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Community Health Access Network (CHAN) a Health Center Controlled Network (HCCN) 501(c)(3) Founded 1995 2008 HIMSS Davies Award Winner Community Health Organization (CHO) Category
Community Health Access Network (CHAN)
a Health Center Controlled Network(HCCN)
501(c)(3) Founded 1995
2008 HIMSS Davies Award WinnerCommunity Health Organization (CHO) Category
CHAN’s HCCN Model• Non profit, 501(c)(3)• Board of Directors: CEOs/EDs of our Full
Members• Fee Structure: Annual Dues, Monthly Shared
Systems Fees (based on # of software licenses)• Robust Committee Structure
– Health Services Committee (Medical Directors, Site Administrators)– EMR Users Group Committee (Providers)– Business Office Manager Users Group (BOMUG)– Finance Committee (meets quarterly)– Others as needed (ie Due Diligence Committee)
CHAN’s HCCN Members6 Full FQHC members with 14 sites + 1 Healthcare for
the Homeless van-Avis Goodwin CHC (1 site; Dover - 1 site; Rochester)-Families First Health and Support Center (1 site;
Portsmouth plus Healthcare for the Homeless Program van)
-Health First Family Care Center (2 sites; Franklin and
Laconia)-Lamprey Health Care, Inc. (4 sites; Raymond,
Newmarket, (2) Nashua )-Manchester CHC (1site; Manchester)-Shackelford Community Resource Center-central TX
(4 sites)4 Affiliate members with 10 sites
-Coos County Family Health Services (2sites; Berlin – 1
site; Gorham)-Ammonoosuc Community Health Services, Inc. (5
sites; Littleton, Woodsville, Whitefield, Franconia,
Warren)-Healthcare for the Homeless Program (1 site;
Manchester)-Harbor Care Clinic, FQHC Healthcare for the
Homeless Program (1 site; Nashua)
What do we offer our members?• Fully implemented and integrated Meaningful Use Certified GE
Centricity Electronic Health Record/Practice Management infrastructure (over 37,000 Observation terms, 65,000 active patient records) – Central server architecture; 37 virtual servers supported on site
• Secure Patient Portal (email, appts, prescription refills, lab results, pt “view only” access to their records)
• Robust Security Infrastructure (BotNet Filter, Intrusion Protection Software)– Back up system, including Kohler generator and heptoflouropropane fire
suppression system which will not harm staff or servers in the event of its release.
– IT staff with 75 years combined CHC experience– 24 hour Help Desk Support– e-form authoring– Staff training
• Robust Data Warehouse with drilldown reporting to support Clinical and Operational Report Development (i.e. UDS, network dashboard reports, clinical quality indicators for individual sites)
Mature EHR Infrastructure-Linkages
MEDICAL EQUIPMENT EKG (Cardiosoft)
Spirometry (Midmark)
Outbound Fax Referral Information
to Specialists Consultation Reports
SCANNING State Lab Results Hospital Documents
(if not linked) Consultation
Reports
CARE CATALYST Patient Entered
Data (BG levels) Patient Requests for
Refills, Appts., Referral Requests.
SECURE MESSAGING Referrals to
Specialists Consultation
Reports Provider/Patient
Communication
HOSPITAL DOCUMENTS (via Electronic Link) Diagnostic Testing Results Emergency Dept Visits Discharge Summaries / H&P’s
LAB RESULTS3+ Reference Labs
Electronic Health Record
Advanced Electronic Prescribing
Clinical and Operations Reporting Infrastructure
• Reporting priorities are determined by members and the
healthcare environment– UDS– Meaningful Use– NH State reporting requirements– Insurers– Network wide QI initiatives
• CHAN develops and posts reports centrally• Members have capability to develop their own reports to
meet their individual needs – Chronic disease management– Recalls and follow-up
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Asthma Case Management Report Note: The report captures the last value entered for Flu Vax, Sx Free Days, Severity Assessment, and Peak Flow assessed within the past 365 days. Visit Hx and medication refills capture data for the past 12 months. Any upcoming appointments will be listed in the appointment section. PATIENT NAME Age 25 ASTHMA, MILD INTERMITTENT, UNSPECIFIED Severity Assessment : Mild Intermittent Flu Vaccination: 10/23/2008 Symptom Free Days Days (past 2 weeks): 6 PFM: 440 05/20/2009 7 Albuterol Refill History (past year): ALBUTEROL 90 MCG/ACT AERO Qty: 1 MDI Refills: 5/20/2009 Visit History (past year) : OV reason: Asthma follow-up 05/20/2009 Provider Name OV reason: meds 04/01/2009 OV reason: Asthma exacerbation/anxiety 01/15/2009 OV reason: lesion labia 12/30/2008 Scheduled Appointments: 11/18/2009 SITE Asthma Follow-Up PATIENT NAME Age 51 ASTHMA, MILD INTERMITTENT, UNSPECIFIED Severity Assessment : Mild Intermittent Flu Vaccination: 0 Peak Flow:
