Northern Virginia Regional Health Information Organization

Plenary Session                                                                                    December 1, 2006

Brief Notes on Presentations

Welcome                                                                                              Jane Woods

            The Commonwealth’s IT Council would announce today which proposals would  be among the 61 chosen to be funded.  The governor is being asked for additional funds. The IRS has put a hold on filing by the RHIO, until it finds out what a RHIO is. Two major concerns:

            When making transitions from hard copy to electronic data, encode the data so that it will be available to all qualified users.

            Financial sustainability for the RHIO.

Kiosk-based Personal Health Records Systems                                    Frank Avignone

             HealthMeans, Inc. adapted a smart card idea from German, Austrian, Slovenian, and Far Eastern health systems.  The patient’s vital information is stored in a chip on an ATM card, secured by a password. The physician or health system can determine how much or how little information to put on the card, to protect privacy.  The patient can determine whether he wants to give the card to a provider.   People can hand in the cards or insert them in kiosks at emergency rooms, clinics, or pharmacies, and their information will be available, so that they don’t have to fill out forms.  The cards help reduce medical errors, overcome difficulties in communication between 2 institutions, and relieve pressure on staff.  Extra funding can be obtained by allowing companies, such as WalMart, to brand the cards.

Electronic Health Records in Private Practice                            Richard Rosenthal

            Dr. Rosenthal put the medical records in his practice into electronic form 10 years ago, using the products of Medical Logic, designed by Mark Levitt (sp?) MD, PhD, who is now with Centricity, part of the GE company.  He was an early adopter of practices that now appear in the allergist association’s 9-page guideline.

            He types his notes directly into the keyboard during the patient’s examination.  He then prints out 2 copies, one for himself and one for the patient.  The document has the patient’s diagnoses and drug history and whatever current prescription the doctor has written.  He also integrates content from medical websites, e.g. WebMD, into the notes, so that this information can be saved in the chart.  He can send print-outs to consulting physicians.

            He still maintains paper charts, which he finds easier to leaf through and which provide a back-up in case of system crash.  He keeps paper records of lab results in the charts; he does not upload data from the lab into the computer.

            Benefits:

            Real-time record                       justification of diagnostic code

            Malpractice defense                  facilitates patient education

            Interface with vendors               access to guidelines

            Clinical graphics                        X-ray reports

            Searchable files             drug interactions

            Patient handouts                       no dictation or transcription

            Impediments to implementing electronic systems:

            MDs often have trouble mastering keyboard and IT skills

            Expense of start-up and maintenance

            Need for a network engineer

            Need for a champion

            Economic justification

            Return on investment goes to the insurance companies, who save on their costs,

             while the doctor has invested in the system.  His return is intangible—improved

             patient care and gratification.

MedVirginia’s Medication Module                                                        Dr. Mark Matthews

            The Powerpoint demonstration illustrated the connections between the elements of the module.  Advantages  for e-prescribing are that the system can import and store multiple data elements from all of the patient’s health care providers and integrate them into the patient’s history.  Contraindications for medications will appear before the doctor prescribes a new medication.  The pharmacist does not have to call for clarification of handwriting.

            There are different levels of electronic support, allowing only persons authorized at each level to see information at that level.

            This system is being adopted by the Rural Virginia E-Health Collaborative.  RX Gateway was the breakthrough software package.

            He thinks patients should assist in paying for the technology, since they benefit.

Committee Reports

            Patient Safety                                                                           Dr. Leslie Elwood

Gave out printed timeline of activities and table of suggested contents for a possible personal health record design.  Comment from the floor that much depends on the state’s development of the Master Patient Index. Second comment that other state groups had not waited for the MPI and  that a system just needed a way of identifying people.  Jane Woods said  that the state had appropriated $250,000 to get the MPI started and hoped  for more from the governor.  She suggested that we have a state speaker at the Plenary Session in March.

