HIE Pilot Project


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HIE Pilot Project

  1. 1. J.C.L.P.H.C.C Chatham County Safety Net Planning Council Health Information Exchange Pilot Project
  2. 2. History/Goals <ul><ul><li>Formed in 2004 by the Chatham County Commission; became an independent 501(c)3 non-profit in 2007 </li></ul></ul><ul><ul><li>Lead by Chatham County Health Department as neutral convener </li></ul></ul><ul><ul><li>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 </li></ul></ul><ul><ul><li>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 </li></ul></ul>
  3. 3. Methods <ul><ul><li>Annual Evaluation to monitor trends in demand and successes in providing service </li></ul></ul><ul><ul><li>Community Needs Assessments to gather information about specific health care needs </li></ul></ul><ul><ul><li>Strategic Planning to meet emerging needs identified in evaluation and needs assessments </li></ul></ul><ul><ul><li>Seeking of grants to implement projects on behalf of entire Council </li></ul></ul>
  4. 4. Information Technology <ul><ul><li>Health Information Technology was identified as the solution to gaps in quality of care in 2005 Strategic Planning Session </li></ul></ul><ul><ul><li>Evaluation trends revealed that Patients </li></ul></ul><ul><ul><li>Seek care in multiple locations </li></ul></ul><ul><ul><li>Have medical information scattered among various providers   </li></ul></ul><ul><ul><li>Have medical records at individual providers that are likely to be incomplete   </li></ul></ul><ul><ul><li>And are vulnerable to errors due to missing information </li></ul></ul><ul><li> And that Chatham County Safety Net Planning Council </li></ul><ul><ul><li>Had an unknown amount of duplication of data in evaluation reports </li></ul></ul><ul><ul><li>Was extremely limited in producing valid data by paper records and limited staff to review them </li></ul></ul><ul><ul><li>Could follow trends in access but could not follow health outcomes </li></ul></ul>
  5. 5. GA DCH Grant Award <ul><ul><li>CCSNPC was named one of three state HIE demonstration projects by the Georgia DCH. Grant funding began in 2008. </li></ul></ul><ul><ul><li>Formation of the IT Consortium </li></ul></ul><ul><ul><li>Members from all CCSNPC providers </li></ul></ul><ul><ul><ul><li>Curtis V. Cooper Primary Healthcare </li></ul></ul></ul><ul><ul><ul><li>J. C. Lewis Primary Health Care Center </li></ul></ul></ul><ul><ul><ul><li>Community Health Mission </li></ul></ul></ul><ul><ul><ul><li>St. Mary’s Clinic </li></ul></ul></ul><ul><ul><ul><li>Good Samaritan Clinic </li></ul></ul></ul><ul><ul><ul><li>Chatham County Health Department </li></ul></ul></ul><ul><ul><ul><li>Memorial University Medical Center (one Emergency Department) </li></ul></ul></ul><ul><ul><ul><li>St. Joseph’s/Candler Health Systems (two Emergency Departments) </li></ul></ul></ul><ul><ul><li>Hosted by Savannah Business Group, Gary Rost </li></ul></ul><ul><ul><li>Open to Community </li></ul></ul>
  6. 6. IT Consortium <ul><ul><li>Steps taken: </li></ul></ul><ul><ul><li>Encourage and support the adoption of Electronic Medical Records by Safety Net Providers </li></ul></ul><ul><ul><li>Work with consultants to design the Health Information Exchange structure to meet the identified CCSNPC and community needs </li></ul></ul><ul><ul><li>Release RFP to vendors   </li></ul></ul><ul><ul><li>Vendor selection and contracting </li></ul></ul><ul><ul><li>Hardware acquisition </li></ul></ul><ul><ul><li>Hosting environment </li></ul></ul><ul><ul><li>Implementation </li></ul></ul>
