Establishing a Recovery Health Establishing a Recovery Health Information Network to Improve Care Information Network to Improve Care

for Displaced Populationsfor Displaced Populations

National Emergency Management SummitNational Emergency Management SummitNew OrleansNew Orleans

March 6, 2007March 6, 2007

Tony Sun, MD, MBA, FACPTony Sun, MD, MBA, FACP Bill Hineman, MBA Bill Hineman, MBA Chief Medical DirectorChief Medical Director Director of Recovery Initiatives Director of Recovery Initiatives

The problem► Storms destroy health care

infrastructure and the connections between patients and providers

The solution► Secure PHI infrastructure for interim

providers► Create a network of interim

providers► Enable patients to reconnect to

established systems Other uses

Today’s AgendaToday’s Agenda

Initial Catastrophe

1 million people evacuated, few with any medical records

>300,000 homes uninhabitable 11 major hospitals lost, including two of

the largest in LA Patients and providers scattered in

different directions. 465 physicians and 874 nurses state wide net loss.

The Ongoing Problem

Many FEMA residents have few tools to resettle

Many are low-income with little access to health care

Most have little or no medical history, medication or treatment plan information for their interim providers

Interim providers were unaware of each other’s activities - even with the patients they share

The Solution:The Solution:Recovery Health Information NetworkRecovery Health Information Network

1.1. Help ensure that displaced residents in Help ensure that displaced residents in FEMA trailer parks receive the right FEMA trailer parks receive the right care at the right time every timecare at the right time every time

1.1. Work with stakeholders to define, Work with stakeholders to define, develop and operate a support develop and operate a support infrastructure that meets their needs infrastructure that meets their needs while meeting Object 1while meeting Object 1

The RHIN Demonstration:The RHIN Demonstration:ObjectivesObjectives

The RHIN Demonstration:The RHIN Demonstration:ObjectivesObjectives

The RHIN Demonstration:The RHIN Demonstration:ScopeScope

Location: Baton Rouge-area FEMA trailer Location: Baton Rouge-area FEMA trailer villagesvillages

Number of residents: 2200+Number of residents: 2200+

Number of providers: 4Number of providers: 4

Timeframe: August 2006 through November Timeframe: August 2006 through November 2007.2007.

Authority: Under auspices of our Medicare QIO Authority: Under auspices of our Medicare QIO contract with CMScontract with CMS

Web-based, to allow access to and sharing Web-based, to allow access to and sharing of information among providersof information among providers

Serve as the primary medical recordServe as the primary medical record Offer relevant decision supportOffer relevant decision support Quick to deployQuick to deploy Easy to use – little opportunity to trainEasy to use – little opportunity to train SecureSecure Enable referralsEnable referrals Patient records must be portable: hard copy, Patient records must be portable: hard copy,

disc, thumb drive, email, etc.disc, thumb drive, email, etc.

The RHIN Demonstration:The RHIN Demonstration: Solution Requirements Solution Requirements

The RHIN Demonstration:Development

Secured limited funding from Centers for Secured limited funding from Centers for Medicare & Medicaid ServicesMedicare & Medicaid Services

Issued an ITB to vendors of EHRs and DM Issued an ITB to vendors of EHRs and DM platforms: Small, large, local (LA), nationalplatforms: Small, large, local (LA), national

► Very limited interestVery limited interest

Formed a steering committee of providers and Formed a steering committee of providers and coordinators of care for target populationcoordinators of care for target population

► Key players are Capital Area Human Services District, Key players are Capital Area Human Services District, Department of Health and Hospitals, Excelth, Inc. and Department of Health and Hospitals, Excelth, Inc. and Southern University School of Nursing, OLOLSouthern University School of Nursing, OLOL

The RHIN Demonstration:Development II

Steering Committee selected DGLSteering Committee selected DGL Work sessions with providers and DGLWork sessions with providers and DGL Software customizationSoftware customization Conversion of paper chartsConversion of paper charts Data entered meds, labs, vitalsData entered meds, labs, vitals Provider trainingProvider training RolloutRollout

The RHIN Demonstration:The RHIN Demonstration:In Full Use by ProvidersIn Full Use by Providers

