Creating sustainable system-level community change through Health
Information Technology
November 9, 2012
Liam Bouchier (Presenter) - CIO/Acting Director Louisiana Public Health InstituteDr. Seema Gai (Author) - NO/AIDS task force, New Orleans AuthorRahul Jain, MPH (Author) – Business Analyst, Louisiana Public Health Institute
Presenter Disclosures
(1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:
Liam Bouchier, Acting Director/CIO LPHI
< There are no personal financial relationships with commercial interests relevant to this presentation >
Demonstrate the value of community involvement and community led large scale complex HIT system implementations.
Describe the value propositions of open source technologies from cost, integration, scalability and sustainability perspectives.
Learning Objectives
Community Change and Open Source
The Opportunity Identifying Outcomes and Setting Goals Identify & Engage with Community Needs Implementing a Sustainable Solution Community Governance – The Change Agents
THE OPPORTUNITY
Beacon Application
Beacon Communities!
Cooperative agreement program with the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC). $13.5 million over three years.
New Orleans was one of 17 awarded Beacon Communities.
IDENTIFYING OUTCOMES AND SETTING GOALS
Establishing the Vision
The mission and vision of the Crescent City Beacon Community (CCBC) initiative [was] to
establish an accountable and efficient healthcare system that provides high quality, coordinated care
to patients.
A reduction in healthcare costs by decreasing preventable Emergency Department and inpatient hospital admissions through better coordination of care for chronic disease patients
Better health outcomes and population health indicators for chronic diseases through HIT enabled Clinical Quality Improvement and Transitions of Care interventions in Patient Centered Medical Homes
Program Goals defined by the Community
IDENTIFY & ENGAGE WITH COMMUNITY NEEDS
Community Assessment & Engagement Framework: Year 1
Community group meetings - First 3 Months Key informant interviews - First 8 Months
Priority Areas Identified!!
re-identified, re-examined, refined, redefined, refocused, redrawn, rewritten, reviewed, re-reviewed….finalized…….Maybe.
Transitions of care (TOC)
Emergency Department Inpatient Specialty Referral Telemedicine
Chronic Care Management
Population management Registry Clinical decision solutions Care plans
Priorities Identified
Care
Co
ordi
natio
n
Communication of information across settings
1. preventable readmissions and ED/IP visits
2. medication errors3. adverse events4. overutilization &
duplication of resources5. patient & caregiver
clarity as to overall plan of care
Sources: National Transitions of Care Coalition, National Quality Forum
Rationale for Transitions of Care
IMPLEMENTING A SUSTAINABLE SOLUTION
Is this what we need?
Transitions of care (TOC)
Emergency Department Inpatient Specialty Referral Telemedicine
Chronic Care Management
Population management Registry Clinical decision solutions Care plans
Priorities established
What is the problem?
Revisiting the Key Informants again. Revalidate use cases
RFI and RFP’s – Written, reviewed and scored by community leaders.
Build what the community needs now! Propriety and Open source technologies
examined. Extensive due diligence on short list of
vendors
Year 2: Identifying/Building the solution – keep it iterative
Successful vendor brought in to revalidate use cases, 1 on 1 interviews with community partners
Implementation planning – Community led implementation team
Designing the solution
Interoperability Open standards, not a proprietary solution
Greater Control on changes/upgrades to the technology, less risk.
Open source community leads the way adhering and pushing industry standards.
Scalability Customizability of solution, ability to quickly
react to community needs.
Why an Open Source Solution?
Scalability Iterative Solution, community improves the
technology over time. Individual customer benefits from entire
community development. Shared savings, reallocation of funds
More flexible and continuous quality improvement.
Not reliant on Vendor for day to day operations.
Why an Open Source Solution?
