Volunteer eHealth Initiative Statewide Design Shop Volunteer eHealth Initiative Memphis Tennessee Re

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Volunteer eHealth InitiativeStatewide Design
ShopVolunteer eHealth InitiativeMemphis
Tennessee Regional Initiative
October, 2004
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Volunteer eHealth Initiative Summary

• Objectives and Desired Outcomes
• Why did this project begin?
• Fragmented health care information particularly
  among TennCare patients is hindering effective
  and efficient patient care
• What will the project accomplish?
• Identify the major health care issues in the
  Memphis area that can be addressed by a regional
  health information infrastructure
• Identify a core set of issues, data elements, and
  institutions and implement a demonstration
  project quickly
• Extend the issues, data elements and institutions
  as quickly as possible
• Measure the impact of these new technologies
• Participate in the national evolution of health
  care data standards.
• Expected Impact
• Patient and Family
• Safer, more timely care Better disease
  management Access to clinical information
  wherever care is delivered More efficient care
  through fewer unnecessary tests and unwarranted
  procedures
• Community
• Broader and simplified data collection more
  accurate regional quality metrics Better public
  health reporting Improvements in emergency
  preparedness due to greater access of regional
  health data More proactive stance toward
  employer and government quality initiatives.
• Provider
• Less time searching for information from other
  facilities Greater assurance of complete and
  safe care delivery Potential for broader
  integration of regional information into site
  clinical decision support systems.
• Overall Financial Impact for Institutions and
  Plans
• Lower overall expense for redundant procedures
  Clear understanding of costs and financial
  benefits for HIT investments as new P4P and other
  funding mechanisms are developed.

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Volunteer eHealth Initiative Summary

• Coverage
• What is the scope of the project?
• Six-month assessment followed by an
  implementation of a clinical data exchange
• Create a viable and self-sustaining information
  infrastructure that enables appropriate and
  comprehensive access to all information required
  to provide medical care and to evolve medical
  data standards
• Establish broad programmatic linkages with public
  health, consumer groups, emergency preparedness,
  agencies and national groups
• Demonstrate 100 exchange of core data elements
  among core medical facilities by the end of 2007.
• Perform extensive cost-benefit analysis and
  impact analysis in the final two years of the
  contract period.
• Constituents
• What entities including type are involved in the
  scope of this project?
• All relevant health care delivery organizations
  within Shelby, Fayette and Tipton counties.
• Governance Structure
• What is your governance structure?
• Governors office
• Program Management Office
• CEO Oversight Group, National Technical Advisory
  Panel
• Workgroups (Clinical, Technical, Privacy and
  Security, Financial)
• Do you have plans to change this structure in the
  future?
• This structure will evolve possibly to a
  non-for-profit organization

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The Clinical Workgroup has established an initial
set of outcomes which have provided a short list
of data elements.
Initial List of Outcomes and Data Elements
Outcomes being evaluated
Data Elements The means used to represent these
data will converge to common approaches over time

• Asthma
• Group B Strep
• Cancer Screenings
• Diabetes Management
• Immunizations
• Hypertension
• Post MI care
• Congestive Heart Failure
• Sickle Cell Pain Management
• Depression
• Medication Management
• Reducing Redundant Testing
• Well Child Screening
• ER Utilization

• Medications
• Problem list
• Lab Results
• Radiology Results
• Cardiology Results
• Weight
• Allergies
• Encounter data
• Where was patient seen
• When was patient seen
• What was done during visit

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Volunteer eHealth Initiative Summary

• Timeline
• Six-month assessment and planning effort
  kicked-off August, 2004 with a January, 2005
  completion date
• AHRQ contract awarded October, 2004. This
  represents a minimal set of constraints on the
  effort and provides capital to achieve early
  results
• Early demonstrations of feasibility by October,
  2005
• Implement 100 of data sharing October, 2007
• Evaluation runs throughout the project
• Project Approach
• The six-month assessment is being completed over
  three phases (assessment, planning and
  recommendation)
• Operational database technology suitable for a
  demonstration project infrastructure is being
  modified to meet the needs of the Project
• Tight coupling of clinical and technical groups
  to identify opportunities and demonstrate
  improvement through information technology.

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Exchange Architecture
Exchange receives data in tagged document format
manages the parsing indexing

• Queue Management
• Parsing indexing

As standards are adopted, interoperability
becomes possible
Data is transferred from participating entities
to the centralized exchange

• Sustainable business model , Governance
• Standards
• Payor/provider linkages, Consumer participation

• Participation Agreement
• Patient Data
• Secure Connection
• Batch / Real-Time

• Governance
• Compilation Algorithm
• Authentication
• Security
• User Access

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Volunteer eHealth Initiative Summary

• Lessons Learned
• What lessons did the project team discover?
• Lorenzi Buy-in because of conflicting missions
  and poorly conceived objectives.
• Lorenzi Perceived loss of control and lack of
  trust in the process.
• Lorenzi Lack of clear ownership over data
  systems and information.
• Lorenzi Lack of clarity about how a CHIN would
  be financed.
• Lorenzi Varying degrees of technology
  sophistication along with the concerns that some
  centralized community-based data repository will
  be created and used inappropriately
• Short-term gain vs. long-term gain Evolving
  technology approach vs. highly structured data
  elements
• Incentives are not aligned
• Everyone has a different view of what the early
  steps really are
• Most have a common view on the ultimate approach
• What challenges has the team faced?
• Time Everybody is rightly focused on pressing,
  organizational needs
• Recognition Many ongoing initiatives
  representing various members of the community
• History Past differences make full trust more
  difficult to achieve
• History Memphis CHIN been there, done that
• NIH Distrust of any new vendor
• Communication Different statements and
  interpretations