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					The Appalachian Region

     “Reducing health disparities
     will require a multifaceted
     approach, focusing on health
     care workforce recruitment,
     infrastructure development,
     and improved access to care.”
             Organizational Structure


  OBTN          SOTN                          ARIC       Services

    Ohio      Southern                     Appalachian    Public &
Department   Consortium        Ohio          Regional      Private
 of Mental   for Children    University    Informatics   contracted
  Health                       CORE        Consortium     services
                            13 Hospitals
OhiONE Telehealth Network

                       13 Academic
                        5 OUCOM Sites
                        4 OU Regional
                       11 Southern
                           Consortium for
                           Children Sites
                       10 ODMH Sites



           Regional Issues

Declining state and federal funding
Isolation of medical information
  Isolation between institutions
  Isolation between disciplines
Socioeconomic profile
Difficulty in recruiting and retaining primary
care physicians
Healthcare Management Issues

Immunization- access to documentation
Lack of access to information for research
Rising cost
   Medical Records
   Insurance and risk management
   Human Resources
   General Operating Costs
Medical errors
Comprehensive Information Systems
       Appalachian Regional Informatics
        Next Generation Grant (NGG)

•Integrated Advanced Information Management Systems
                    Program (IAIMS)
          •National Library of Medicine (NLM)
           •National Institute of Health (NIH)
  •Department of Health and Human Services (DHHS)
         Mission Statement

To create a sustainable and replicable model
      for integrated advanced information
 management systems for rural healthcare in
                Appalachian Ohio.
         Building a Model
            (mission statement cont.)

     The model will establish a formal
       organizational structure and a
 comprehensive technical plan for a shared
    medical information system to benefit
primary and behavioral healthcare providers,
    biomedical researchers and medical


  -Alcohol, Drug Addiction and Mental Health Services
-317 Board of Athens, Hocking and Vinton Counties and
           the Southern Consortium for Children
      -Appalachian Behavioral Healthcare Center
            -Doctor’s Hospital of Nelsonville
                -Health Recovery Services
              -O’Bleness Memorial Hospital
                -Tri-County Mental Health
                     -Ohio University
                 College of Osteopathic Medicine
                College of Health & Human Services
                   Edison Biotechnology Institute
               Three County Profile

              Sample Area – Defined Population
                                                       Percent       of
                                            Percent       of      people
                                           65 years    children    under
         Population   Percent   Percent    of age or    <18 in    200% of
Counties     =         white    minority     older     poverty    poverty

Athens     62,235        94         6        9.3        19.4       47.4

Hocking    28,436        98         2        13.1       14.6       33.0

Vinton     13,150        98         2        12.1       50.7       42.8

    Three counties were selected as the sample area for this project.
    Why an Electronic Medical Record?

Paper records have at least 4 weaknesses:
  1.   Lack of standardization in content
  2.   Lack of standardization in format
  3.   Incompleteness
  4.   Inaccuracies

  Source: Committee on Improving the Patient Record,
  Institute of Medicine
               Process vs. Practice

Physicians spend up to 38% of their time
  writing up patient charts.
Nurses spend up to 50% of their time writing
 up charts.
Medical records are misplaced or missing in
 30% of patient visits.
The average patient record weighs 1.5 lbs.
Source: Committee on Improving the Patient Record,
     Institute of Medicine
         Cost and Quality Benefits

A quality-assurance staff can review 3 paper
  records per hour.
Based on predetermined data-base criteria, a
  quality-assurance staff can review 400
  electronic medical records per hour.
The average patient visit generates 13 pieces
  of paper.
The average office spends $10 per visit to
  track and file paper records.
Source: Committee on Improving the Patient Record,
     Institute of Medicine
          Patient Care & Errors

A patient’s age is not included in the medical
  record 10% of the time.
A diagnosis is not recorded in the patient’s
  record 40% of the time.
Physicians, while taking a medical history,
  fail to note the chief complaint in the
  patient’s record 27% of the time.
Source: Committee on Improving the Patient Record,
    Institute of Medicine
       Improve Patient Care/
       Reduce Medical Errors

 Control                   Create
Operating                 Research
  Cost                    Database
Questions ?