Thank you for inviting me to the conference. MTeHC believes providing a broad view of the patient’s health record to a clinician at the point of care is a critical component in providing the right care at the right time, in the right setting. This morning I want to give you an overview of the activities of the MTeHC over the past 3 yrs.
The mission of the
Bob Gordon has since made the same presentation to Chattanooga health care delivery executives.Regional Informatics at Vanderbilt involved as a result of the Memphis launch
There was much activity during this period. Some funding might be available from the state.
The MTeHC Board continued to meet in 2009. In late spring, we convened work groups to begin the development of a full RFP process to select a vendor. The RFP was created and distributed to vendors. Nine responses were received. We were headed toward demonstrations with 3 vendors but we were asked to stop the process so HIP TN could have time to understand what the state needed to do to receive federal funds. In December we were released from our holding position.
One of the first discussions was about deciding whether or not to apply for a Beacon Community Award. MTeHC chose not to proceed with the application process due to time limitations to gather community support and having no existing operational exchange. Middle TN did have the 25-30% EHR adoption by primary care physicians.
We kept the barrier to participate low for Memphis health care facilitiesWe kept the operational costs low for the Memphis exchange, we will do the same for Nashville.Members of our work groups have participated in the HIPTN activities
The planning grant will provide funds to support a full business planning effort.Once the business plan is in place, other funding can be received from the state.MTeHC expects to reside as a node on the HIP TN network of networks as a Qualified Organization.MTeHC WG participants are actively engaged in HIP TN activities.
This is our current Board representation. We do expect to expand the Board in the future.
Care coordination efforts, case management, biosurveillance, quality reporting.Essentially, case-controlled studies showed an absolute drop in admissions from the ED of 2-3%. at $1667 per admission greater than $950,000 cost savingsadjusted for payer mix, co-morbidities, age, site, etc.
This list first defined in 2009 by the Sustainability WG is still the list of participants we expect to include in the HIE.
We know health delivery organizations need to exchange health information as one step toward meeting meaningful use requirementsWe expect reimbursement models to change.HIE can support Patient Centered Medical Homes and ACOs.During the H1N1 flu last year, we were able to show the increase in patients seeking care for flu-like symptoms in the Memphis exchange in realtime.
Benefits to communities such as Nashville supporting programs such as the Mayor’s Healthy Nashville.We can provide baseline measures of health of the community and then measure the impact of programs and incentives to live healthier.
Last but not least, engage as partners the organizations in the community such as the Nashville Technology Council and the Health Care Council to support and help us move forward.
2. The Middle TN eHealth Connect (MTeHC)<br />Historical summary of activities: 2007-2008-2009<br />Our work in: 2010<br />Future plans: 2011 and beyond<br />
3. MTeHC <br />Mission<br /><ul><li>Middle Tennessee eHealth Connect improves the effectiveness and efficiency of healthcare delivered to every member of the community without regard to payer by connecting healthcare providers throughout Middle Tennessee. </li></ul>Vision<br /><ul><li>Middle Tennessee eHealth Connect will improve the amount and quality of patient health information through secure access leading to measurable improvements in clinical outcomes, quality of care and cost effectiveness to benefit patients, families, providers, payers, employers, and the public health.</li></li></ul><li>History of the Middle Tennessee eHealth Connect - 2007<br />Informal meetings were held throughout the year to discuss the possibility of data exchange.<br />Bob Gordon presented to a Middle Tennessee group on the start-up of the Memphis exchange.<br />Leadership from St. Thomas, Nashville General, TriStar/HCA and Vanderbilt University Hospitalsigned a Memorandum of Understanding. <br />
4. History of the Middle Tennessee eHealth Connect - 2008<br />Reggie Coopwood, MD as convener and later as Chairman of the Board<br />Regional Informatics as facilitators of the process<br />February 4th planning session <br />Work Groups were established <br />Charge given by the Board to investigate the possibility of “piggybacking” on the Memphis Exchange<br />3-4 months of work ensued with a decision to adopt the governance model <br />
5. History of the Middle Tennessee eHealth Connect - 2009<br />Work began to define a sustainability model for Health Information Exchange.<br />Members of our team developed a proforma modeling tool to look at multiple ways to fund the exchange.<br />The question is “who receives value from the existence of the exchange?”<br />Bylaws were adopted and the Middle Tennessee eHealth Connect was incorporated as a non-profit.<br />ARRA was passed by Congress.<br />MTeHC issued an RFP in July. <br />HIP TN activities began in August/September timeframe.<br />Request came to MTeHC to stop vendor selection process.<br />
