
The Dating Game: Learning to Share
• ED notes • Radiology reports
• MRI
• Outpatient clinic
notes (if available) • CT
• Plain Films
• Hospital discharge
summaries • Rx’s written (if use e-
prescribing)
• Lab and pathology
reports • Problem List
• Follow up
care/referral
information
The Dating Game
Charleston Area eHealth Alliance Architecture Model
The Prenup
Legal Web
• Hosting Agreement TELUS
• Master Agreement MUSC
• Participation Agreement LFHC
- INSURANCE Coverage CeHA
• Business Associate Agrmts
• Bylaw Revisions ECMC RSFH
• 501(c) 3 Status
THS
Others
The Marriage
Go Live February 2011
Thus far:
• Matched over 25K records
• Over 150 users accessed last month
• Multiple accounts of BENEFITS
The Celebrations
• "I believe we are seeing direct and indirect
benefits positively affecting pt care. We had a girl
recently who had extensive lab testing including a
positive flu test and came to us the next day and
did not disclose her other hospital visit the day
before. The labs were immediately available to
me, the patient was reassured, additional testing
was not done and Medicaid was not billed for
unnecessary testing. This was a very busy day, so
we were able to have this patient in and out of
the ED in very short time, making space for others
who needed the bed.”
The Celebrations
• . The value of "time saved" during a patient
encounter is a difficult thing to measure, but
is without a doubt a significant benefit of this
HIE.
• We are essentially able to increase the
bottom line by shortening visits so more
patients can be seen using the same amount
of resources. Viewing the records from all of
the hospitals will be the holy grail."
The Celebrations
• “I had a gentleman present with focal seizure like
activity. Stated that he had not been seen
by neuro and no studies done yet. Looked him
up, and he had had CT, MRI, EEG, LP… was seen
by 3 neurologists and scheduled for
outpatient follow up. Nothing needed to be done
in the ER upon presentation this at this
time.
Another patient came in with very
questionable history and concern for drug
seeking. Not on state listing (too soon to be
logged). Was seen multiple times at separate
facilities.”
Next Steps:
• Developing a study of SAVINGS (time & $$)
• Getting ready to be one of 11 Veteran
Administration demonstration sites across US
• Looking at growth throughout the South Carolina
Success Drivers and Potential Barriers
Success Drivers
POTENTIAL
• the patients’ best interests BARRIERS
• Mission-driven and meets Community
Responsibility
• Resources, Resources,
• Hospital/Provider Savings Resources!
• the RIGHT partners (IT, Legal) • Legal Agreements
• the support of Leadership • Not utilizing models of
success
• Being leaders vs. being mandated with
health info exchange
• the shared learning among hospitals