            Legal and Documents                                                               Alan Goldberg

The law is trying to catch up with the changes technology has brought to  patient privacy, but his committee is devoted to assisting all stakeholders—patients, providers, payors, vendors, and technology experts—in working together. The committee suggests that N VA RHIO be registered as a 501(c)(3) not-for-profit charity.  There would have to be a charitable purpose; the IRS does not currently accept the RHIO as a charitable organization.  He thinks that it ought to qualify because it has a good purpose, people want RHIOs, and there is no good reason not to permit it.  A member of the audience said that the RHIO could register as a 501(c)(4) service organization instead.  It would not have to have a charitable purpose.

            Technology Committee                                                             Mike Corrigan

There was a Powerpoint demonstration.  The committee had attended presentations, one by IBM.  It had studied the IT systems of local  hospitals and it was planning to have a focus group in Reston through the Reston Citizen’s Association.  They think the RHIO will choose a hybrid system in the end.  The system would have 2 levels of information, one for all to look at (medication information available for emergency personnel) and one for personal data protected by privacy measures.

The powerpoint listed scenarios for determining which information belongs in which level.

Emergency room standards have not been developed in all areas yet; these are a crucial component.  Representative Stark will be an important voice in Congress on this issue.

There is also a need for regulatory relief

Outreach                                                                                              Ian Kremer

The committee is waiting to determine its message until it finds out what project or projects the RHIO will undertake.  Meanwhile, it has determined that its message should be inclusive, accessible, responsinve, and outcome-oriented.  People should know what benefit they will derive from being in or supporting the RHIO.  It should respect integrity and privacy.  The outreach committee should be able to answer the 5 Ws and H of journalism:  who, what, where, when, why, and how. 

Meanwhile, the committee is compiling a complete list of contacts.

Finance                                                                                    Colleen Rooney

There was a Powerpoint demonstration.  The committee recommended getting the RHIO idea to market by starting with an administrative claims data exchange. This would be a value proposition for all the major stakeholders—labs, radiologists, consultants.  The committee recommended a phased approach, starting with the big organizations.  The committee recommended seeking funds from the organizations who would benefit from the RHIO.  It is compiling a list of potential donors.

The committee also recommended a business model combining a subscription fee and a transaction fee.  It also recommended taking into account the views of the VA Commission on Joint Technology.

Closing Remarks                                                                                              JP Auffret

            Current activities are still being organized by the steering committee.  The Board and formal organization will be finalized next spring.  Dr. Hazell suggested getting the major insurers together to ask for funding.  Jane Woods suggested that the Outreach Committee prepare its contact list and a general-purpose education module.

Addendum

            A follow-up discussion was held on December 7, 2006.  Jane Woods, Dr. J.P. Auffret, Dr. Mark Meiners, Dr. J. Goodlett McDaniel, Janet Palmisano, and Sidney Johnson attended.

            There was much discussion about identifying the motivations of the key stakeholders in the area, including vendors, and demonstrating that participating in the establishment of a RHIO could meet their needs.   Members of this group determined that the RHIO should focus on the creation of electronic Personal Health Records that were portable and held by consumers.  Hospitals, insurance companies, physicians, and other health care providers would need assistance in seeing in what ways they would benefit from PHRs.  Developing the sophistication and expertise needed to implement them will be the Northern Virginia RHIO’s distinctive approach.  Successful development will attract the attention of Washington decision-makers and interested parties nationwide.

            A plan emerged to engage the interest of the general population, to build pressure for a RHIO from the ground up.  If the public were educated on the benefits of PHRs, and if the media took up the idea, there would be a groundswell of public desire for them.

            The Outreach Committee, with cooperation from all other committees, will be asked to develop a module, including a Powerpoint presentation, that could be used by anyone in the RHIO who had the opportunity to speak to a community group, e.g. Rotary, Optimists, PTAs.  RHIO speakers would be listed on GMU’s Speakers’ Bureau.  The module would explain what PHRs are and why consumers would benefit from them.

            The processes of creating PHRs and marketing the idea to the public would be complementary and mutually stimulating.  The interaction of these processes would itself be a worthwhile subject for a research project on the social marketing and extent of penetration of the PHR and RHIO ideas.   Opportunities for funding will be sought.

            Members of this group will circulate suggestions for ideas to include in the module, taking the consumer’s point of view.   Dr. Meiners will contact the chairman of the Outreach Committee, Ian Kremer.