# Presentation: 612038

## Creating Health Information Exchanges: The Indiana Network for Patient Care

- Shaun Grannis, MD, MS
- Research Scientist
- Regenstrief Institute / IU School of Medicine

## The Challenge: Silos of Information

## Silos of Information

- Electronic Medical Record System

- Jane Receives Immunizations @ Health Department

- Data delivered to immunization registry

- Jane Receives Immunizations and other care (measurements, labs, diagnoses, etc) @ Clinical Practice

- Data delivered to EMR

- Immunization Registry

## Silos of Information

- Immunization Registry

- Electronic Medical Record System

- Registry Web Interface

- EMR Interface

- ???????????

## INPC - Humble Beginnings 

- Regenstrief tasked in 1972 to “stitch” these silos of information together -> the Regenstrief Medical Record System (RMRS/Wishard)
- In 1994, began stitching together information across institutions (INPC/Indianapolis)
- In 2003, working towards stitching the state together (INPC/Indiana)

**Notes:**
The hospital problem of data fragmentation recapitulates itself in the community
We describe our efforts toward a community wide electronic record, to solve this problem

## Consolidating the Silos

- Immunization Registry

- Electronic Medical Record System

- Patient ID:  123LMNOP
- Name:  Jane Doe
- DOB: 01/01/04
- SSN:  N/A
- Address: 555 Johnson Road
- City: Indianapolis
- State: Indiana
- ZIP: 46202

- Patient ID:  6789XYZ
- Name:  Jane Ellen Doe
- DOB: 01/01/04
- SSN:123-45-6789
- Address: 555 Johnson Road
- City: Indianapolis
- State: Indiana
- ZIP: 46202

- Global Patient Index

- Concept Dictionary

- Global ID:	45678
- Name:  	Jane Ellen Doe
- Lots of Demographics..
- MRF1 ID:  	OU81247
- MRF2 ID:  	4564356
- PH MRF ID: 	123LMNOP
- MRF3 ID:	6789XYZ

- DTaP Dose Count:	30936-9
- HIB Dose Count:	30938-5
- IPV Dose Count:	33555-4
- VZV Dose Count:	30943-5
- MMR Dose Count:	30940-1
- HepB Dose Count:	30937-7

- Jane Doe’s Immunizations:
- 3/1/04	DipTetaPur
- 3/1/04	HemInfB
- 3/1/04	PolioVir
- 3/1/04	HepaB

- Jane Ellen Doe’s Shots:
- 5/1/04	DTaP Imm
- 5/1/04	HIB Imm
- 5/1/04	IPV Imm
- 7/9/04	DTaP Imm
- 7/9/04	IPV Imm

- 30936-9 30938-5 33555-4 30937-7

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

## Consolidating the Silos

- Immunization Registry

- Electronic Medical Record System

- Global Patient Index

- Concept Dictionary

- St. Vincent MRF

- Clarian MRF

- Wishard MRF

- Community MRF

- Public Health MRF

- Global Patient Index

- IUMG MRF

- Concept Dictionary

- The Indiana Network for Patient Care

## INPC System Design

- Separate medical record vault per institution
- Each vault in separate physical files, but centrally located
- Standardized data structure – All use same software and observation codes
- Patient demographics linking via global registry
- Combine on the fly when needed

## INPC – Participants 

- INPC – Participants

- Includes 17 hospitals from the 5 major Indianapolis hospital systems (95% of non-office care)
- National and regional laboratories
- Includes county and state public health departments
- 35% of outpatient practices
- Both major cardiology
- 	referral centers
- Four homeless care centers

## INPC hospital participants

**Health Department**
**Practice/Clinic**
**Hospital**

**LabCorp**

**Quest**

**MCHD**

**Rx data**

- In progress

**Heart Center of Indiana**

**The Indiana Heart Hospital**

## A “Big” Repository by US Standards

- In the system:
- 1.3 million patients, 5 million registration “events”
- 24 million orders
- 660 million coded results
- 12 million dictated reports
- 8.8 million radiology reports
- 25 million prescriptions
- 480,000 EKG tracings
- 45 million radiology images
- Added Per Year:
- 600,000 ambulatory encounters
- 50,000 inpatient encounters

## Docs4Docs - Links to office practices

- Results delivery service (Docs4Docs)
- Results flow through INPC central to Docs4Docs and are routed to MD in-boxes
- All hospitals send reports through same mechanism
- Improved office efficiency and convenience
- Eliminates mail and (almost) fax costs

## Current status 

- 280 practices from 3 Hospital systems (about 1800 MDs)
- Indiana Health Information Exchange (IHIE) is Regenstrief’s corporate partner
- Scheduled for whole city by end of 2005 through IHIE
- Uses same data streams as structured EMR – but simpler structure
- Will provide links to all MDs for other purposes

## Slide 14

## Slide 15

## Founding Members

- Hospital systems
- Clarian Health Partners
- St. Francis Hospitals and Health System
- St. Vincent Health Care
- Wishard Health Services
- Community Hospitals of Indiana
- Government
- City of Indianapolis
- Public Health
- State Department of Health
- Marion County Health Department
- Research
- IU School of Medicine
- Regenstrief Institute
- Medical societies
- Indianapolis Medical Society
- Indiana State Medical Association
- Economic development
- BioCrossroads / Central Indiana
- 	Corporate Partnership

## Benefits Accrue to Stakeholders Across System

**Annual**
**economic**
**value ($M)**

**Patients**
**Physicians**
**Hospitals**
**Labs**

**Physicians**
**Hospitals**

**Patients**
**Physicians**
**Hospitals**
**Payors**

**Patients**
**Physicians**
**Hospitals**
**Payors**
**Employers**

**Patients**
**Physicians**
**Hospitals**
**Public health**
**Payors**
**Employers**

**Beneficiaries****1**

**Patients**
**Hospitals**
**Labs**
**Public health**

**Patients**
**Researchers**
**Investigators**
**Pharma companies**

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

**LONG-TERM ECONOMIC BENEFIT**
**TO CENTRAL INDIANA ****WILL EXCEED $120M ANNUALLY**

**Notes:**
Value: 

## Achieving full value requires structured data

**Percent**

**Capture electronically**

**Connect & interface**

**Standardize and store data**

**76%**

**5%**

**19%**

- C!TL, BCG calculations

## Questions / Discussion

- Shaun Grannis, MD, MS
- Research Scientist
- Regenstrief Institute / IU School of Medicine
- sgrannis@regenstrief.org