Innovations in Clinical Connectivity

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Innovations in Clinical Connectivity
Communication

• HIT Summit
• 10-17-05

Barbara Walters DO, MBA Senior Medical Director
Dartmouth-Hitchcock
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Agenda

• Introduction
• Dartmouth-Hitchcock description
• Our communication connectivity journey
• EMR
• Patient Portals
• Evisits
• Transperency and P4P
• Role of Government

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Dartmouth-Hitchcock

• Dartmouth-Hitchcock Clinic
• Mary Hitchcock Memorial Hospital
• Dartmouth Medical School
• VA Medical Center in White River Junction,
  Vermont
• A collaboration of independent providers called
  the Dartmouth-Hitchcock Alliance.

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Dartmouth-Hitchcock Operations

• 1,500,000 outpatient visits per year
• 21,000 inpatients
• 1000 physicians
• 7500 employees
• 900 medical students, residents fellows
• 125 million annual funded research
• 1.1 billion operating budget

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Dartmouth-Hitchcock IS

• Business Practice Software IDX, enterprise wide
• Comprehensive wired/wireless network
• 6,000 devices deployed
• 3 EMR platforms Centricity, Allscripts and eCIS
• Paper Chart almost obsolete
• Extensive eRx

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Electronic Medical Records

• Early adopter with legacy, now 3 EMRs
• Mandated eRX
• Radiology Information Systems and PACS
• AIS

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What We Didnt Want
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Patient OnLine Overview

• Secure web based product that allows us to
  communicate electronically with patients aka
  Patient Portal.
• Integrated with our practice management
  system-IDX
• Live since Oct. 2001
• Functionality appts, referrals, Rx, account
  status, demographics, clinical messaging, evisits
• Approximately 20,000 active accounts.
• Patient base of 200,000
• 215 Provider FTEs

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What We Came Up With
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The results
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Time of day..
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Age Range of POL Users
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E-Visit Guideline

• A patient using POL technology has the option of
  visiting a provider with whom they have had a
  previously established therapeutic relationship,
  for advice, diagnosis and therapy that previously
  would have required a face-to-face interaction in
  the office
• There is a fee assessed for this service
• Provider gets RVU credit for a completed eVisit

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Patient Starts an E-Visit
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Provider Ends the E-Visit
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Examples of eVisit requests

• Sinusitis
• Pain in left hip and lower back
• Elbow and shoulder pain
• Bloody stools
• Back pain
• Anxiety
• Water weight gain

• Knee pain
• Difficulty walking
• Seasonal depression
• Diabetes
• Cold sx. diabetes
• Osteoporosis
• Pain weight problems

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E-visit Challenges

• Statistics
• Patients are more comfortable with the concept
  than the Doctors!
• Slow start up out of sight out of mind
• SWAT approach
• Niche application when does this become
  everyday work?
• Grammar and writing skills

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Sharing the Electronic Medical Record with
Patients
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Vision Goals for Sharing the EMR

• Display the Prescribed Medication List
• Display Allergies and Immunizations
• Display test results
• Which results?
• What timeframe?
• To annotate or not to annotate?
• Answers Focus groups
• Display the Progress Note

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Meds, Allergies Immunizations

• Went live April 12, 2005
• Two months of data
• 3066 pts. Logged into POL 17,218 times
• 1244 pts. looked at meds 7642 times
• 89 report a med tasks, 87 questions about a med
  task
• 898 pts looked at all/imm 2574 times
• 30 report a med/all tasks, 2 questions

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Allergy Examples

• Report an allergy
• Substance Latex
• Reaction Contact Dermatitis
• Tx Hydrocortisone cream and benadryl
• Date of reaction 1/1/00

• Report an allergy
• Substance Sulfa meds
• Reaction rash
• Tx received an injection
• Date 6/1/84

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Future?

• Expose progress notes
• Pt. entered data into the EMR
• Surveys
• Pre-visit data
• Community collaborative and data reconciliation

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Transparency

• Pay for performance
• Patient Safety
• Public reporting
• Consumer Driven Healthcare

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Role of the Government

• Infrastructure Cost
• Standard setting
• Exchange of clinical information
• Interfaces
• Common definitions

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Questions?