  7. 7. IT Consortium- Accomplishments <ul><ul><li>Encourage and support the adoption of Electronic Medical Records by Safety Net Providers </li></ul></ul><ul><ul><ul><li>J.C. Lewis Primary Health Care and Memorial Emergency Department first to adopt EMR’s </li></ul></ul></ul><ul><ul><ul><li>St. Mary’s Clinic and Community Health Mission next </li></ul></ul></ul><ul><ul><ul><li>Curtis V. Cooper Primary Healthcare received Federal Stimulus Funds to purchase EMR system , currently in vendor selection process </li></ul></ul></ul><ul><ul><li>Work with consultants to design the Health Information Exchange structure to meet the identified CCSNPC and community needs </li></ul></ul><ul><ul><ul><li>Primary challenge was to link 8 – 10 unrelated providers </li></ul></ul></ul><ul><ul><ul><li>Safety Net providers have limited funds and staff </li></ul></ul></ul><ul><ul><ul><li>Providers want to retain option of selecting the EMR system right for them </li></ul></ul></ul><ul><ul><ul><li>Providers want to have control over their own medical records </li></ul></ul></ul><ul><ul><ul><li>Elected to structure HIE based on CDR and EMPI </li></ul></ul></ul><ul><ul><li>Release RFP to vendors- March 2009   </li></ul></ul>
  8. 8. IT Consortium - Accomplishments <ul><ul><li>Vendor selection and contracting </li></ul></ul><ul><ul><ul><li>Initial bids received were in the $2 to $5 million range </li></ul></ul></ul><ul><ul><ul><li>Invited vendors to present to CCSNPC IT Consortium to familiarize them with community goals and scale of project </li></ul></ul></ul><ul><ul><ul><li>Released a follow up RFP asking for smaller scale Pilot Project bids </li></ul></ul></ul><ul><ul><ul><li>Unanimous vote to contract with Orion Health </li></ul></ul></ul><ul><ul><ul><li>Contract negotiations lengthy; involved detailed development of SOW </li></ul></ul></ul><ul><ul><li>Hardware acquisition </li></ul></ul><ul><ul><ul><li>Had initially considered software as a solution or using hospital-based servers </li></ul></ul></ul><ul><ul><ul><li>As project developed, identified importance of CCSNPC- managed database </li></ul></ul></ul><ul><ul><li>Hosting environment- Location identified </li></ul></ul><ul><ul><li>Implementation of Pilot Project </li></ul></ul><ul><ul><ul><li>Involves J. C. Lewis Primary Health Care Center, Memorial Emergency Department and CCSNPC as manager of database and holder of software licenses </li></ul></ul></ul><ul><ul><ul><li>Began October 2009 </li></ul></ul></ul>
  9. 9. 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
  10. 11. 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.
  11. 12. Implementation Challenges <ul><ul><li>Hardware Set up </li></ul></ul><ul><ul><li>Establishment of HL7 messaging </li></ul></ul><ul><ul><ul><li>J. C. Lewis EMR Vendor had not previously established HL7’s </li></ul></ul></ul><ul><ul><ul><li>Delays and Glitches, but ultimately successful </li></ul></ul></ul><ul><ul><ul><li>Quest Laboratory HL7 development </li></ul></ul></ul><ul><ul><li>Establishment of VPN’s </li></ul></ul><ul><ul><li>Testing Environment </li></ul></ul><ul><ul><ul><li>Checking and rechecking data in system </li></ul></ul></ul><ul><ul><ul><li>User training </li></ul></ul></ul><ul><ul><ul><li>User testing </li></ul></ul></ul><ul><ul><li>Move to Production Environment </li></ul></ul><ul><ul><ul><li>Elected not to backload patient data except for demographics </li></ul></ul></ul><ul><ul><ul><li>Initial database does not include record of every patient </li></ul></ul></ul><ul><ul><ul><li>Elected to extend User Acceptance training to allow database to grow </li></ul></ul></ul>
