The Tipping Point:
Moving DIRECT(ly) from
Availability to Adoption
September 17, 2013
Presentation Overview:
• Tennessee’s Direct secure messaging
implementation program (Health eShare)
• Pilot community init...
Tennessee’s Health eShare Effort
• Utilize these best practices and
lessons learned from the pilot
communities for statewi...
Health eShare’s Incentive Program
Tennessee offers $500 per participant with an assigned,
unique Direct email address.
Par...
Health eShare Direct Pilot Informants
HIT Specialists &
HISP Vendor (ICA)
University of Memphis
FedEx Institute for Techno...
U of M FedEx Institute:
- Trailed HIT Specialists & identified
implementation “glitches”
- Source for independent assessme...
ICA:
- CareAlign® web portal was used as Direct
interface within pilot communities
- Worked with Qsource to align Direct i...
Memphis
Community Pre-pilot
Focus Group
Pre-pilot Inventory
of Provider Inputs
Into:
• Direct Knowledge
• Barriers
• Needs...
Tennessee Pilots
• Three Communities: Urban, Semi-Urban and Rural
• Use Cases were developed by each community
• Commitmen...
Surprising Pilot Results
The financial incentives for participating were not as effective
a motivator as anticipated.
Part...
Best Practices & Lessons Learned
- Rogers’ Innovation Adoption Curve
Motivation and incentives are changing in potential i...
The Tipping Point
A Statewide Effort
• Expanding participating HISP Vendors
• Statewide Marketing campaign
• Assessing use cases and incenti...
Lessons Learned
• The Law of the Few
• The Stickiness Factor
• The Power of Context
The Three Rules of Epidemics*
*Source:...
The Law of the Few
• The 80/20 Principle
• Connectors, Mavens and Salesmen
• Knowledgeable, influential peers create sprea...
The Stickiness Factor
• Messages need to make an impact
• Make your message memorable
• Keep it simple; but effective
Mark...
The Power of Context
• Community/provider characteristics
• Support requirements
• The value of incentives
• Organizationa...
The Tipping Point: The Law of the Few
The Tipping Point: The Stickiness Factor
The Tipping Point: The Power of Context
• “Dear Colleague“ letter
• At the elbow support
• Technology
sensitivity/obsolesc...
Next Steps
• Rapidly Expanding HISP Marketplace
• “Organically” Growing Pilot Markets
• Compendium of Use Cases and Linkin...
The Tipping Point….
Discussion
What questions
do you have?
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iHT² Health IT Summit New York 2013 - Case Study "The Tipping Point: Moving DIRECTly from Availability to Adoption"

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Case Study "The Tipping Point: Moving DIRECTly from Availability to Adoption"

Featuring: Dawn FitzGerald, Chief Executive Officer, Qsource

As part of the American Recovery and Reinvestment Act (ARRA), awards were made to states to create the necessary infrastructure for widespread adoption of Direct technology. In partnership with the State of Tennessee, Department of Finance and Administration, and Office of eHealth Initiatives, Qsource was contracted to provide technical assistance to healthcare professionals in selecting, implementing and using certified Direct technology to improve the quality and value of healthcare.

A key component of the project was the selection of pilot communities in which to identify, develop and implement use cases that were sufficient to create a social and behavioral threshold for universal community-based adoption of Direct technology. Together with ICA as our Direct technology vendor, Qsource implemented the pilot over 5 months, culminating in a report of lessons learned from these pilots. These lessons learned are being used to inform Tennessee’s statewide roll out of Direct with the goal of achieving 4,000 users by February, 2014. This presentation will highlight best practices and lessons learned with regard to Direct implementation, along with up to date information on the status of Tennessee’s statewide rollout of Direct technology.

Learning Objectives:

∙ Attendees will be able to describe three general principals of expanding provider adoption
∙ Attendees will receive a brief review of Rogers’ Innovation Adoption Curve and the various incentives that are effective promoting early IT adoption
along that curve
∙ Attendees will hear valuable lessons learned in IT adoption from three distinct healthcare communities

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iHT² Health IT Summit New York 2013 - Case Study "The Tipping Point: Moving DIRECTly from Availability to Adoption"