6. History of the Middle Tennessee eHealth Connect – 2010 (Jan-June)<br />MTeHC re-started the process to build an exchange<br />MTeHC received $150,000 grant from Cigna<br />The MTeHC Board (with assistance from the Tennessee Hospital Association) studied ED utilization in Davidson County<br />The Board decided to investigate whether joining with Memphis on the ICA infrastructure would help in keeping costs low.<br />Dr. Coopwood departs to Memphis (The MED)<br />Larry Kloess (TriStar) becomes the Chairman of the Board<br />
7. Middle Tennessee eHealth Connect 2010 Currently…<br />We expect to sign a Community Amendment to Memphis/ICA Core Service Agreement within the next 45 days.<br />MTeHC will be a second HIE operating on the same infrastructure as Memphis gaining some economies of scale.<br />Middle TN and Memphis data will not be co-mingled.<br />We will adhere to the idea that we must keep technology and operational costs low in order to be sustainable.<br />Work Groups are, once again, active in their respective roles.<br />
8. Looking Ahead to Upcoming Activities<br />Office of eHealth offers state planning grant to create a business plan<br />Gives MTeHC the opportunity to engage in a strategic planning process <br />Plan will also include a goal for expansion of Board membership to be representative of the cross-section of our community<br />Other HIEs (planned and operational) will also be creating their business plans.<br />
9. 2010 Current Governance & Infrastructure <br />Board of Directors <br />Larry Kloess – HCA/TriStar Health System, CEO (President & Board Chair)<br />Wes Littrell – Saint Thomas Health Services, President & CEO STHS Affiliates/Chief Strategy Officer<br />Jason Boyd – Nashville General Hospital, Interim CEO<br />Larry Goldberg – Vanderbilt University Hospital, CEO<br />Craig Becker – Tennessee Hospital Association, President<br />Kasey Dread – Nashville Academy of Medicine, Executive Director <br />Dr. Clifton Meador – Safety Net Consortium/Meharry-Vanderbilt Alliance, Executive Director<br />State of TN <br />Metro Government of Nashville & Davidson County<br />Project Management Office<br />Regional Informatics at Vanderbilt (independent)<br />We operate under strict guidance from the board <br />
10. Why do this?<br />We have access issues and will continue to have access issues.<br />We have people who move from care setting to care setting regularly.<br />We have overuse problems across all payer types.<br />We have primary care and non-emergent care being delivered in high-cost Emergency Department settings.<br />We believe HIE can support care improvements through the provision of health information required to support measurable improvements and efficiencies in the health of populations.<br />Our evaluation plan in Memphis is not yet published but will show some benefits.<br />
11. Initial Stakeholders of the MTeHC <br />(Patients and their families are the focus of the Middle Tennessee efforts)<br />These organizations either provide care or support the care delivery process.<br />Ambulatory Providers <br />Safety Net Clinics<br />Hospitals <br />Employers <br />Heath Plans <br />Government (as a payer and an employer)<br />
12. Initial Work <br />Initially <br />Availability of information at Hospitals and Safety Net Clinics <br />ARRA – Medicare & Medicaid <br />Meaningful use incentives <br />Growth<br />Aggressive expansion of data from other providers with expanded access<br />Northern border to Southern Border in Middle TN<br />Other Possibilities<br />Patient Centered Medical Home<br />ACOs<br />Population Health<br />Research<br />
13. MTeHC HIE General Architecture – Data Handling<br />Clinical Results, Encounters, and Patient Demographics<br />Hospital 1<br />Hospital 2<br />ICA Parsers<br />Clinic 1<br />Clinic 2<br />
14. Examples of data in the Exchange<br />Encounter Summaries<br />Laboratory Results<br />Discharge Summaries<br />
15. Potential Benefactors of Exchange<br />Patients <br />Decreased duplicate testing, Out Of Pocket expenses, Opportunity Costs, Radiation exposure<br />Data can be accessed across multiple providers<br />More opportunity to be informed about their care<br />Clinicians/Providers<br />Immediate access to patient information from other institutions<br />Reports that obviate the need to order tests<br />Safer transitions in care<br />Lower costs burden of quality reporting<br />Employers <br />Reduced utilization of services<br />Lower costs to insure employees<br />Reduced medical spending associated with adverse events (such as hospitalizations) <br />Government<br />Lower costs of Medicare and Medicaid care delivery<br />Public Health<br />Measure and track health improvement initiatives through research and public programs<br />Track influenza outbreaks<br />
16. Sustainability Strategies<br /><ul><li>Goal is to have those that benefit, pay in proportion to the benefit received
17. Areas of potential benefits to payers and employers:</li></ul>Disease management (e.g. Diabetes, asthma)<br />Specific populations (e.g. Obesity)<br />Pain management <br />Workman’s compensation<br /><ul><li>Identify segments of the population where government benefits from the system (e.g. Medicaid, uninsured/safety net, employees)
18. Identify non-government payers (large payers, self-funded employers and health plans)</li></li></ul><li>Critical Success Factors – Lessons Learned<br />Maintain and Grow the Coalition<br />Across delivery settings<br />Northern border-to Southern border<br />Board Leadership <br />Expanded and Engaged<br />Ops Management<br />Keep Technology and Operations costs low<br />Low Barrier to participate technically<br />Strong Community Identity <br />Perception<br />Participation<br />Supporting the right care at the right place<br />Leverage strong Nashville Healthcare Market identity<br />