1	Nationwide Health Information Network
2	CareSpark NHIN Participants: VA Kaiser Permanente Highlights: Demonstration of value of self entered data and consent into the consumer’s PHR Use of the NHIN to secure recent medication history from the VA’s EMR. The patient updating her PHR after her VA care visit
3	Regenstrief Institute NHIN Participants: HealthBridge HealthLINC Highlights: Demonstration of clinician workflow in an ambulatory setting by updating medication history upon check-in for view by the clinician at Point of Care Use of clinical decision support (CDS) to check active medications and allergies when writing an electronic prescription to enhance patient safety
4	HEALTHeLINK/HIXNY NHIN Participants: Carespark Regenstrief Institute MedVirginia Highlights: Demonstration of value of pulling in a patient’s history from the NHIN as well as RX-HUB and reconciling with the patient at Point of Care Use of Clinical Alerts when writing an electronic script to assure patient safety
5	MedVirginia Highlights: Focus on medication reconciliation in a hospital setting to assure patient safety and adherence to JACHO requirements that that health care organizations develop a process to document a complete list of the patient's medications at the time of the patient's admission or entry into the health care setting New discharge prescriptions are communicated to an outpatient pharmacy. Clinician provides medication, allergy, and other information to patient and next provider of care
6	Medication Management Use Case
7	Nationwide Health Information Network Chris Voigt, Health Information Architect, CGI (CareSpark) William H. Bestermann Jr., MD, Medical Director, Holston Medical Group Divya Shroff, MD, Associate Chief of Staff - Informatics Department of Veterans Affairs December 16, 2008
8	Participants in the Demonstration Each organization has a NHIN-conformant gateway located across the country and will dynamically exchange patient healthcare records in today’s demonstration.
9	CareSpark Health Information Exchange
10	Department of Veterans Affairs
11	Kaiser Permanente
12	Ambulatory Medication Management Demonstration Self-Entered Data into a Personal Health Record Clinicians will have access to data entered by the consumer enabling them to see over-the-counter and herbal substances being taken for a more complete clinical picture. Collection of Medication and Allergy Information Electronically Retrieve consumer medication history and allergies from one or more electronic sources originating both within the clinician’s region and nationwide. Aggregated View of Retrieved Patient Health Information Portals enable the care giver to view the retrieved patient health data through an aggregated format for medications, allergies, and problems as well as any self-entered data Electronic Prescribing and Prescription Decision Support Utilizing ePrescribing tools along with decision support, a more complete clinical picture of the consumer’s health condition will allow the clinician to provide a more effective, efficient and accurate prescription for the consumer.
13	Chronic Illnesses and an Active Lifestyle
14	Beginning of Mary’s Medical Journey
15	Mary’s Continuing Medical Journey in Kingsport
16	An Active Participant: Self Entered Medication Data Mary self-enters her medication and allergy information
17	Providing OTC and Herbal Information Mary also self-enters any OTC and Herbal medications she is taking
18	Mary’s Preference for Sharing Her Data Mary sets her preference for sharing her data within CareSpark and the NHIN
19	Mary’s Medical Story Continues
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21	Mary’s Personal Health Record
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23	Mary Receives Her Prescription
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35	Ambulatory Medication Management Recap
36	Introduction Today’s demonstration will examine Medication Reconciliation Retrieving a patient’s medication and allergy history Reviewing this information with the patient Clinical Decision Support Improving patient safety Electronic Prescribing Enhancing the prescribing process / workflow How does the NHIN support these important clinical systems and processes?
