Creating Health Information Creating Health Information Exchanges: Exchanges:

The Indiana Network for The Indiana Network for Patient CarePatient Care

Shaun Grannis, MD, MS Shaun Grannis, MD, MS

Research ScientistResearch Scientist

Regenstrief Institute / IU School of MedicineRegenstrief Institute / IU School of Medicine

The Challenge: The Challenge: Silos of InformationSilos of Information

Silos of InformationSilos of Information

Electronic Electronic Medical Record Medical Record

SystemSystem

Jane Receives Jane Receives Immunizations @ Health Immunizations @ Health

DepartmentDepartment

Data delivered Data delivered to to

immunization immunization registryregistry

Jane Receives Jane Receives Immunizations and other Immunizations and other

care (measurements, care (measurements, labs, diagnoses, etc) @ labs, diagnoses, etc) @

Clinical PracticeClinical Practice

Data delivered Data delivered to EMRto EMR

ImmunizatioImmunization Registryn Registry

Silos of InformationSilos of Information

ImmunizatioImmunization Registryn Registry

Electronic Electronic Medical Record Medical Record

SystemSystem

Registry Registry Web Web

InterfaceInterface

EMR EMR InterfaceInterface

??????????????????????

INPC - Humble Beginnings INPC - Humble Beginnings

Regenstrief tasked in 1972 to Regenstrief tasked in 1972 to “stitch” these silos of information “stitch” these silos of information together -> the Regenstrief Medical together -> the Regenstrief Medical Record System (RMRS/Wishard) Record System (RMRS/Wishard)

In 1994, began stitching together In 1994, began stitching together information across institutions information across institutions (INPC/Indianapolis)(INPC/Indianapolis)

In 2003, working towards stitching In 2003, working towards stitching the state together (INPC/Indiana)the state together (INPC/Indiana)

Consolidating the SilosConsolidating the Silos

ImmunizatioImmunization Registryn Registry

Electronic Electronic Medical Record Medical Record

SystemSystem

Patient ID: 123LMNOPPatient ID: 123LMNOPName: Jane Doe Name: Jane Doe DOB: 01/01/04DOB: 01/01/04SSN: N/A SSN: N/A Address: 555 Johnson RoadAddress: 555 Johnson RoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202

Patient ID: 6789XYZPatient ID: 6789XYZName: Jane Ellen DoeName: Jane Ellen DoeDOB: 01/01/04DOB: 01/01/04SSN:123-45-6789SSN:123-45-6789Address: 555 Johnson Address: 555 Johnson RoadRoadCity: IndianapolisCity: IndianapolisState: IndianaState: IndianaZIP: 46202ZIP: 46202

Global Global Patient Patient IndexIndex

Concept Concept DictionaryDictionary

Global ID:Global ID: 4567845678Name: Name: Jane Ellen Doe Jane Ellen Doe Lots of Demographics..Lots of Demographics..MRF1 ID: MRF1 ID: OU81247OU81247MRF2 ID: MRF2 ID: 45643564564356PH MRF ID: PH MRF ID: 123LMNOP123LMNOPMRF3 ID:MRF3 ID: 6789XYZ6789XYZ

DTaP Dose Count:DTaP Dose Count: 30936-930936-9HIB Dose Count:HIB Dose Count: 30938-530938-5IPV Dose Count:IPV Dose Count: 33555-433555-4VZV Dose Count:VZV Dose Count: 30943-530943-5MMR Dose Count:MMR Dose Count: 30940-130940-1HepB Dose Count:HepB Dose Count: 30937-730937-7

Jane Doe’s Immunizations:Jane Doe’s Immunizations:

3/1/043/1/04 DipTetaPurDipTetaPur3/1/043/1/04 HemInfBHemInfB3/1/043/1/04 PolioVirPolioVir3/1/043/1/04 HepaBHepaB

Jane Ellen Doe’s Shots:Jane Ellen Doe’s Shots:

5/1/045/1/04 DTaP ImmDTaP Imm5/1/045/1/04 HIB ImmHIB Imm5/1/045/1/04 IPV ImmIPV Imm7/9/047/9/04 DTaP ImmDTaP Imm7/9/047/9/04 IPV ImmIPV Imm

30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30937-30937-77

30936-30936-9 9 30938-30938-5 5 33555-33555-4 4 30936-30936-9 9 33555-33555-44

Consolidating the SilosConsolidating the Silos

ImmunizatioImmunization Registryn Registry

Electronic Electronic Medical Record Medical Record

SystemSystem

Global Global Patient Patient IndexIndex

Concept Concept DictionaryDictionary

St. St. Vincent Vincent

MRFMRF

Clarian Clarian MRFMRF

Wishard Wishard MRFMRF

Community MRFCommunity MRF

Public Public Health MRFHealth MRF

Global Global Patient Patient IndexIndex

IUMG MRFIUMG MRF

Concept Concept DictionaryDictionary

The Indiana Network for Patient The Indiana Network for Patient CareCare

INPC System DesignINPC System Design Separate medical record vault per Separate medical record vault per

institutioninstitution Each vault in separate physical files, Each vault in separate physical files,

but centrally locatedbut centrally located Standardized data structure – All use Standardized data structure – All use

same software and observation codes same software and observation codes Patient demographics linking via Patient demographics linking via

global registryglobal registry Combine on the fly when neededCombine on the fly when needed

