TRANSITIONS OF CARE: The Power of Community Health Information Exchange
2 0 1 4 A N N UA L R E P O R T
DISCOVER THE VALUE IN THE ROCH
Better information for better patient care. The world of healthcare is ever-changing. There have been and will continue to be many transitions, but there is one thing that is constant: Rochester RHIO’s commitment to helping provide a better quality of patient care.
ESTER RHIO The state of healthcare information is changing. Adoption of electronic health records (EHRs) has grown exponentially over the last several years. And in a world where many of us are walking around with tiny, powerful computers in the palms of our hands, there is an expectation that our health information will follow us wherever we go. Across the U.S., regional health information organizations like the Rochester RHIO are connecting hundreds of hospital systems and medical practices, allowing authorized medical providers to access test results, lab reports, radiology results, clinical reports, medication history, insurance eligibility, and more. Our role as a community health information exchange (HIE) continues to evolve as well. We have demonstrated our ability to support hospital systems and regional healthcare organizations and their data needs. This year, the Rochester RHIO was named a qualified entity of the Statewide Health Information Network of New York (SHIN-NY), which seeks to create a fully integrated statewide HIE that will connect New York’s 10 RHIOs and foster greater collaboration among health care providers across the state. In addition, the RHIO will also be a key asset for the Delivery System Reform Incentive Payment Program (DSRIP), the main funding mechanism of the Medicaid Redesign Team (MRT) Waiver Amendment. At the Rochester RHIO, we focus on supporting quality healthcare and seamless transitions of care, while enhancing healthcare system efficiency. Through our work locally and with the state, we are being recognized for our progressive, innovative approach to collaborative healthcare. In the pages to follow, we highlight how the Rochester RHIO is paving the way for regional health information organizations around the country to do the same. Ted Kremer Executive Director Rochester RHIO
IT’S A HEALTHCARE EMERGENCY, INF Early on a Tuesday morning, a 57-year-old male named Tom presents in the emergency room complaining of chest pain.
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7 6 8
At the point of discharge, Tom’s primary
Because Dr. Wilson was able to look
The VHR confirmed that the
care physician and cardiologist receive
at the patient’s previous images, he is
reading obtained during the EKG
another ALERT sent via DIRECT that
able to quickly treat and discharge
is Tom’s normal baseline, and the
he has been released, so they know to
Tom right in the emergency room,
final diagnosis was nothing more
provide proper follow-up care.
avoiding costly duplicate testing and
than muscle spasm pain!
unnecessary inpatient care.
ORMATION IS CRITICAL 5000+ ALERTS
Within minutes of his arrival, the
are delivered to clinicians every month.
Rochester RHIO issues an ALERT sent via DIRECT to Tom’s primary care physician and cardiologist,
Studies have shown that when patients’ comprehensive records were consulted, they are:
letting them know that he is being seen in the emergency department.
The ED physician, Dr. Wilson, orders
27%
less likely to be subject to radiological scans
30%
less likely to be admitted to the hospital from the emergency room.
55%
less likely to be readmitted to a hospital within 30 days.
an electrocardiogram (EKG) on Tom,
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which produces abnormal readings. Typically, the next step is to perform a heart catheterization to more closely examine the heart and
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blood vessels—which may require hospital admission.
Upon searching the VHR, Dr. Wilson finds prior cardiovascular imaging
13 of 18
studies for Tom—performed just eight weeks before.
emergency departments (and 22 urgent care clinics!) in the region use the RHIO’s Virtual Health Record
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+44% But before admitting Tom to the hospital for further testing, Dr. Wilson consults Rochester RHIO’s Virtual Health Record (VHR), a web-based clinical query tool.
Between April 2013 and May 2014, users of the RHIO’s Virtual Health Record increased the number of clinical images views by 44%
FROM PRIMARY CARE TO SPECIALIST: AX THE FAX! Emily is 18 years old and recently visited her primary care physician, Dr. Tate, for a physical.
INF
2 Dr. Tate ordered blood work—including an A1c test to assess her
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average blood sugar level over the past three months.
At the time, she complained of excessive thirst and frequent urination, and a weight check indicated she had lost several pounds since the previous year.
6 Emily was able to easily receive the care that she needed from the specialist without worrying about transferring records, prior test results, and more. All of this was done seamlessly through the use of the Rochester RHIO.
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ORMATION IS CRITICAL In the past
12 months,
6,844,603
3 Dr. Tate received Emily’s test results via Rochester RHIO’s eResults
clinical reports were delivered
Delivery, which delivers results directly to physicians’ clinical inboxes.
directly into regional physician
This eliminates the need to log in to multiple portals for results, or consult separate faxed documents that are not integrated into the patient’s electronic record.
practice EHR systems for
1197 240
ordering providers in
Emily’s A1c levels were elevated above normal
practices.
ranges, so Dr. Tate decided to refer her to an endocrinologist.
4 To complete the referral, many doctors’ offices would fax or courier the necessary paperwork over to the specialist’s office. Instead, Dr. Tate utilizes the RHIO’s
945 RHIO users have their DIRECT address included in the RHIO’s DIRECTory.
DIRECT messaging to send the paperwork
Regional providers can add
for Emily’s referral electronically—
their addresses to the list
instantly and securely—to the endocrinologist’s office.
at info@grrhio.org.
