# Presentation: 616932

## Connecting to the Future:The Use of Electronic Health Information Exchange to Reduce Health Disparities

## SMRTNETSecure Medical Records Transfer Network

- An Expandable Health Information Exchange for Treatment Providers and Their Support Systems

## Where Are Your Health Records?

- Physician(s)
- Hospital(s)
- Specialist(s)
- Pharmacy (local, chain, mail in)
- Indigent clinic
- FQHC
- Laboratories
- Native American facility
- Veterans Administration
- Public health

## Who Has Scattered Records?

- Hospital and ED use
- Uninsured
- Moved
- Change Insurance
- Change provider
- Health Department
- Community health center
- VA
- Native American
- Elderly
- Specialist use

## Here is Enrico, our patient...

## Foot Surgery

- 1-15-02
- Bone Spur removal

- Diagnosed
- With Asthma
- 5-27-99

- Diagnosed with
- IBS   9-30-02

- Chronic Headaches

- Diagnosed
- With Arthritis
- 4-29-06

- Diagnosed
- With Depression
- 4-29-06

- Prescribed medication for
- Elevated LDL Cholesterol
- 12-22-05

- Enrico has disconnected healthcare providers, records, timeframes

## Foot Surgery

- 1-15-02
- Bone Spur removal

- Diagnosed
- With Asthma
- 5-27-99

- Diagnosed with
- IBS   9-30-02

- Chronic Headaches

- Diagnosed
- With Arthritis
- 4-29-06

- Diagnosed
- With Depression
- 4-29-06

- Prescribed medication for
- Elevated LDL Cholesterol
- 12-22-05

- SMRTnet brings them together.

## Why This is So Important

- Our medical records are scattered. This costs lives, injuries, and significant money
- Our medical system is largely paper based.  “Paper Kills”

## Three county area

- 24.1% families under poverty level
- 33.5% Native American
- Median family income
- Area $ 28,320
- State $ 35,313
- US $ 42,409

## An Inclusive Safety Net Project

- One of the most inclusive exchanges in the country
- Data exchange agreement being used by HHS to help them resolve issues at the national level
- $ 1.5 million “AHRQ Transforming Healthcare Quality through Information Technology (5-UC1-HS016131-02), $ 1.9 million local sources

## One of Every Provider Institution

- Public Health			Oklahoma State Department of Health
- Mental Health			Oklahoma Department of Mental Health 				and Substance Abuse Services
- Hospital			Tahlequah City Hospital
- Native American Tribe		Cherokee Nation Health Services
- University			Northeastern State University
- Indian Health Service		Hastings Indian Medical Center
- Community Health Center	NEO Comm. Health Center

## Types of eRecords

- Community record
- Eprescribing
- Personal health record

## Data to be SharedBased on Continuity of Care Record

- Demographics
- Allergies and Reactions
- Diagnosis
- Pharmacy
- Laboratory results
- Immunization
- History/visits
- Providers
- Five health risk factors as defined by prevention science taskforce, aspirin use, cholesterol, blood pressure, alcohol abuse, tobacco
- Social history*
- Insurance *
- Advanced directives *
- Plan of Care *

## Types of Providers

- Hospitals
- Community Health Centers
- Public Health
- Mental Health and Drug Abuse
- University
- Tribal Health
- Indian Health Service

- Physicians
- Dentists
- Pharmacies
- Chiropractors

## Benefits of Community Record

- Accurate history from all sources in the network.
- Improve diagnostic speed
- Decrease repeat tests and rule out need for other tests
- Improve quality from seeing activities that have occurred elsewhere
- Coordinate care as all provider share the same record
- Track clients between ED and other health facilities

## Benefits of ePrescribing

- Improve patient safety
- Right drug
- Least expensive drug
- Right spelling
- Right dosage
- Up to date pharmacy science
- Eliminate drug interaction
- Catch drug abusers
- Prescriptions sent electronically, fax, or printed out, no handwriting
- Can see if patient is refilling prescription

