San Diego is an advanced healthcare market where leaders of patient care organizations are moving forward rapidly on risk-based contracting, population health and care management initiatives, and advanced development of health information exchange, as noted in a recent series of articles by Healthcare Informatics Editor-in-Chief Mark Hagland.
Within this regional market, UC San Diego Health, the academic health system of the University of California San Diego in La Jolla, is advancing forward on a number of fronts to improve health information exchange, health information management and revenue integrity. In a recent interview, Cassi Birnbaum, system-wide director of health information management and revenue integrity at UC San Diego Health, outlined the health system’s roadmap for health information exchange initiatives and shared the progress made, to date, on several grant-funded health IT pilot projects.
UC San Diego Health executive leaders are focused on leveraging technology to ensure providers have the right information at the right time, Birnbaum says. The health system participates in San Diego Health Connect (SDHC), the metro area’s health information exchange (HIE). Birnbaum, who serves as secretary on SDHC’s board of directors, says, “I’ve been involved (with SDHC) in many capacities, from when it was a Beacon community to where we’re at right now, where we are an independently viable, regional HIE.”
Birnbaum also views the success of SDHC as indicative of the collaborative spirit among healthcare provider organizations in San Diego. “Even though we are fiercely competitive, as many of us are vying for the same patients, I think we do come together as it relates to IT initiatives. I think for the greater good, we do come together, probably much more than other regions, and I think that San Diego Health Connect is a great example.”
SDHC is seeing particular success with its EMS Hub project, which aims to improve coordination between emergency medical services and hospital emergency departments (EDs). As the ability for EMS providers to have access to relevant health data is critical, the State of California Emergency Medical Services Authority (EMSA) developed a model to advance bidirectional data exchange—from an HIE organization to the on-scene EMS provider and from the EMS provider back to the receiving facility and the HIE.
To this end, EMSA developed the Search, Alert, File and Reconcile (SAFR) model to serve as an HIE framework for EMS by defining the minimum functionality necessary to achieve HIE. The California EMSA was awarded a grant from the Office of the National Coordinator for Health IT (ONC) to pilot the SAFR model as a new EMS HIE workflow. In July 2016, California began two pilot SAFR implementations with SDHC named as one of two HIEs to serve as information hubs, with the Orange County Partnership Regional Health Information Organization (OCPRHIO) serving as the second hub.
UC San Diego Health is a pilot site for the SAFR project, which has been live since April 2017 in the city of San Diego, according to Birnbaum. The pilot involves American Medical Response (AMR), the agency that supports EMS services in the City of San Diego, and both main hospitals of UCSD Health—UC San Diego Medical Center in Hillcrest and the La Jolla campus.
The project focuses on four functionalities: the Search functionality enables paramedics to search individuals’ health information for past medical history, medications and allergies; the Alert functionality enables the receiving hospital to receive real-time data about an individual’s status directly onto a dashboard in the ED; the File functionality enables the structured data of the EMS electronic patient care report (ePCR) to be filed directly into the receiving hospital’s EHR system; and the Reconcile functionality enables the EHR information to be reconciled back into the EMS ePCR for use in clinical quality measures and population health.
“The ER or trauma center is able to see the EMS run sheet, all the documentation, any EKGs that are done in the field, and any other pertinent information that needs to be transmitted to us,” Birnbaum says. “So, once we identify the patient within our enterprise-wide master person index, and our electronic health record (EHR) is Epic, we are able to pull in all the information and assimilate that just within our EHR. And that information is available not only for the emergency room and trauma providers, but also if the patient is transferred to another unit in our organization.”
Drilling down into the progress of the project, for the Search functionality, paramedics are finding HIE data on 42 percent of the patients they query from the scene or in-route, according to Birnbaum. What’s more, the receiving hospital ED sees real-time data in their EHR from the paramedics in 87 percent of the runs, she says. An electronic PCR is sent from the paramedics to the ED’s EHR, and with more than half of cases (55 percent), the ePCR is sent within 24 hours of the patient arriving at the ED. And, 37 percent of the time, an updated report from the hospital is sent back to the paramedics. And, these numbers are considered highly successful by the California EMSA, she says.
Due to the success of the project, SDHC is planning to expand to more ED and agencies, and others EDs are likely to implement SAFR in the next six months, according to Birnbaum.
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