Health Information Technology

Vision of the Future

Mrs. Cruz is a 75-year-old woman who has lived in Santa Cruz all her life. She lives modestly but independently at a local senior housing complex, with her health insurance covered by Medicare/Medi-Cal. One evening, rushing to answer her telephone, she trips and falls, breaking her hip. In the ambulance, in pain and frightened, she concentrates on the soothing voice of the paramedic who has come to transfer her to the hospital's Emergency Department (ED). "Can you tell me what medications you're on right now?" he asks. "And who is your doctor?" Flustered, she worries that she won't remember the many medications she is taking. And which of her doctors should she mention to the nice young paramedic?

With her permission, the paramedic is able to use an expanded County-wide health information exchange (HIE) to access her electronic health record (EHR) and medical home. By the time she arrives at the ED, the medical team already has a complete, reconciled list of her current medications, which include Coumadin (warfarin) for stroke prevention - crucial information to have when surgery is being considered.

Her medical odyssey from that point on includes a brief inpatient stay, a stint at a skilled nursing facility (SNF) to recuperate, and follow-up visits to her primary care doctor - the one whose name she couldn't quite remember in the ambulance. At every transition of care, up-to-date information about her medications, recent hospital visit, and treatment regimen arrives and leaves with her, following her from the ED to the med/surg floor to the SNF, a home health agency, and her primary care doctor's office.

With clear, accurate information shared among all these providers, she becomes - without even realizing it - yet another poster child for the Beacon community that Santa Cruz County has been expanding since its award in March 2010. Unlike her neighbor, who had a similar injury the year before, Mrs. Cruz is not readmitted to the hospital because of medication errors that went undetected or because crucial treatment information was not reported. Instead, while her recuperation is slow and difficult, it takes place at home, uninterrupted by additional hospital trips and crises.

At the community-wide Quality Improvement meeting a month later (sponsored by the Santa Cruz Beacon consortium), her doctors contrast her neighbor's case and her own as an example of what the newly expanded Beacon HIE can do, in terms of both cost and quality. And Mrs. Cruz, unaware of her star billing at the forum, gives away the area rug she tripped over - just as her granddaughter had been nagging her to do for months.

This is the Santa Cruz Beacon (SBC) consortium's vision for the future: clinical patient information following a patient across different organizational (and EHR network) boundaries within Santa Cruz County, reducing costs and improving quality at key junctures in transitions of care.

Retinal Screening Project

Retinal Screening Project: HIP purchased a digital retinal camera for the use of the safety net clinics to annually screen uninsured patients with diabetes who are at high risk for treatable conditions which would otherwise lead to blindness. Housed at the County Clinic in Watsonville, the screening exams are read by private ophthalmologists. Building on the County's adoption of an electronic health record an interface was also built to send the results back to the patient's electronic health record, alerting the physician at county clinics and updating the preventive health prompts.