establishing a recovery health information network to improve care for displaced populations
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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.
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