37	The Indiana Network for Patient Care Operational since 1995 Serves Indianapolis metro area and other parts of Indiana 1.7M patients 22 institutions It contains over 1.5B observations 25M text reports 12M radiology images
38	Patient Profile: Mary Paltrow Mrs. Mary Paltrow 57 year old female recently moved to Indianapolis previously lived in Ohio Where are her medical records? HealthBridge (HIE in Cincinnati) HealthLINC (HIE in Bloomington) Indivo Personal Health Record (PHR) RxHub (Commercial Pharmacy Benefit Manager)
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50	Key Points The NHIN data exchanges occur automatically, between registration and the clinical encounter When Dr. Simonaitis walks into the exam room, Mrs. Paltrow’s known Medications and Allergies are available for review on the Gopher Order Entry system
51	The Clinical Encounter Dr. Simonaitis examines Mrs. Paltrow, then logs into the Gopher computer to write prescriptions…
52	Demonstration of Gopher Prescribing Login and selection of patient Verification of allergy Erythromycin Reordering a previous prescription Imipramine Formulary decision support Felodipine is non-formulary Amlodipine is preferred alternative Allergy detection Azithromycin is blocked by allergy to Erythromycin family Drug-Drug Interaction Levofloxacin is blocked by interaction with Imipramine Augmentin is a better choice Select pharmacy to receive electronic prescriptions Sign and complete the session
53	Summary of Key Points The NHIN supports important clinical processes Medication Reconciliation Standards for accessing a patient’s medication and allergy history Clinical Decision Support Standards for sharing interoperable data Electronic Prescribing Standards to support clinical workflow
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55	Who We Are HEALTHeLINK is Western New York’s Clinical Information Exchange (WNYCIE) It is a collaborative effort among physician, hospital, and insurance organizations in the Western NY area HEALTHeLINK is presenting on behalf of NYeC, whose constituents include WNYCIE and our partner in this project, Healthcare Information Xchange of NY (HIXNY) a RHIO/HIE in Eastern NY) Project Management support was provided to NYeC by CSC
56	Our Focus Today’s presentation will demonstrate the ability to query eligibility, medication history, and clinical information from various exchanges as well as generate an electronic prescription. Most importantly we will demonstrate the ability of the office nurse, along with the patient, to reconcile patient medications and allergies.
57	Using the NHIN The HEALTHeLINK query to the NHIN interface will return allergy and medication history. Seeing a historical list may help a patient to remember infrequent allergies. Reading through a medication list will allow the patient to be reminded of all the medications they have taken in the past. With the help of the patient, the nurse can determine which medications are active and then save those to the patient’s record.
58	Our Patient Mary M. Paltrow is our test patient.
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60	Recap The NHIN allowed us to retrieve medication history from Carespark and Regenstrief; this assisted the nurse when gathering a complete and accurate list of medications from the patient. Previously encountered allergies were also retrieved from the NHIN. When prescribing medication for the patient, the physician was alerted to the allergy to Vivitrol. The data retrieved from the NHIN caused this warning to appear and the doctor was able to avoid prescribing a medication that would cause an allergic reaction for this patient.
61	Nationwide Health Information Network
62	MedVirginia Background Virginia's Regional Health Information Organization Launched MedVirginia Solution, a Health Information Exchange (HIE), in the fall of 2005. MedVirginia Solution collects hospital, lab and pharmacy data and organizes it into one single patient-centric electronic chart
63	Demonstration Overview Consumer self-reported information and additional information are accessed and gathered via health information exchange New discharge prescriptions are communicated to an outpatient pharmacy Clinician provides medication, allergy, and other information to patient and next provider of care
64	Anna Rooney 44 year old female Type II diabetes Neck strain Depression and Anxiety
65	Patient Visit with Dr. Filicko Annual physical Review of allergies and current medications with Anna Anna provides additional information Discontinued use of Toradol Anna reports problem with congestion Samples of Robitussin-DM supplied to patient
66	Anna’s symptoms Robitussin-DM started immediately after the visit with Dr. Filicko Severe headache, nausea and shortness of breath Patient is taken to the Emergency Department of Memorial Regional Medical Center, a Bon Secours inpatient facility
67	ED Encounter Triage nurse reviews allergies and medications with patient while getting vitals Anna reports use of Glucophage and the new decongestant Anna’s BP is dangerously high so she is immediately roomed and diagnostics are started Possible Heart Attack Possible Stroke
68	Medication Reconciliation Verifies penicillin allergy Medication history retrieved via SureScripts Nardil is shown as an active med that did not show previously on Anna’s record The Robitussin-DM is highly contraindicated with the Nardil which is an Monoamine Oxidase Inhibitor (MAOI) medication Triage Nurse notifies the attending physician treating Anna about this new information
69	Diagnosis and Inpatient Treatment Diagnostic procedures rule out a cardiac or neurological episode New information about Nardil received Confirmation with patient that both Nardil and Robitussin-DM were taken Diagnosis is a hypertensive crisis as a result of the contraindicated medications Patient is admitted inpatient and treated with IV vasodilator medication
70	Discharge Discussed the importance of notifying physicians of her full list of medications MedVirginia Solution was used to e-Prescribe Flonase for Anna to use for congestion Up-to-date medication information available immediately to other providers
71	Benefits Medication information was available via a secure electronic source helped to supplement patient provided information Medications prescribed at discharge can be e-prescribed and communicated directly to an outpatient pharmacy Post-discharge medications can be clearly communicated to subsequent providers of care.
72	Questions and Answers