2009 Diabetes Education Program Clinical Chart Audit(trended 2006-2009 data)
0%
100%
2006
2007
2008
2009
MU ready reports
Core Hypertension: Blood Pressure Measurement (NQF 0013)
Alternate Weight Assessment and Counseling for Children and Adolescents
(NQF 0024) Childhood Immunization Status (NQF 0038)
Menu Asthma Pharmacologic Therapy (NQF 0047, PQRI 53) Diabetes: HbA1c Poor Control (NQF 0059, PQRI 1) Diabetes: LDL Management & Control (NQF 0064, PQRI 2)
Anticoagulation Office Visit
Network benefits (per a CHC member)
• Access to centralized knowledge bank for minimal cost
• Advanced infrastructure • Creates cooperation and friendly competition
between members – “Coopitition”• Upgraded EHR system will meet “Meaningful
Use” certification; direct financial benefits to CHC’s
Current CHAN Projects which address meaningful use…
• Data Warehouse Expansion– allows independent agencies access and utilization of the CHAN DW
• Upgrade of GE EMR to Meaningful Use v9.5• Upgrade of PM to GE v10 to support 5010 electronic
claim submission required as of 1/1/12• Preparation for ICD-10, to ensure cross matching will
support reimbursement • Collaboration with stakeholders for development of NH
HIE• Network Master Patient Index to support HIE
CHAN MU Core Objectives Scorecard
Problem List Medication List Demographics Smoking Status Vital Signs Drug Interactions Medication Allergy Lists Orders E-prescribing
Report Clinical Quality Measures to CMS of State
Decision Support Risk AnalysisClinical Summaries-in
processHIE- in processPHR-in process
CHAN MU Menu Objectives Scorecard
Drug formulary checks Lab test results Pt lists by condition Patient Education Medication Reconciliation Immunization Registries – no State capabilities Syndromic Surveillance – no State capabilities
Pt reminders – in processPt electronic access-in processTransitions of care-in process
NH HIE Phase I- Project Initiation and Planning
Phase II – Transition Phase III - Implementation
NH HIE American Recovery and Reinvestment Act- Funding
for Health IT includes….. State HIE Cooperative Agreement Program (ONC);
announced 8/20/09 Letter of intent submitted to ONC – 9/11/09
(Designated Entity to apply for grant; NH DHHS) Notification of Federal allocation of $5.5M – 9/22/09 Application submitted to ONC – 10/16/09 NH Health Information Exchange Planning and Implementation
Project (HEIPI) begins - 11/2/09
Phase 1: HEIPI Project Initiation
• NH DHHS hired staff dedicated to NH HIT/HIE and HIEPI project– Dave Towne; State HIT Coordinator– Elizabeth Shields; Project Manager
• NH DHHS hired Consulting Partner; Massachusetts eHealth Collaborative (MAeHC) to lead creation of NH’s HIE Strategic and Operational Plan
• Stakeholder Engagement. Identify Stakeholders and subsequent Work Groups
• Establish NH HIT/HIE Website
Phase 1; HEIPI Project Initiation…cont
• Stakeholders (including, but not limited to)– Large/Small hospitals– NH State Legislators– CHCs, Bi-State PCA, CHAN– NH Medical Society– NH Hospital Association– AARP NH– Health Plans– NH DHHS– Home Care Association of NH
• Work Groups– Governance (includes CHAN rep)– Finance (includes CHAN chc rep)– Technical Infrastructure (includes chc rep)– Business and Technical Operations (includes CHAN chc rep)– Legal/Policy
Phase1; HEIPI Planning Phase• Identify HIE phases
– Phase 1; Secure routing– Phase 2; Expanded secure routing– Phase 3; Community record
• Determine Governance Model– Health Information Organization (HIO) – Public-Private Partnership
• Determine legality– Legislation filed as HB489; establishes a HIO for the electronic exchange
of health information. • Determine market need• Begin to develop sustainability model; visit key stakeholders
Phase 2; Transition• Launching of the Interim Advisory Group (IAG);
4/29/11– The IAG is a transitional, public-private governance
body for the HIE project– The IAG acts under the authority of the NH DHHS
Commissioner transitioning to a Board with full authority
– The IAG provides public-private governance to the state level HIE project pending launch of the HIO
Phase 2; Transition…cont.
• Work Group Tasks/Activities– Governance Workgroup
• Transition to IAG• Support Legislative Process• Set contingency plan and its triggers w/stakeholders
– Finance• Market test value of proposed HIO services• Draft the Business Plan
– Technology• Find and engage a Technical Services Partner (TSP) to set up and
operate the technology platform – RFI and RFP process• Evaluate, prepare, and certify Health Information Services Providers
(HISPs) to connect– Legal/Policy
• Support legislative process• Develop HIO policies and procedures for HIO
• Draft business plan
Phase 3; Implementation
Stay tuned!!