HOSPITAL DISCHARGE: THERE’S NO Eight days ago, 70-year-old Betty fell at home and fractured her hip. Her surgery went well, and her recovery is on track. Betty is ready to be transferred to a long-term and post-acute care (LTPAC) facility for rehabilitation. In order to develop a care plan for Betty, the
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hospital sends a patient care summary with information about her injury and care via DIRECT to her LTPAC facility of choice.
6 During the course of her home care, Betty’s doctors, home care nurse, physical therapist and occupational therapist will all consult the RHIO’s Virtual Health Record on a regular basis to view Betty’s latest lab results and radiology images.
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The Home Care provider provides
After six weeks of inpatient rehabilitation at the LTPAC facility, Betty
notification to the RHIO to indicate that
moves once again—to home, where she benefits from home care.
Betty is an active patient.
PLACE LIKE HOME! To obtain further information about Betty, the
+37
rehab team utilizes Rochester RHIO’s Virtual Health Record.
%
Clinician access of patient health information in the RHIO’s Virtual Health Record increased by 37%
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between April 2013 and May 2014
+12.5
%
They review everything
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from the images of her
The number of healthcare
hip fracture to her last
providers and staff who actively
few years of clinical
use the RHIO’s Virtual Health
lab reports, hospital
Record increased by 12.5%
admissions, and more in order to gather the
instructions are sent from the hospital to the LTPAC facility via DIRECT, replacing the stack of paper that has traditionally been handed over at the time of transfer.
1682 1258 163
HEALTH PLAN 1%
All of her discharge and transfer HOSPITAL 52%
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PRIVATE PRACTICE 39%
admission.
Total number of users of RHIO’s Virtual Health Record System
LONG TERM CARE 1%
3248
HOME CARE 2%
required for a new
ED/URGENT CARE 5%
critical information
78
34
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DISCOVER THE VALUE IN THE ROCH More than 1,000,000 unique patients have provided RHIO consent to at least one of their healthcare providers. That’s 77% of the regional population.
And 97% said “Yes!”
Rochester RHIO serves thirteen counties: Orleans (17) 1% Monroe (1,274) 77%
Wayne (41) 2%
Genesee (39) 2% Ontario (170) 10% Wyoming (17) 1%
Livingston (22) 1%
Yates (18) 1%
Seneca (6) 0.5%
Number of Physician Participants by Geography Allegany
14
1%
Orleans
17
1%
6
0.5%
Chemung
13
1%
Seneca
Genesee
39
2%
Steuben
25
2%
22
1%
Wayne
41
2%
1274
77%
Wyoming
17
1%
10%
Yates
18
1%
Livingston Monroe Ontario
170
Schuyler (17) 1% Allegany (14) 1%
Steuben (25) 2%
Clinton
Chemung (13) 1%
Franklin St. Lawrence
Essex Jefferson
Rochester RHIO is one of 10 RHIOs that comprise the SHIN-NY:
Lewis
Hamilton
MONROE GENESEE
WYOMING
ONTARIO YATES
SCHUYLER Chautauqua
Cattaraugus
ALLEGANY
Montgomery
Madison
Schenectady
Cayuga Otsego
Cortland
Rochester RHIO
HEALTHeLINK
SENECA
Taconic Health Information Network and Community (THINC)
Erie
Onondaga LIVINGSTON
Health Information Xchange New York (HIXNY)
Saratoga
Fulton
WAYNE
Tompkins
Schoharie
Albany
Chenango Greene
STEUBEN CHEMUNG
Tioga
Washington
Oneida
ORLEANS
Columbia
Niagara
Rensselaer
Oswego
e-Health Network of Long Island
HealtheConnections
Herkimer
Warren
Southern Tier Health Link (STHL)
Broome
Delaware
Ulster Dutchess
Sullivan
Interboro RHIO
Putnam
Orange
Bronx RHIO
Westchester
Rockland
Heathix
Bronx New York Kings Richmond
Suffolk Queens Nassau
ESTER RHIO 47,099,411 clinical reports were added to the RHIO in the past 12 months Lab results
13,713,065
Radiology Reports
1,519,047
Admission/Discharge Reports
29,828,696
Clinical Reports
1,232,697
EMS Reports
805,936
6,000,000
ADT
5,000,000
DOCS
The Rochester RHIO’s health information exchange includes clinical data from
2007–2014
RAD
4,000,000
LAB
3,000,000 2,000,000 1,000,000
The world of healthcare is ever-changing. There have been and will continue to be many transitions, but there is one thing that is constant: Rochester RHIO’s commitment to helping provide a better quality of patient care.
May
April
March
February
January
December
November
October
September
August
July
June
0
More than
70
healthcare organizations provide data to the RHIO, including: • Hospitals • Radiology centers • Cardiology practices • Emergency medical services • Health plans • Homecare agencies • Eldercare providers
Contact the Rochester RHIO Support Line: 1.877.865.RHIO (7446) Email: info@grrhio.org Website: www.RochesterRHIO.org Twitter: @RochesterRHIO