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San Diego Beacon: San Diego Regional Health Information Exchange. James Killeen, MD SD Beacon Technical Lead Professor of Clinical Emergency Medicine UCSD School of Medicine. Beacon Community Program. - PowerPoint PPT Presentation

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San Diego Beacon:San Diego Regional Health Information ExchangeJames Killeen, MDSD Beacon Technical LeadProfessor of Clinical Emergency MedicineUCSD School of Medicine

$20b investment in health IT2These 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 ProgramOverviewFunded 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 nationTransition from a grant-funded initiative to an self-sustaining independent organization providing services to the health care community

4ARRA & HITECH ActHITECH Priority Grant Programs nationwide meaningful use Medicare and Medicaid Meaningful Use Incentive PaymentsHealth IT Regional Extension Center ProgramGrants to states and state-designated entities for Health Information Exchange (HIE)$20b in Health HITelectronic health recordse-prescribing, e-care and telemedicinecommunity health initiativesfoster private sector investment in innovation

5Build 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.

ONCs Beacon Community Program where HITECH comes to lifeBeacon Communities funded to:

17 Beacon Communities7Hawaii County Beacon CommunityHilo, HISoutheast Michigan Beacon CommunityDetroit, MICrescent City Beacon CommunityNew Orleans, LADelta BLUES Beacon CommunityStoneville, MSKeystone Beacon Community Danville, PAUtah Beacon CommunitySalt Lake City, UTBeacon Community of Inland NorthwestSpokane, WAGreat Tulsa Health Access Network Beacon CommunityTulsa, OKSoutheastern Minnesota Beacon CommunityRochester, MNRhode Island Beacon CommunityProvidence, RIGreater Cincinnati Beacon CommunityCincinnati, OHSouthern Piedmont Beacon CommunityConcord, NCSan Diego Beacon CommunitySan Diego, CAWestern New York Beacon Community Buffalo, NYColorado Beacon CommunityGrand Junction, COBangor Beacon CommunityBrewer, MECentral Indiana Beacon CommunityIndianapolis, IN

Represent communities from Hawaii to Maine, with more advanced E.H.R adoption and HIT infrastructure investments.Diverse communities with very different starting points (very sophisticated delivery systems e.g., Geisinger, Intermountain Mayo, and HIEs e.g., HealthBridge, IHIE, to rural communities in the Mississippi Delta and other very competitive provider markets like San Diego and New Orleans). Award was given to a lead organization (listed here), but was very much awarded to all the other partners (payers, providers, employers, public health departments etc).7San Diego BeaconConnecting ambulances to emergency roomsPatient event notification to providers and payorsWireless cardiac device pilotCommunity Health Information ExchangePatient information available to providers across systems at the point-of-careAccessible in ED, hospital, clinicReporting (Immunizations, Public Health)

San Diego Beacon

CDCCommunity AVA/DODState/Local GovernmentCommunity BClinicsEMSCounty PH

SD VA/DOD

Build and Strengthen Health IT

Kaiser

SD VA/DOD

EMSCounty PHClinics

Others

Hospitals

Suite of ServicesPre-hospital data available to hospitals electronicallyPre-hospital recordECG, ImagesSearch capability into the HIEImmunizationOptimize vaccine administration strategiesImport data from non-traditional settingsAdd Immunization ForecastingSyndromic SurveillanceEnhance reporting capabilitiesRadiology ImagingImport Medical Device DataImplantable devicesWireless DevicesHIE Construction

ClinicalPre-Hospital & 911Population & Public HealthSan Diego BeaconImprove Quality, Population Health, Costs

Cardiovascular DzChildhood IZSyndromic SurveillanceRedundant TestsED/hospital Readmits14Integrated Clinical Experience

Integrated SolutionImmunizations15

More than 700,000 LivesUCSD, Sharp, Rady, Scripps, & Medical Groups within San DiegoImmunizations

SDB Hosting Immunization ServerProvides routing of ADT and MU Reporting messages to SDIR and SD CountyLab Data Normalization and ELR

Syndromic Surveillance: ADT messages18

Verbal ReportWritten ReportECG

Simplify this just to be about patient care: Too much focus on registration, just focus on patient arrival, verbal report, then written report (often lost)19Prehospital HIEPrehospital data available to hospitals electronicallyPrehospital recordElectrocardiograms & ImagesHIE also back to field providersEMS Application PartnersSD City EMSAMR (Initiated)Fieldsaver (Initiated)

