More Info: www'hhs'govhealthit phdatastandards'info www'ehealthinitiative'org

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Marcus Cheatham(517) 887-4476mcheatham_at_ingham.or
gwww.cacvoices.org/rhio
More Infowww.hhs.gov/healthitphdatastandards.in
fowww.ehealthinitiative.org
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Health Disparities are Common and Severe
YPLL by Race and Sex
YPLL 75 Age at death
Source MDCH Vital Records. Rates per 100,000
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Mortality Data from 1998-2004
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How can HIE Serve Vulnerable Populations?
Vulnerable People Not In the System
Faulty, late or Missing information
Cant See Health Status And Health Disparities
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Doctor
State PH
Federated Databases
Interface
Interface
Edge Server
Edge Server
Record LocatorMaster Patient Index
Lab, Radiology, Pharmacy, ER
Local PH
RHIO Architecture
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• Scenario Dr. Smith orders a complete blood
  count (CBC) in an outpatient clinic. The regional
  reference lab performs the test and delivers the
  result electronically using a clinical results
  delivery platform managed by the regional HIE.
• Step 1 Dr. Smiths order for a CBC is delivered
  to regional lab or hospital-based lab
• Step 2 Lab performs the test and results are
  electronically transmitted and processed through
  the regional HIE.
• Step 3 Regional HIE identifies Dr. Smith and
  forwards clinical result to his electronic Inbox
  (provider index).
• Step 4 Dr. Smiths office manager incorporates
  the output into Dr. Smiths existing workflow
• Discussion
• In this scenario the regional HIE coordinates
  delivery of clinical results by maintaining an
  up-to-date provider index and connections to
  laboratories (and other ancillary testing
  facilities).

Making Data AvailableResults Delivery
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We need to develop true public health use
cases. AHIC Biosurveillance Use Case Transmit
essential ambulatory care and emergency
department visit, utilization, and lab result
data from electronically enabled health care
delivery and public health systems in
standardized and anonymized format to authorized
Public Health Agencies with less than one day lag
time.
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Public Health Use Case I. A physician refers an
indigent diabetic patient to the health
department for regular diabetes management.
The patient is able to give permission for an
HD diabetes counselor to see the relevant portion
of their private data. The diabetes counselor is
able to view the data over a secure internet
connection and add periodic HbA1Cs and a few
other items to the patient record. Later when
the patient returns to the physician the
physician can see their progress and discuss it
with them.
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Public Health Use Case II A local
bronchologist, or a public health analyst wants
to know "How many children and youth under age
18 living in a specified low income area were
prescribed selected asthma medications last year
versus five years ago? How many were seen in EDs
with selected asthma symptoms? How many received
selected asthma diagnoses from their primary care
doctor or a specialist? They are able to
request a table of aggregated results from a
researcher attached to their local RHIO.
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We can create the capacity by embedding it in the
businesses processes of RHIOs. An Infomediary
would be in the business of providing aggregated
data services to RHIO participants and others.
An infomediary would add value to the RHIO by
creating additional product lines and would
produce direct savings for participants. Public
health could purchase services from infomediaries
or enter into public/private partnerships with
them.
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Explore Policy Challenges

• Clarify Privacy and Confidentiality issues. Many
  people wrongly believe Public Health cannot use
  the data in RHIOs for privacy reasons.
• Mitigate real threats to individuals. Major
  problem with data is not privacy but commercial
  or political use.
• Draw attention to real gaps in data exchange
  e.g. local disease reporting vs. pandemics,
  chronic disease and access to care vs.
  communicable disease.
• Change reimbursement structures to reward PH
  participation.
• Explore mandated role for RHIOs. E.g. if NEDSS
  is populated through RHIOs timeliness and
  completeness will increase.
• To have population wide data RHIOs must have
  patient records. How should we define the
  minimum data set RHIOs should have?