HIE Pilot Project

J.C.L.P.H.C.C Chatham County Safety Net Planning Council Health Information Exchange Pilot Project

History/Goals
Formed in 2004 by the Chatham County Commission; became an independent 501(c)3 non-profit in 2007
Lead by Chatham County Health Department as neutral convener
Composed of representatives from both hospital systems, providers of health care to the uninsured, city and county government, local non-profit agencies and citizen groups
Charged with working together to find efficient and effective methods to improve access to and quality of health care delivery to uninsured Chatham County citizens

Methods
Annual Evaluation to monitor trends in demand and successes in providing service
Community Needs Assessments to gather information about specific health care needs
Strategic Planning to meet emerging needs identified in evaluation and needs assessments
Seeking of grants to implement projects on behalf of entire Council

Information Technology
Health Information Technology was identified as the solution to gaps in quality of care in 2005 Strategic Planning Session
Evaluation trends revealed that Patients
Seek care in multiple locations
Have medical information scattered among various providers
Have medical records at individual providers that are likely to be incomplete
And are vulnerable to errors due to missing information
And that Chatham County Safety Net Planning Council
Had an unknown amount of duplication of data in evaluation reports
Was extremely limited in producing valid data by paper records and limited staff to review them
Could follow trends in access but could not follow health outcomes

GA DCH Grant Award
CCSNPC was named one of three state HIE demonstration projects by the Georgia DCH. Grant funding began in 2008.
Formation of the IT Consortium
Members from all CCSNPC providers
Curtis V. Cooper Primary Healthcare
J. C. Lewis Primary Health Care Center
Community Health Mission
St. Mary’s Clinic
Good Samaritan Clinic
Chatham County Health Department
Memorial University Medical Center (one Emergency Department)
St. Joseph’s/Candler Health Systems (two Emergency Departments)
Hosted by Savannah Business Group, Gary Rost
Open to Community

IT Consortium
Steps taken:
Encourage and support the adoption of Electronic Medical Records by Safety Net Providers
Work with consultants to design the Health Information Exchange structure to meet the identified CCSNPC and community needs
Release RFP to vendors
Vendor selection and contracting
Hardware acquisition
Hosting environment
Implementation

IT Consortium- Accomplishments
Encourage and support the adoption of Electronic Medical Records by Safety Net Providers
J.C. Lewis Primary Health Care and Memorial Emergency Department first to adopt EMR’s
St. Mary’s Clinic and Community Health Mission next
Curtis V. Cooper Primary Healthcare received Federal Stimulus Funds to purchase EMR system , currently in vendor selection process
Work with consultants to design the Health Information Exchange structure to meet the identified CCSNPC and community needs
Primary challenge was to link 8 – 10 unrelated providers
Safety Net providers have limited funds and staff
Providers want to retain option of selecting the EMR system right for them
Providers want to have control over their own medical records
Elected to structure HIE based on CDR and EMPI
Release RFP to vendors- March 2009

IT Consortium - Accomplishments
Vendor selection and contracting
Initial bids received were in the $2 to $5 million range
Invited vendors to present to CCSNPC IT Consortium to familiarize them with community goals and scale of project
Released a follow up RFP asking for smaller scale Pilot Project bids
Unanimous vote to contract with Orion Health
Contract negotiations lengthy; involved detailed development of SOW
Hardware acquisition
Had initially considered software as a solution or using hospital-based servers
As project developed, identified importance of CCSNPC- managed database
Hosting environment- Location identified
Implementation of Pilot Project
Involves J. C. Lewis Primary Health Care Center, Memorial Emergency Department and CCSNPC as manager of database and holder of software licenses
Began October 2009

Integration Engine Clinical Data Repository J. C. Lewis Health Center Electronic Medical Records View Portal Master Patient Index Consolidated Medical Record Consolidated Medical Record Clinical Care Information Emergency Visit Summary Memorial Univ Med Center Emergency Department Electronic Medical Records

Patient Privacy Protecting patient privacy is a critical component of Concerto Portal. Custom access policies can be created for individual patients. All access to patient records is fully audited.

Implementation Challenges
Hardware Set up
Establishment of HL7 messaging
J. C. Lewis EMR Vendor had not previously established HL7’s
Delays and Glitches, but ultimately successful
Quest Laboratory HL7 development
Establishment of VPN’s
Testing Environment
Checking and rechecking data in system
User training
User testing
Move to Production Environment
Elected not to backload patient data except for demographics
Initial database does not include record of every patient
Elected to extend User Acceptance training to allow database to grow

Implementation Challenges
Contracting among Pilot Project participants
Developed Business Associate Agreement and MOU
Privacy and Policy
Developing fields
Consulted with a number of existing HIE’s to review their documents
Began with a Privacy and Policy Document, to be developed into a Privacy and Policy Manual by a Steering Committee during the Pilot Project period
Each provider responsible for adding information about HIE to their respective patient consent forms
Opt in/Opt out availability
User Engagement
User training
User testing
Community / Patient Engagement
Simple, non-technical Power Point developed to explain function and advantages of HIE
Focus groups and development of printed patient information planned

Lessons Learned
Stay focused on the community issue
Will help in decision making
Keeps a collaborative group on the same page
Provides meaningful use
Stay focused on patients, not technology
Technology is the tool, not the end point
Community members, users and patients themselves understand the meaning for them, not the technical jargon
Everything is more complicated than you anticipate
And takes longer and costs more!
Keep your mind and options open
Allow time to develop processes
If you wait to start until everything is “perfect,” you will never start
Keep looking for errors; don’t assume something is working

Community Benefits
The Health Information Exchange will
Provide Patients
With a longitudinal summary medical record in the CCSNPC database
Reduction of the same paperwork multiple times
Reduction of repeat testing- labs, radiology, etc.
Avoid delays in appropriate care and medical errors
Provide Healthcare Providers
Complete, secure, easily accessible electronic records
Communication among providers through secure, safe protected electronic portals with information updates in real time
Ability to see complete information and avoid duplication and errors
Provide Chatham County Safety Net Planning Council
With unduplicated records and accurate counts of patients served
Ability to follow trends in access AND health outcomes
Secure repository of patient records in case of emergency evacuation

Encounters Allergies/Alerts Medications Laboratory Tests Radiology Studies CCSNPC CCSNPC CCSNPC CCSNPC CCSNPC CCSNPC

Encounters Allergies/Alerts Medications Laboratory Tests Radiology Studies CCSNPC Hospitals Public Health Correctional Health Private Providers Behavioral Health State HIE’s

http://www.chathamsafetynet.org	883
http://safetynet.gachd.org	110
http://healthinformationexchanges.org	14
http://webcache.googleusercontent.com	1
http://www.gachd.org	1

HIE Pilot Project

by Chatham Co. Safety Net Planning Council on Jun 07, 2010

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HIE Pilot Project — Presentation Transcript