San Diego2010 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

eRAPMessagingEvent notification for ED Visit, Admit or DischargeProvidersPayorsHealth SystemsFederal PartnersProject 25ED visits and charges reduced substantially in 6 month pre/post comparison for enrollees

Financial Impact

EMS EMR vendor EMS HubSan Diego

San Diego, CA

26

Smart Analytics Algorithms

Identifying 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 ED40 y/o Post Traumatic Brain Injury

40 y/o Post Traumatic Brain Injury

40 y/o Post Traumatic Brain Injury

ArrestedReleased from JailP25Alerts to P25

Community GovernanceIndependent entity establishedInitial board slate with representation from major healthcare providers in San DiegoDan GrossSharp COORob Smith, MDVA CMOAlbert OriolRady CIOT. GehringCEO, SDCMSDavid Guss, MDUCSD DEM ChairN. MacchioneHHSA DirectorBill SpoonerSharp CIOL. FerrariAnthem/BCJoe Traube, MDScripps CMIOJ. Burritt, RNKaiserS. EscobozaCEO, HASDICN. DiazCEO, CHGS. OKaneCEO, CCCR. BrownCEO, Scripps Green 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.orgSan Diego Beacon

Questions?

Chart116090

VisitsVisits

Initial SelectonProject 25 Manuscript - Preliminary Data SummaryRevised 7/18/12Report Period:A total of 34 Project 25 participants were enrolled between 3/07/11 through 12/21/2011. UCSD utilizationdata was provided between July 2009 and May 2012; however, utilization data reported here are limited33 participants with service dates no more than 6 months before and after each participant's specificenrollment date. A total of 160 service dates were documented during the pre-enrollment period, and90 service dates were documented during the post-enrollment period.1. Number of service dates by pre and post enrollment period.All Service Dates Provided Between July 2009 and May 2012Service Dates Limited to 6 Months Before and After EnrollmentParticipantIDPre-EnrollmentPost-EnrollmentTotalPre-EnrollmentPost-EnrollmentTotal2358137111415184915060626310313031330636133161728634123322843214515281297183026430921112521461372028255301051552419431010203241034369272452923514241258191023143710102062302340416221032369332162711516721324103133118422213817724314241732011291261821321111201119105151232210010505349312617258210202123912044432511221224022291341342010110111101000Total65717683316090250

General SummaryProject 25 Manuscript - Preliminary Data SummaryRevised 7/18/12Report Period:A total of 34 Project 25 participants were enrolled between 3/07/11 through 12/21/2011. UCSD utilization data was provided between July 2009 and May 2012; however, utilization data reported here are limited 33 participants with service dates no more than 6 months before and after each participant's specific enrollment date. A total of 160 service dates were documented during the pre-enrollment period, and 90 service dates were documented during the post-enrollment period.Demographic Characteristics1. Participant age at enrollment.NMedianIQRAge at enrollment3347.441.7, 60.02. Participant gender.GenderN%Male2884.8Female515.2Total33100.03. Participant race.RaceN%White2472.7Black412.1Hispanic26.1Native American13.0Unknown26.1Total33100.0Visit Characteristics4. Visit type by pre- and post-enrollment visits.Pre-EnrollmentPost-EnrollmentOverallVisit TypeN%N%N%Inpatient2515.688.93313.2ED/Urgent11571.95460.016967.6Other2012.52831.14819.2Total160100.090100.0250100.05. Top 5 principal diagnoses at pre- and post-enrollment visits at inpatient and ED/Urgent visits.Pre-enrollment (n=140 visits)N%NONDEPENDENT ABUSE DRUGS2115.0ALCOHOL DEPENDENCE SYNDROME1510.7ALCOHOLIC PSYCHOSES128.6EPILEPSY75.0ABDOMINAL SYMPTOMS75.0Post-enrollment (n=62 visits)N%ABDOMINAL SYMPTOMS69.7NONDEPENDENT ABUSE DRUGS46.5DEPRESSIVE DISORDER OT46.5OBSERVE CONDITIONS NOT FOUND46.5ALCOHOLIC PSYCHOSES34.8Overall (n=202 visits)N%NONDEPENDENT ABUSE DRUGS2512.4ALCOHOL DEPENDENCE SYNDROME178.4ALCOHOLIC PSYCHOSES146.9ABDOMINAL SYMPTOMS136.4AFFECTIVE PSYCHOSES94.56. Payor by pre- and post-enrollment vis

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