San Diego Beacon:San Diego Regional Health Information Exchange
James Killeen, MDSD Beacon Technical LeadProfessor of Clinical Emergency MedicineUCSD School of Medicine
“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
Beacon Community Program
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
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ARRA & HITECH Act
• HITECH Priority 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
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Build 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.
ONC’s Beacon Community Program – where HITECH comes to life
• Beacon Communities funded to:
17 Beacon Communities
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Hawaii County Beacon Community
Hilo, HI
Southeast Michigan Beacon Community
Detroit, MI
Crescent City Beacon CommunityNew Orleans, LA
Delta BLUES Beacon Community
Stoneville, MS
Keystone Beacon Community Danville, PA
Utah Beacon Community
Salt Lake City, UT
Beacon Community of Inland Northwest
Spokane, WA
Great Tulsa Health Access Network Beacon
CommunityTulsa, OK
Southeastern Minnesota Beacon Community
Rochester, MN
Rhode Island Beacon Community
Providence, RI
Greater Cincinnati Beacon Community
Cincinnati, OH
Southern Piedmont Beacon Community
Concord, NCSan Diego Beacon Community
San Diego, CA
Western New York Beacon Community
Buffalo, NY
Colorado Beacon Community
Grand Junction, CO
Bangor Beacon CommunityBrewer, ME
Central Indiana Beacon Community
Indianapolis, IN
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)
San Diego
Beacon
CDC
Community A
VA/DOD
State/Local Government
Community B
ClinicsEMS
County PH
SD VA/DOD
Build and Strengthen Health IT
Kaiser
SD VA/DOD
EMS
County PH
Clinics
Others
Hospitals
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
HIE Construction
Clinical
Pre-Hospital & 911
Population & Public Health
San Diego Beacon
• Improve Quality, Population Health, Costs
Cardiovascular Dz Childhood IZSyndromic Surveillance
Redundant TestsED/hospital Readmits
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Integrated Clinical Experience
Integrated Solution
Immunizations
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• More than 700,000 Lives• UCSD, Sharp, Rady, Scripps, & Medical Groups within San Diego
ImmunizationsSDB Hosting Immunization Server
Provides routing of ADT and MU Reporting messages to SDIR and SD County
Lab Data Normalization and ELR
Syndromic Surveillance: ADT messages
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Verbal Report
Written Report
ECG
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)
San Diego
• 2010 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
eRAP
Messaging
• Event notification for ED Visit, Admit or Discharge– Providers– Payors– Health Systems– Federal Partners
Project 25
• ED visits and charges reduced substantially in 6 month pre/post comparison for enrollees
Financial Impact
EMS EMR vendor
EMS HubSan Diego
San Diego, CA
Q1 2011 Q2 2011 Q3 2011 Q4 2011 Q1 20120
10
20
30
40
50
33.3
15.8
7.7
0.0
Performance on false positives STEMI incidents, by Quarter
False positive STEMI incidents
Perc
ent
Smart Analytics AlgorithmsIdentifying 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 ED
40 y/o Post Traumatic Brain Injury
40 y/o Post Traumatic Brain Injury
40 y/o Post Traumatic Brain Injury
Arrested
Released from Jail
P25
Alerts to P25
“ 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.org
San Diego Beacon
Questions?