Issues in Integrating Child Health Information Systems

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Issues in Integrating Child Health Information
Systems

• MCH-EPI Conference
• December 8, 2005
• Kristin Saarlas, MPH

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Presentations will address the following
questions

• Why integrate child health information systems?
• How do I know if the benefits of integration are
  worth the costs?
• What are the functions of an ICHIS and how do we
  know if it successful?
• What is a community of practice and what is it
  doing to forward our thinking in this area?
• What are states learning about developing
  successful ICHIS and their impact on the lives of
  children and families?

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Session Overview

• Background on integrated child health information
  systems (ICHIS)
• Development of a business case on ICHIS
• A framework for ICHIS principles, core fxns, and
  performance measures
• Connections A Community of Practice
• First hand experiences from 2 states Oregon and
  Colorado

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A bit of background

• Public Health Informatics Institute is located
  within a non-profit organization and funded
  primarily by RWJF, HRSA/MCHB, and CDC.
• Mission is to advance public health
  practitioners ability to strategically manage
  and apply health information systems.
• Work in child health information systems has
  included
• 13 year All Kids Count National Program (RWJF
  supported) where we worked with over 30 state and
  LHDs to develop immunization registries and
  ICHIS,
• Developing a business case and framework for
  integrating NBS w/other CHIS funded by HRSA
  RWJF
• Supporting a Community of Practice with the
  HRSA/MCHB integration grantees (SPRANS grants) to
  identify and share best practices

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Why do we need integrated CHIS?

• Many children do not receive all preventive or
  therapeutic services in a timely manner
• Several studies have found low immunization
  coverage rates to be correlated with insufficient
  screening for lead and anemia
• Multiple PH programs focus on the same target
  population w/o coordination of services
  outreach
• There is a need for population-based information
  that can better identify at-risk children and
  target programs and services to their needs

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Goal of integrated CHIS

• To provide all appropriate information to
  patients/families, providers, and programs so
  they can make timely and accurate decisions on
  the delivery of care, assess population needs and
  assure services and follow up care are being
  provided.
• Premise that better (complete and timely)
  information leads to improved service delivery
  and improved health outcomes for children.
• Integration - providing a range of information to
  the end user in a simple, comprehensive format so
  he/she can readily take all indicated actions. We
  refer to integration of data to the end user
  regardless of the IT/IS model.

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Targeted programs/systems for integration

• 1st tier
• Immunizations (immunization registries)
• Newborn dried blood spot (NDBS) screening
• Early hearing detection and intervention (EHDI)
• Vital registration
• 2nd tier
• WIC
• Lead screening
• Medicaid/EPSDT
• Birth defects surveillance
• Early Intervention

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Why these?

• Top 4 areas chosen share characteristics
• Recommended for all infants/children
• Carried out/begin in newborn period
• Time-sensitive
• Primarily delivered in private sector but have
  strong public sector component
• Mandated in most/all states

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Many challenges to integration
Use of Data

• Requires collaboration/communication between all
  stakeholders governance of data sharing
• Leadership and perceived need
• Challenge of linking disparate pre-existing
  systems Issues of deduplication of data from
  years of categorical funding ? program
  information silos that may not be compatible with
  other information systems

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Key Elements for Success

• Leadership
• Project governance
• Project management
• Stakeholder involvement
• Organization and technical strategy
• Technical support and coordination
• Financial support and management
• Policy support
• Evaluation

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Business case on ICHIS

• What is a business case and why do we need one?
• States need to justify return on their investment
  due to limited resources
• Increasing focus on measuring outcomes
• Need for sustainable funding
• A business case provides a model to quantify
  benefits and costs
• Flexible various state and local models and
  future growth of ICHIS

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Process for development

• Hired Lewin Group health economist Tim Dall in
  April
• Formed workgroup of stakeholders from PH, private
  physicians, family advocates, health plans
• Solicited input from expert health economists and
  program specialists
• Researched literature
• Site visit to RI in Nov will beta test in
  selected states in Jan
• Training of states, LHDs in spring
• Use the model, continuous improvement

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Programs included

• Immunizations (immunization registries)
• Newborn dried blood spot screening systems (NDBS)
• Early Hearing, Detection and Intervention program
  (EHDI)
• Lead
• EPSDT
• WIC
• Birth Defects

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Integration Benefits

• Focus on improved effectiveness of services,
  efficiency, quality of care, coordination of
  care, health outcomes
• Areas of Benefits
• Benefits to Families
• Benefits to Physicians/providers
• Public Health Decisions
• Data Quality
• Case Management

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Benefits to Families

• Parents have access to CHIS information in
  consolidated format
• Reminders/recalls
• Convenience when moving/changing providers
• Time saved (scheduling appts, missing records,
  reduced data entry)
• Reduced visits/efficiency and coordination of
  care
• Improved health outcomes (reduced lifetime care
  costs, increased earnings of family/child)

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Benefits to providers

• Providers have access to data they didnt have
  before
• Reduce chart pulls if electronic access is
  available
• Quality of carereduction in duplicative
  services, timeliness of care, pay for performance
• Increased number of visits? Increased revenues?

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Benefits to public health

• Assess risk factors to completeness of care
• ID medical home and health care utilization rates
• Linkage to other datahospital discharge,
  education, social services
• Long term surveillancepopulation trends
• Quality assurancepublic health role
• Changes in policies?

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Challenges to developing a business case

• Added/marginal value of integration vs value of
  programs and independent systems
• Lack of data on costs and benefits on individual
  programs and IS
• Change in behavior that integration of data
  bringsi.e., data not available now to
  physicians, whos responsible for follow up
• ROI not always basis for decision making

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Conclusions

• Integration of child health information systems
  continues to progress among states
• Many models to learn from
• Most states still in planning or early
  implementation
• Need leadership and sustained funding
• Use of integrated data necessary to
  sustainability

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Acknowledgements

• PHII staff, Dave Ross, Ellen Wild, Alan Hinman,
  Terry Hastings
• HRSA/MCHB Debbie Linzer, Michele Puryear, Marie
  Mann
• AKC and HRSA Connections members

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Thank You!

• Contact Information
• Kristin Saarlas
• Deputy Director
• Ksaarlas_at_phii.org
• www.phii.org