Despite two failed attempts to set up a health information exchange, the San Diego Beacon eHealth Community is powering forward to develop value for its stakeholders by electronically transferring electrocardiograms from ambulances to hospitals and providing patient event notifications and order authorizations to payers.During a National eHealth Collaborative webinar, “Spotlight on the Beacon Communities: Utah & San Diego,”on May 24, Anupam Goel, M.D., the San Diego Beacon co-principal investigator, highlighted the steps his Beacon Community was taking to achieve sustainability and bring value to its participants.The San Diego Beacon’s goals focus on improving patient outcomes for acute myocardial infarctions; reducing ED visits, 30-day readmission rates, and repeat imaging tests; as well as enhacing immunization rates and syndromic surveillance. “We think there’s a lot of potential value in reducing emergency department visits in hospital admissions, and if done appropriately, potentially reducing repeat imaging tests,” said Goel.
Patient Event Notifications and ACOsOne initiative planned by the San Diego Beacon is to provide patient event notifications via its exchange. The exchange will gather admission/discharge/transfer (ADT) messages from all inpatient facilities, translate them into secure messages, and notify recipients of a message in their secure account with a standard email to their unsecured account. Not only will the exchange gather ADT messages, it will provide critical care summary documents, operative notes, discharge summaries, and radiologic images, so physicians can have a textual context for a patient, not just a problem list, said Goel. Patient event notifications will also alert outpatient providers when their patients are admitted to, or discharged from, an ED or inpatient facilitiy.A longer-term strategy for sustainability will be to notify payers and acccountable care organizations’ of patients who are seen at outside facilities. Another element will be to eventually allow test authorization and referrals via the exchange. “For the purposes of authorizing a referral or a test, it may be easier to say, ‘Hey payer, we got you a connection into the Beacon that allows you information access in real-time to potentially reduce the time it takes to get an order authorized,’” said Goel. “If we can develop some protocols that automate some of that authorization process, we can deliver even more value to the payers in that respect.”Electronic Electrocardiogram TransferThe San Diego Beacon will also transfer electrocardiograms electronically from ambulances to hospitals. Goel said that the goal is to get the information to the providers as quickly as possible before the patient arrives to the hospital so it can decide if a cardiac catheterization team needs to be activated to perform the procedures necessary to reduce damage to the heart.“The [IT] building at this point is getting the ambulances and their electrocardiogram machines to transmit their data wirelessly from the machine to the hospital ahead of time,” said Goel. “So we had to equip ambulances with transmissions, and then hospitals with receivers to allow them to do the data transmission.”The San Diego Beacon is one of 17 Beacon Communities that were awarded $12-15 million each over a three-year period to be a proving ground for how meaningful use, exchange of health information, and interoperability are implemented to achieve better health outcomes at lower cost, said Janhavi Kirtane, director of clinical transformation, HHS Office of the National Coordinator for Health Information. In year two, Kirtane said, eight communities have already achieved early results, having two or more performance measures trending positively. “Really, this is the slow, in-the-trenches work of improvement at the practice level, to really work across these complex systems and often competitive boundaries to achieve the goals that are put forth in this program,” she said.Before receiving the $15.3 million Beacon grant, San Diego had fairly advanced hospital IT, with multiple healthcare systems and providers already having electronic health records; but there were not many connections among the health systems. There were “pockets of excellence,” said Goel, which included the San Diego Regional Immunization Registry; data sharing over the NwHIN among Kaiser, the VA, and the Department of Defense; STEMI (ST segment elevation myocardial infarction) centers; and data sharing between emergency departments (EDs) and federally-qualified health centers.With a history of two failed HIE attempts and prior data sharing pilots being too limited to drive behavior change, the competitive San Diego healthcare marketplace has been threatening the success of IT in the area, said Goel. He added that, in the past, health systems have been driven to off-load unfunded patients and retain funded patients, which has limited and marginalized information exchange efforts. There has also been suspicion among competing organizations that a clinical data repository might be used to steal patients, which has altered the San Diego Beacon’s development strategy moving forward, said Goel.Goel added: “The big challenge for the San Diego Beacon that we have not been able to see in lots of other places is this challenge that many systems have different electronic medical records and sharing data is limited by essentially the least common denominator, what can be shared and the rules around HIE to HIE exchange are less well-defined.”