  12. 13. Implementation Challenges <ul><ul><li>Contracting among Pilot Project participants </li></ul></ul><ul><ul><ul><li>Developed Business Associate Agreement and MOU </li></ul></ul></ul><ul><ul><li>Privacy and Policy </li></ul></ul><ul><ul><ul><li>Developing fields </li></ul></ul></ul><ul><ul><ul><li>Consulted with a number of existing HIE’s to review their documents </li></ul></ul></ul><ul><ul><ul><li>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 </li></ul></ul></ul><ul><ul><ul><li>Each provider responsible for adding information about HIE to their respective patient consent forms </li></ul></ul></ul><ul><ul><ul><li>Opt in/Opt out availability </li></ul></ul></ul><ul><ul><li>User Engagement </li></ul></ul><ul><ul><ul><li>User training </li></ul></ul></ul><ul><ul><ul><li>User testing </li></ul></ul></ul><ul><ul><li>Community / Patient Engagement </li></ul></ul><ul><ul><ul><li>Simple, non-technical Power Point developed to explain function and advantages of HIE </li></ul></ul></ul><ul><ul><ul><li>Focus groups and development of printed patient information planned </li></ul></ul></ul>
  13. 14. Lessons Learned <ul><ul><li>Stay focused on the community issue </li></ul></ul><ul><ul><ul><li>Will help in decision making </li></ul></ul></ul><ul><ul><ul><li>Keeps a collaborative group on the same page </li></ul></ul></ul><ul><ul><ul><li>Provides meaningful use </li></ul></ul></ul><ul><ul><li>Stay focused on patients, not technology </li></ul></ul><ul><ul><ul><li>Technology is the tool, not the end point </li></ul></ul></ul><ul><ul><ul><li>Community members, users and patients themselves understand the meaning for them, not the technical jargon </li></ul></ul></ul><ul><ul><li>Everything is more complicated than you anticipate </li></ul></ul><ul><ul><ul><li>And takes longer and costs more! </li></ul></ul></ul><ul><ul><ul><li>Keep your mind and options open </li></ul></ul></ul><ul><ul><li>Allow time to develop processes </li></ul></ul><ul><ul><ul><li>If you wait to start until everything is “perfect,” you will never start </li></ul></ul></ul><ul><ul><ul><li>Keep looking for errors; don’t assume something is working </li></ul></ul></ul>
  14. 15. Community Benefits <ul><ul><li>The Health Information Exchange will </li></ul></ul><ul><ul><li>Provide Patients </li></ul></ul><ul><ul><li>With a longitudinal summary medical record in the CCSNPC database </li></ul></ul><ul><ul><li>Reduction of the same paperwork multiple times </li></ul></ul><ul><ul><li>  Reduction of repeat testing- labs, radiology, etc. </li></ul></ul><ul><ul><li>  Avoid delays in appropriate care and medical errors </li></ul></ul><ul><ul><li>Provide Healthcare Providers </li></ul></ul><ul><ul><li>Complete, secure, easily accessible electronic records </li></ul></ul><ul><ul><li>Communication among providers through secure, safe protected electronic portals with information updates in real time </li></ul></ul><ul><ul><li>Ability to see complete information and avoid duplication and errors  </li></ul></ul><ul><li> Provide Chatham County Safety Net Planning Council </li></ul><ul><ul><li>With unduplicated records and accurate counts of patients served </li></ul></ul><ul><ul><li>Ability to follow trends in access AND health outcomes </li></ul></ul><ul><ul><li>Secure repository of patient records in case of emergency evacuation </li></ul></ul>
  15. 16. Encounters Allergies/Alerts Medications Laboratory Tests Radiology Studies CCSNPC CCSNPC CCSNPC CCSNPC CCSNPC CCSNPC
  16. 17. Encounters Allergies/Alerts Medications Laboratory Tests Radiology Studies CCSNPC Hospitals Public Health Correctional Health Private Providers Behavioral Health State HIE’s