COMMITTEE ON PATIENT SAFETY AND QUALITY
Minutes of Meeting on October 24, 2006
Members present: Leslie Ellwood, MD, Chair
Charles Alexander,
AARP
Connie Bourne,
MedHealthSolutions
Kenneth Geoly,
MD, INOVA
Jim Harris,
INTEL
Jeff Odell,
MED Virginia
Corey Riley,
Prince William Health Center
Nancy Thompson,
Health Care Insights, LLC
Attending members introduced
Charge to the Committee:
“Develop scenarios on NOVARHIO capability in the areas of basic information
exchange, medications, allergies, immunizations, sentinel events,, and emergencies
for Years 1, 2, and 3. Review MEDVirginia and Indiana capabilities, Review
potential RHIO role in helping facilitate physician practice adoption of EMRs.”
1) Minutes from October 6 meeting reviewed.
Noted designation of safety and quality data in a RHIO database as follows:
PATIENT SAFETY
ALLERGIES
MEDICATIONS
IMMUNIZATIONS
CRITICAL DIAGNOSES (PATIENT
PERMISSION to include)
LAB RESULTS (APPROVED
BY PROVIDER for transfer to RHIO)
RADIOLOGY RESULTS
ENHANCE QUALITY OF CARE
HOSPITAL TRANSCRIPTIONS
(Discharge Summary)
OFFICE BASED RECORDS (EMR)
E-REFERRALs
SENTINAL EVENTS (DIAGNOSES)
EMERGENCY CONDITIONS
PERSONAL HEALTH INFORMATION
2) L Ellwood reported on Committee Chairs
meeting on October 16, 2006. Chairs decided sharing of Committee minutes would
be desirable and that each Committee should identify actions needed from other
committees in their minutes. (Safety and Quality, Outreach, Documents, Finance,
and Infrastructure)
3) At the initial meeting, the Committee
had recommended an initial focus on Pharmacy, Laboratory, Radiology, and Immunizations
as currently available IT databases that would be relatively easy to access.
We confirmed this plan with the additional attendees for this meeting.
4) At the initial meeting, the Committee
had decided to identify hospital IT capabilities so as to align the RHIO database
with the area hospitals. Information was provided by Committee representatives
from HCA Reston, Northern Virginia Hospital Center, and INOVA Hospital Systems.
Mohammed Beyad submitted information for HCA Reston, Archie McPherson submitted
information from HCA Reston, and Ken Geoly provided information for INOVA
Health Systems. The IT capabilities are reported in the following table.
| IT
Functions |
INOVA
Health Systems |
NO
VA Hospital Center |
HCA
Reston |
| Laboratory |
X |
X |
X |
| Inpatient
Medications |
X |
X |
X |
| Outpatient
Medications at discharge |
NO |
NO |
NO |
| Radiology
Reports |
X |
X |
X |
| Digital
Radiography |
X
(PACS) |
NO |
NO |
| Physician
Order Entry |
NO |
By 2008 |
NO |
| Selected
Transcription reports |
X |
? |
? |
Comments
- All three major hospitals meet the initial
need to provide data for laboratory, inpatient medications, and radiology
results.
- Inpatient medications are most often short-term
treatment and may not reflect long term medication requirements.
- Medications prescribed at discharge are
not captured by hospital pharmacy.
- Laboratory data may vary by hospital as
to reference ranges of normal results or the methodology for a specific
lab test may cause variation in results, and laboratory data may be displayed
in different formats.
- Digital radiograph transmission would
be less useful than the transmission of radiology reports.
5) The Committee reviewed non-hospital
data sources for Lab, Pharmacy, Radiology
- Three major commercial laboratory sources
with IT data and reports were identified for northern Virginia: LabCorp,
Quest Diagnostics (includes former American Medical Labs), or Fairfax Medical
Laboratory.
- Retail Pharmacy sources include CVS, Rite
Aid, Eckard, Walgreen, WalMart, Safeway, Giant, CostCo, and others. However,
in addition to individual IT systems, they share common information files
through companies such as SureScript or RxHub. RHIO could either query each
pharmacy or query the centralized information sources.
- Radiology sources would include the hospital
based radiology services plus the several private radiology groups with
stand alone imaging centers in northern Virginia.
6) Immunization sources would include
- Local Health Departments
- Virginia Immunization Registry
- Health Plans who could convert claims
data to immunization record
- (physician office immunization records
are usually paper)
7) Personal Health Information (PHI) would
be consumer entered health information that would involve entering personal
health information into specific fields on a PHI database. Information entered
by the consumer would not be validated by any objective information and should
be used with caution. However, it could provide significant information not
captured from objective data sources. Data could also include alternative
medications and treatment.
Committee members are asked to email L
Ellwood (lellwood@cox.net) suggestions
on appropriate content for a PHI database
8) Other pertinent discussion included:
Essential demographic information to accurately
identify individuals would need to be developed. Other reports have indicated
that as few as 5-6 identifiers are needed to accurately identify an individual.
Once the RHIO selects the critical identifiers, we would have to assure that
all data sources also contain that demographic information. Part of the IT
grant money established by the General Assembly is to be used to establish
a Master Patient Index. The time line for the MPI has not been established
and whether it would form a demographic basis for RHIOs in the Commonwealth
has not been determined. (Refer to Infrastructure Committee)
The RHIO may wish to consider a data navigator
bar for each individual to report the available data and the time and source
of each. Such a navigator bar would allow persons accessing the RHIO database
to select the information desired.
Noting the 2006 legislation on physician
immunity for laboratory and other reports, clarification of the accountability
of a physician downloading information that includes abnormal results from
a RHIO database is needed. (Refer to Documents Committee)
Noting the current penetration of office
based Electronic Health Records is less than 20%, the RHIO may be confronted
by different needs for access to the database. Some physicians may possess
EHRs that will download and incorporate RHIO data directly into the patient
records. Others may have EHRs not capable of integrating the data and reports
will be a separate information source. Many physicians will not have EHR but
could download and print RHIO information through a web based portal. The
ability to integrate the data into an EHR is optimal and should be promoted
as physicians choose EHR systems.
9) Next Steps
- Minutes will be distributed to all committee
members for additional comment.
- Committee members will provide suggestions
for appropriate information (data fields) for consumer entered personal
health information record.
- L Ellwood will draft one, two, and three
year scenarios for a NV RHIO based on discussions of two committee meetings.
Scenarios will be distributed to committee members for comment.
Submitted by Leslie Ellwood, MD
October 26, 2006
703 934 5755