From their mobile units at the FEMA From their mobile units at the FEMA villages, providers can:villages, providers can:► Access their own patients’ recordsAccess their own patients’ records► Access records of the patients they share with Access records of the patients they share with

other on-site providersother on-site providers► Make electronic referrals containing relevant Make electronic referrals containing relevant

clinical informationclinical information

The RHIN Demonstration:The RHIN Demonstration:Full Capability for PatientsFull Capability for Patients

With Web access, patients can:With Web access, patients can:► View their own recordsView their own records► Grant access to other providersGrant access to other providers► Add/update information in segregated fieldsAdd/update information in segregated fields

The RHIN Demonstration:The RHIN Demonstration:ResultsResults

Demonstration to run until November 2007Demonstration to run until November 2007 High provider satisfaction:High provider satisfaction:

► Average provider training: 45-60Average provider training: 45-60 minutes minutes► Opening access to providers’ fixed locationsOpening access to providers’ fixed locations

The RHIN Demonstration:The RHIN Demonstration:Results IIResults II

Expected outcomes:Expected outcomes:► Decreased duplication of services by multiple Decreased duplication of services by multiple

providersproviders► Reduced errors in patient careReduced errors in patient care► Reduced opportunities for Medication fraudReduced opportunities for Medication fraud

The RHIN: Additional BenefitsThe RHIN: Additional Benefits

Built-in ability to:Built-in ability to:► Monitoring of patients over timeMonitoring of patients over time► Customize and track quality indicators by:Customize and track quality indicators by:

– Individual, location, condition, etc.Individual, location, condition, etc. Disease surveillanceDisease surveillance Provider- and site-level reporting support Provider- and site-level reporting support

improved management of scarce health improved management of scarce health care resourcescare resources

HL7 compliant for interoperabilityHL7 compliant for interoperability

Why the RHIN WorksWhy the RHIN Works

Web-based solution for the gaps in Web-based solution for the gaps in communications infrastructure that have communications infrastructure that have interfered with delivery of high quality careinterfered with delivery of high quality care

Providers identified the gaps and helped design Providers identified the gaps and helped design the solutionthe solution

The RHIN’s methods of gathering, storing and The RHIN’s methods of gathering, storing and sharing PHI are highly intuitive and far superior sharing PHI are highly intuitive and far superior than the systems the RHIN replacesthan the systems the RHIN replaces

Very willing vendorVery willing vendor

RHIN Hardware Requirements Hardware Requirements

CMS has funded laptops for providers:CMS has funded laptops for providers:► Dell Latitude D620 laptop with Cingular G3 Dell Latitude D620 laptop with Cingular G3

CardCard► Windows XP and Internet ExplorerWindows XP and Internet Explorer

Digital cameras to add patient photo to Digital cameras to add patient photo to medical record for securitymedical record for security

Other Uses for the RHIN

Evacuee shelters after any disaster or civic disruption

Triage facilities for disease outbreaks

Pre-populated personal medical record for fragile populations: e.g. Dialysis, nursing home, multiple chronic disease, etc.

Who We Are

Louisiana Health Care Review is a business division of Louisiana Health Care Review is a business division of Integrated Health Management Solutions.Integrated Health Management Solutions.

Integrated Health provides:Integrated Health provides:► Tools and strategies to integrate patients, providers and payersTools and strategies to integrate patients, providers and payers► HIT consultingHIT consulting► Quality improvement and utilization management for Medicare Quality improvement and utilization management for Medicare

and Medicaid clientsand Medicaid clients Tony Sun, MD, MBA, FACPTony Sun, MD, MBA, FACP

Chief Medical DirectorChief Medical Directortsun@lhcr.orgtsun@lhcr.org

Bill Hineman, MBABill Hineman, MBADirector of Recovery InitiativesDirector of Recovery Initiativesbhineman@lhcr.orgbhineman@lhcr.org

(225)926-6353(225)926-6353

Maslow's Hierarchy of Needs

1.1. Physiological: hunger, thirst, bodily Physiological: hunger, thirst, bodily comforts, etc.; comforts, etc.;

2.2. Safety/security: out of danger; Safety/security: out of danger;

3.3. Belongingness and Love: affiliate with Belongingness and Love: affiliate with others, be accepted; and others, be accepted; and

4.4. Esteem: to achieve, be competent, gain Esteem: to achieve, be competent, gain approval and recognition.approval and recognition.