Members present:
Leslie Ellwood, MD, CoChair
Connie Bourne, MedHealth Solutions
Charles Alexander, AARP
Jeff Odell, MedVirginia
Nancy Thompson, Health Care Insights

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) Committee reviewed what health information would be described as Patient Safety and as Enhance Quality of Care:

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

To promote health consumer use of and support for the RHIO, need to assure PATIENT ACCESS TO HEALTH INFORMATION EXCHANGE FOR PERSONAL HEALTH INFORMATION
Patients able to ACCESS INFORMATION
Patients able to ENTER PERSONAL HEALTH INFORMATION

2) L Ellwood and J Odell reported on the Health Information Exchange in MedVirginia, a RHIO in the Richmond area. MED VIRGINIA - HEALTH INFORMATION EXCHANGE (Richmond HIE)
Potential Data sources identified by MedVirginia
Clinical results from hospitals
Clinical results from office practices
Discharge summaries from hospitals
Reference Lab Results
Radiology reports
Physician e-Prescribing
Patient entered information
Registries (Immunization, others)

Current status of Med Virginia
System includes 4 Bon Secours Hospitals and 2 Sheltering Arms Facilities. Data available for physicians include
Radiology reports
Lab reports
Transcriptions
Non hospital sources include
Reference Labs
Health partners
LabCorp
PSA History (VA Urology Practice)

3) L Ellwood summarized the Indiana Hospital based model presented for review in the previous RHIO meetings.

INDIANA MODEL
Two hospital systems (5 hospitals) post lab, radiology, and discharge summaries on a secure web portal. Physicians may access the information from their offices via the web. May provide info for about 70% of patients in the area. .

4) Based on information gained in the preparatory meetings for the RHIO, the Committee identified possible sources in northern Virginia that could be included in a RHIO data base.
Possible Northern Virginia Data Sources

Hospitals (INOVA, HCA, VA HOSP CTR)
Reference Laboratories
Pharmacy
e-Prescribing
Radiology digital images
Physician EMR (currently limited 13 to 17% of Physician offices according to several surveys of physician office practices at the national, state, and local levels.) (VA experience in implementing EMR presented by N. Thompson)
Immunization Registry (Virginia Department of Health)
Converted Claims Data from Health Plans
Disease Registries (usually hospital based)

Patient entered Personal Health Information

5) Discussion focused on identifying health information already in e-format for initial selection. Since all major hospitals in the northern Virginia area have some electronic health information system, need to encourage upgrades to systems that would promote exchange of information and promote interest among physicians in EMR. Doctor order entry should be an initial addition to hospital based systems to promote patient safety. 80% of errors involve medications. Pharmacy is a segment of health care with significant IT use. e-Prescribing if more widely used by hospitals and physician offices could provide an initial database for the RHIO to provide medication history and medication alerts. Digital radiology currently allows access to practicing physicians with access to radiology images.
Patient entered Personal Health Information needs to be a strong part of the RHIO to both provide information not available in medical records and to promote consumer / sponsor interest. Discussed the fact that widespread use of alternative medicine and OTC medications (estimated 60% of patients use a treatment or medication not reported to the physician).

6) As requested in the Committee Charge, the Committee considered the issue of STAGED IMPLEMENTATION GOALS (year 1 to year 3)
Discussion focused on need to pick "easy hanging fruit" first (data already collected or stored electronically) as the core of the RHIO database. Pharmacy, labs, radiology, immunization registries are current easier options. As we choose data for start up, we will need to consider data availability and IT capabilities to collect and store data.
Strategies to overcome physician resistance to using electronic health records need to be part of planning

Next Steps

1) Recommend that Outreach Committee pursue invitation to Health Plans to participate. J Odell suggested that if RHIO data can be used to improve their quality matrix (such as HEDIS performance) they will be more interested.
2) Need information from the three major hospitals as what data they would expect to be able to make available to a RHIO. M Beyad (HCA)and Archie McPherson (Va Hospital Center) are assigned to this Committee. Geoff Brown (CIO INOVA) has been active in RHIO development to date. J Odell suggested a phase 1 strategy would be to align the RHIO with the hospital data capabilities.
3) View demos of various RHIOs to determine their data sources and use.

Organization. Members in attendance thought that midday meetings on Tu, Wed, and Th would be preferred meeting time. Need at least one meeting in October. Primary objective would be to gain information from the three hospital systems. L Ellwood will inform the other members of the Committee of today's actions.