## Benefits of Personal Health Record

- Allows patient to see their health information in an understandable way
- Can add information such as herbals, allergies and reactions
- Allows patient to audit chart use

## How A Health Information Network Can Improve Health Disparities

## Gather Data from Many Sources for Quality Improvement and Research

- Special populations use many providers
- Only aggregated data will give enough information over time to establish comprehensive health facts
- Data is standardized in measurement systems
- Data is current

## Lower cost of Care for the Uninsured

- Recent SMRTNET Oklahoma City ten hospital study:
- ED reductions from network
-   $ 1,714,000
- Reduced lab  $ 351,002
- Reduced inpatient and observations
-   $ 7,439,713
- Total of $ 9,504,762

## Common Science Based Prevention

- Research group chaired by David Satcher, National Commission on Prevention Priorities
- Ranked 25 leading prevention measures based on best science available
- Based on effectiveness and cost effectiveness
- Published American Journal of Preventative Medicine 2006
- www.prevent.org/content/view/46/96/

## Oklahoma Health Rankings

- 	Conditions		OK		US
- Heart Disease 	307.1 	240.8
- Stroke			66.4 	56
- Smokers		26.0 	20.8
- High bp		28.0 	24.8
- High chol.		32.0 	33.1
- Binge drinking	13.0 	14.9

## Measures Selected

- Intervention					CPB+CE Score
- 1) Discuss Benefits of daily aspirin use		10
- 2) Measure blood pressure and treat 		  8
- 3) Screen for lipid disorders and treat	  	  7
- 4) Screen adults for tobacco use,
- 	provide brief counseling, offer
- 	pharmacotherapy				10
- 5) Screen those at risk for problem 		  8
- 	drinking and provide counseling
- 	and follow-up

## Geographic Pockets Can Be Identified for More Intense Efforts

- Sometimes health problems are more intense in pockets, such as injuries, communicable diseases, and environmental influences
- These areas can them be more focused for intervention

## Customized Algorithms Can Be Developed

- Different populations may need different algorithms
- System can be programmed to provide alerts

## Build an Electronic Health Record for the Uninsured

- If we are not going to insure people then we need to at least provide them with a portable electronic health record
- Can be accomplished by creating a phantom insurance company and submitting claims to it

## Improve Funding Environment

- Grants are available based on data
- Special population health data can help qualify an area for these grants
- Health centers can be established through some of these grants
- Opportunities for intervention care research

## Cost to Oklahoman’s from Disconnected Health Records

- $ 1.2 billion in healthcare costs of $ 20.1 billion health care expenditures in Oklahoma*
- This is a minimum of 6% of all health expenditures
- 1,139 potential lost lives
-        * Estimate based in U.S. Center for Medicare and Medicaid Services 2004 and medical inflation at 6.65 % through 2007. $ 1.7 billion projected by 2011 against medical costs of $ 25.8 billion.

## Overview of Cost Savings for Statewide Adoption of SMRTNET

- Year	All Oklahoma	State Govt.	Medicaid          Deaths 						                         Avoided
- 2007	$ 100.6 million	$ 20.1 million       $ 10.1 million     101
- 2008	$ 205.1 million	$ 41.0 million       $ 19.8 million     172
- 2009	$ 349.7 million	$ 69.9 million       $ 32.3 million     247
- 2010	$ 539.8 million	$ 107.9 million     $ 48.2 million     325
- 2011	$ 784.8 million	$ 156.9 million     $ 67.7 million     407

**Total Cost Based on Percentage of Providers Using System**

## Cost Benefits Based on Statewide SMRTNET Initiative

## In summary, HIE can help reduce health disparities by:

- Gather data from many sources for treatment, quality improvement and research
- Lower costs for the uninsured
- Customize algorithms for special populations
- Identify “pockets” and address those specifically
- Build an electronic health record for the uninsured
- Improve funding by providing special population data