ED/IP notification system: Year 3
Prioritization of essential intervention elements
Identification of specific data inputs and outputs (Use case development)
Workflow mapping
EMR user interface development
Testing and go-live
Clinical Intervention Approach
COMMUNITY GOVERNANCE – THE CHANGE AGENTS
Administrative Committee
Organizational Subcommittee
SustainabilitySubcommittee
Clinical QISubcommittee
HIT Subcommittee
Information Systems
Administration
Infrastructure
Governance is iterative and evolving (even when you don’t want it to be!)
Administrative Committee
GNOHIE Adoption
Strategic Planning
Sustain-ability
Org. Structure/Legal Entity
Fiscal
Membership Expansion
Criteria
Providers
Intervention
Sustain-ability
Funding Sources
Payers
TOC
Analytics & Reporting
HIT Use Optimiza
tion
CCM
Data Use/
SharingAccess /Credenti
als
Patient Align-ment
Privacy
Physical Infra-
structure
Organizational
Sustainability Clinical QI
HIT
Community leaders are Key!
ED/IP NOTIFICATION SYSTEM
Foundational supporting Policies
Data Sharing Agreements
Patient Consent
Data Use, Retention & Disclosure
Breach Notification
Sensitive Data
Grievances
How much data is too much data?
Clinical relevance
EMR data element
generation & digesting
capabilities
1st Key Decision point: Data Elements
Where is my Medical Home? Who should receive ED/ IP notifications?
2nd Key Decision point: PCP alignment
Where, when and to whom should information from another setting be transmitted?
1. Ability to easily distinguish information related to other settings
2. Notification frequency3. Flexibility for routing and review
3rd Key Decision point: Notification Frequency
Notification triaging Follow-up types Follow-up timing Communication with other settings
4th Key Decision point: Follow up protocols
Transitions of care (TOC)
Emergency Department Inpatient Specialty Referral
Currently being tested using the Direct Protocol
Telemedicine
Chronic Care Management
Population management Centralized Data repository 2 years of clinical backfill.
Registry Data cubes being built
using real-time encounter and ICD9 codes.
Clinical decision solutions Care plans
Chronic care management platform
Community disease registries.
What about the other priorities?
o Allows Health Professionals easy access to patient information from across the healthcare system, giving them a single picture of that patient’s medical history.
o Provides a way to connect different healthcare systems to share health information securely and in a timely fashion at the point of care.
o Drives down cost by eliminating unnecessary procedures and reducing preventable readmissions.
o No added costs or visits for the patient.
Other abilities
Additional benefits:o Provides the ability to analyze and manage
population health and trends that can help to improve the system of care.
o Allows physicians to communicate securely thus coordinating and improving patient care.
o Connection to state and national level health information infrastructure e.g. connection to Louisiana Health Information Exchange (LaHIE).
What about the other priorities?
ReferencesLouisiana health care redesign concept paper (2006). Submittal to HHS – Center for Medicaid and Medicare Services, http://www.allhealth.org/briefingmaterials/ConceptPaperforaRedesignedHealthCareSystem–CMSConceptPaper-710.pdf
Adler-Milstein, J., & Jha, A. K. (2012). Sharing clinical data electronically: A critical challenge for fixing the health care system. JAMA : The Journal of the American Medical Association, 307(16), 1695-1696. doi:10.1001/jama.2012.525; 10.1001/jama.2012.525
DeSalvo, K. B., & Kertesz, S. (2007). Creating a more resilient safety net for persons with chronic disease: Beyond the "medical home". Journal of General Internal Medicine, 22(9), 1377-1379. doi:10.1007/s11606-007-0312-3 Hagland, M. (2013). The Louisiana public health Institute/Crescent city beacon community. in new orleans, a public health consortium takes patient-centered care metro-area wide. Healthcare Informatics : The Business Magazine for Information and Communication Systems, 30(1), 18, 20, 26.
Thank you!
Liam Bouchier,
Acting Director/CIODivision of Information Services Louisiana Public Health Institute (LPHI)Suite 1200, 1515 Poydras New Orleans, LA, 70112
504.301.9835 (W) 504.383.5352 (M)