INPC – Participants INPC – Participants Includes 17 hospitals from the 5 major Includes 17 hospitals from the 5 major

Indianapolis hospital systems (95% of non-office Indianapolis hospital systems (95% of non-office care)care)

National and regional laboratoriesNational and regional laboratories Includes county and state public health Includes county and state public health

departmentsdepartments 35% of outpatient practices35% of outpatient practices Both major cardiologyBoth major cardiology

referral centersreferral centers Four homeless care centersFour homeless care centers

INPC hospital participantsINPC hospital participants

Health DepartmentPractice/ClinicHospital

LabCorpLabCorp

QuestQuest

MCHDMCHD

Rx dataRx data

In p

rog

ress

Heart Center of Indiana

The Indiana Heart Hospital

A “Big” Repository by US A “Big” Repository by US StandardsStandards

In the system:In the system:- 1.3 million patients, 5 million 1.3 million patients, 5 million

registration “events”registration “events”- 24 million orders24 million orders- 660 million coded results660 million coded results- 12 million dictated reports12 million dictated reports- 8.8 million radiology reports8.8 million radiology reports- 25 million prescriptions25 million prescriptions- 480,000 EKG tracings480,000 EKG tracings- 45 million radiology images45 million radiology images

Added Per Year:Added Per Year:- 600,000 ambulatory encounters600,000 ambulatory encounters- 50,000 inpatient encounters50,000 inpatient encounters

Docs4Docs - Links to office Docs4Docs - Links to office practicespractices

Results delivery service (Docs4Docs)Results delivery service (Docs4Docs) Results flow through INPC central to Results flow through INPC central to

Docs4Docs and are routed to MD in-Docs4Docs and are routed to MD in-boxesboxes

All hospitals send reports through same All hospitals send reports through same mechanismmechanism

Improved office efficiency and Improved office efficiency and convenienceconvenience

Eliminates mail and (almost) fax costsEliminates mail and (almost) fax costs

Current status Current status 280 practices from 3 Hospital systems 280 practices from 3 Hospital systems

(about 1800 MDs)(about 1800 MDs) Indiana Health Information Exchange Indiana Health Information Exchange

(IHIE) is Regenstrief’s corporate partner(IHIE) is Regenstrief’s corporate partner Scheduled for whole city by end of 2005 Scheduled for whole city by end of 2005

through IHIEthrough IHIE Uses same data streams as structured Uses same data streams as structured

EMR – but simpler structure EMR – but simpler structure Will provide links to all MDs for other Will provide links to all MDs for other

purposespurposes

Founding MembersFounding Members Hospital systemsHospital systems

- Clarian Health PartnersClarian Health Partners- St. Francis Hospitals and Health SystemSt. Francis Hospitals and Health System- St. Vincent Health CareSt. Vincent Health Care- Wishard Health ServicesWishard Health Services- Community Hospitals of IndianaCommunity Hospitals of Indiana

GovernmentGovernment- City of IndianapolisCity of Indianapolis

Public HealthPublic Health- State Department of HealthState Department of Health- Marion County Health DepartmentMarion County Health Department

ResearchResearch- IU School of MedicineIU School of Medicine- Regenstrief InstituteRegenstrief Institute

Medical societiesMedical societies- Indianapolis Medical SocietyIndianapolis Medical Society- Indiana State Medical AssociationIndiana State Medical Association

Economic developmentEconomic development- BioCrossroads / Central IndianaBioCrossroads / Central Indiana

Corporate PartnershipCorporate Partnership

0

20

40

60

80

100

120

140

Credentialing Eligibilitychecking

Public health Results delivery Research Decisionsupport

Disease mgmt

Benefits Accrue to Benefits Accrue to Stakeholders Across SystemStakeholders Across SystemAnnual

economicvalue ($M)

•Patients•Physicians•Hospitals•Labs

•Physicians•Hospitals

•Patients•Physicians•Hospitals•Payors

•Patients•Physicians•Hospitals•Payors•Employers

•Patients•Physicians•Hospitals•Public health

•Payors•Employers

Beneficiaries1 •Patients•Hospitals•Labs•Public health

•Patients•Researchers• Investigators•Pharma companies

(1) Includes quality of care/other non-economic beneficiaries as wellSource: BCG Analysis & Estimates

LONG-TERM ECONOMIC BENEFITTO CENTRAL INDIANA

WILL EXCEED $120M ANNUALLY

LONG-TERM ECONOMIC BENEFITTO CENTRAL INDIANA

WILL EXCEED $120M ANNUALLY

Achieving full value requires Achieving full value requires structured datastructured data

Percent

Capture electronically

Connect & interface

Standardize and store data

0

10

20

30

40

50

60

70

80

90

100

76%

5%

19%

C!TL, BCG calculations

Questions / DiscussionQuestions / Discussion

Shaun Grannis, MD, MS Shaun Grannis, MD, MS Research ScientistResearch Scientist

Regenstrief Institute / IU School of MedicineRegenstrief Institute / IU School of Medicinesgrannis@regenstrief.orgsgrannis@regenstrief.org