San Diego Beacon: San Diego Regional Health Information Exchange

1. 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

3. Beacon Community Program “These 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

4. Overview • Funded 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 nation • Transition from a grant-funded initiative to an self-sustaining independent organization providing services to the health care community

5. ARRA & HITECH Act • HITECHPriority Grant Programs  nationwide meaningful use • Medicare and Medicaid Meaningful Use Incentive Payments • Health IT Regional Extension Center Program • Grants to states and state-designated entities for Health Information Exchange (HIE) • $20b in Health HIT • electronic health records • e-prescribing, e-care and telemedicine • community health initiatives • foster private sector investment in innovation 5

6. ONC’s Beacon Community Program – where HITECH comes to life • Beacon Communities funded to: Build and strengthenhealth IT infrastructure and exchange capabilities - positioning each community to pursue a new level of sustainable health care quality and efficiency over the coming years. Improvecost, 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.

7. 17 Beacon Communities Bangor Beacon CommunityBrewer, ME Western New York Beacon Community Buffalo, NY Beacon Community of Inland NorthwestSpokane, WA Southeastern Minnesota Beacon Community Rochester, MN Rhode Island Beacon Community Providence, RI Southeast Michigan Beacon Community Detroit, MI Keystone Beacon Community Danville, PA Central Indiana Beacon Community Indianapolis, IN Utah Beacon Community Salt Lake City, UT Greater Cincinnati Beacon Community Cincinnati, OH Colorado Beacon Community Grand Junction, CO Southern Piedmont Beacon Community Concord, NC Great Tulsa Health Access Network Beacon Community Tulsa, OK San Diego Beacon Community San Diego, CA Delta BLUES Beacon Community Stoneville, MS Hawaii County Beacon Community Hilo, HI Crescent City Beacon Community New Orleans, LA

8. San Diego Beacon • Connecting ambulances to emergency rooms • Patient event notification to providers and payors • Wireless cardiac device pilot • Community Health Information Exchange • Patient information available to providers across systems at the point-of-care • Accessible in ED, hospital, clinic • Reporting (Immunizations, Public Health)

9. State/Local Government Community B VA/DOD County PH San Diego Beacon CDC Community A SD VA/DOD EMS Clinics

10. Build and Strengthen Health IT Clinics Hospitals SD VA/DOD Kaiser EMS Others County PH

11. Suite of Services • Pre-hospital data available to hospitals electronically • Pre-hospital record • ECG, Images • Search capability into the HIE • Immunization • Optimize vaccine administration strategies • Import data from non-traditional settings • Add Immunization Forecasting • Syndromic Surveillance • Enhance reporting capabilities • Radiology Imaging • Import Medical Device Data • Implantable devices • Wireless Devices

12. HIE Construction Pre-Hospital & 911 Clinical Population & Public Health

13. San Diego Beacon Cardiovascular Dz Childhood IZ Syndromic Surveillance Redundant Tests ED/hospital Readmits Improve Quality, Population Health, Costs

14. Integrated Clinical Experience Integrated Solution

15. Immunizations • More than 700,000 Lives • UCSD, Sharp, Rady, Scripps, & Medical Groups within San Diego

16. Immunizations • SDB Hosting Immunization Server • Provides routing of ADT and MU Reporting messages to SDIR and SD County

17. Lab Data Normalization and ELR

18. Syndromic Surveillance: ADT messages

19. Verbal Report Written Report ECG

20. Prehospital HIE • Prehospital data available to hospitals electronically • Prehospital record • Electrocardiograms & Images • HIE also back to field providers • EMS Application Partners • SD City EMS • AMR (Initiated) • Fieldsaver (Initiated)

22. San Diego • 2010 OSHPD Data: • 24% (nearly one in four) of all 30-day readmissions occurs at a different hospital (excludingVA, NMCSD) • 15% of all ED patients and 69% of “frequent fliers” were seen in multiple hospitals

23. eRAP

24. Messaging • Event notification for ED Visit, Admit or Discharge • Providers • Payors • Health Systems • Federal Partners

25. Project 25 • ED visits and charges reduced substantially in 6 month pre/post comparison for enrollees Financial Impact

26. EMS EMR vendor EMS Hub San Diego San Diego, CA

29. Smart Analytics Algorithms Identifying Patients with In-Home Difficulties

30. Smart Analytics Algorithms Identifying Patients with Substance Abuse Issues

31. Smart Analytics Algorithms Identifying Patients with Psychiatric/Behavioral Problems

32. 59 y/o Serial Inebriate Patient

33. Serial Inebriate Patient RAP Trigger=SIP counselor sent to ED

34. 40 y/o Post Traumatic Brain Injury

35. 40 y/o Post Traumatic Brain Injury

36. 40 y/o Post Traumatic Brain Injury Arrested P25 Released from Jail Alerts to P25

39. “Information should follow the patient, and artificial barriers – technical, business-related, bureaucratic – should not get in the way ” • David Blumenthal, MD, Former Director, ONC

40. www.sandiegobeacon.org

41. San Diego Beacon

42. Questions?