  1. 1. The Tipping Point: Moving DIRECT(ly) from Availability to Adoption September 17, 2013
  2. 2. Presentation Overview: • Tennessee’s Direct secure messaging implementation program (Health eShare) • Pilot community initiatives and lessons learned using Rogers’ Diffusion of Innovation Theory • The Tipping Point: Using the three rules of epidemics as an approach to statewide roll-out
  3. 3. Tennessee’s Health eShare Effort • Utilize these best practices and lessons learned from the pilot communities for statewide rollout Phase 1: Work with at least two pilot communities and HISP vendors to define use cases, best practices and test implementation strategies • 4,000 participants by January 2014 Phase 2: Generate widespread adoption and USE of Direct technology across the entire spectrum of health professionals
  4. 4. Health eShare’s Incentive Program Tennessee offers $500 per participant with an assigned, unique Direct email address. Participants applying for the incentive must: • Be licensed professionals that are in good standing with the State • Be listed in the provider directory on the Health eShare website • Establish at least one Direct account with a DTAAP accredited HISP Vendor • Send at least one non-test Direct message for each user account • Comply with HIPAA and/or other applicable regulations within each participant’s professional role and responsibility
  5. 5. Health eShare Direct Pilot Informants HIT Specialists & HISP Vendor (ICA) University of Memphis FedEx Institute for Technology Center for Supply Chain Management Community Participants Provider interviews & Focus Group Inputs
  6. 6. U of M FedEx Institute: - Trailed HIT Specialists & identified implementation “glitches” - Source for independent assessment of implementation and process flow - Offered workflow solutions
  7. 7. ICA: - CareAlign® web portal was used as Direct interface within pilot communities - Worked with Qsource to align Direct incentive, registration & authentication processes - Provided ongoing data for populating the web-based provider directory and map - Produced ONC provider metrics - Partnered on idntifying use-cases and integrating with other HISPs & HealthVault®
  8. 8. Memphis Community Pre-pilot Focus Group Pre-pilot Inventory of Provider Inputs Into: • Direct Knowledge • Barriers • Needs • Opportunities • Potential Use Cases Sample Feedback: “Currently we are spending a huge amount of time faxing. It is a drain on our resources as well as a hold up with patient care. We are hoping this process will resolve a significant component of that”. “We need to be better at sharing information with specialists and need the information back from them. They spend the same amount of time because we didn’t get the chest X-Ray, for example”. “We are trying to take the burden off the patient because now we have to ask them what the specialist told them since we don’t get reports. We don’t want the patient to have to be the messenger”. “For those who have gone through Stage 1, we are looking at Stage 2 practice management capabilities that are less expensive and/or less cumbersome”.
  9. 9. Tennessee Pilots • Three Communities: Urban, Semi-Urban and Rural • Use Cases were developed by each community • Commitment was established via community charter • Rapid Cycle Implementation: 6 months Community Demographics Use Case Hickman County Rural (pop. 25,000) Community Health Campaign: Patient Portal Chattanooga Semi-urban (pop. 340,000) Care Transitions: Hospital to Community (home, physician, home health, nursing home) Memphis Urban (pop. 930,000) ACO Implementation
  10. 10. Surprising Pilot Results The financial incentives for participating were not as effective a motivator as anticipated. Participant adoption and use case varied depending on community use case, but in general, participation and sustainability were low: • Used regularly for case manager referral • Tried but not used regularly for hospital to physician referral • Patient portal rarely, if ever used
  11. 11. Best Practices & Lessons Learned - Rogers’ Innovation Adoption Curve Motivation and incentives are changing in potential impact as Direct achieves greater adoption. Source: Rogers, E.M. (2003) Diffusion of Innovations (5th edition), New York, NY, Free Press Desire to be a leader/champion Ease of use/simplicity Incentives/Costs Value/Usefulness Requirement
  12. 12. The Tipping Point
  13. 13. A Statewide Effort • Expanding participating HISP Vendors • Statewide Marketing campaign • Assessing use cases and incentives that work After working with 3 pilot communities, Health eShare is now expanding adoption efforts statewide. • Physicians • Hospitals • Home Health & Long-term Care Facilities • Laboratories • Department of Health We hope to reach this goal by achieving a widespread adoption of Direct technology across the entire spectrum of health professionals, with an emphasis on:
  14. 14. Lessons Learned • The Law of the Few • The Stickiness Factor • The Power of Context The Three Rules of Epidemics* *Source: Malcolm Gladwell (2000), The Tipping Point, New York, NY, Little Brown
  15. 15. The Law of the Few • The 80/20 Principle • Connectors, Mavens and Salesmen • Knowledgeable, influential peers create spread • Find appropriate champions Participant Recruitment
  16. 16. The Stickiness Factor • Messages need to make an impact • Make your message memorable • Keep it simple; but effective Marketing the Product
  17. 17. The Power of Context • Community/provider characteristics • Support requirements • The value of incentives • Organizational buy-in • Use cases that “sell” Know the Customer
  18. 18. The Tipping Point: The Law of the Few
  19. 19. The Tipping Point: The Stickiness Factor
  20. 20. The Tipping Point: The Power of Context • “Dear Colleague“ letter • At the elbow support • Technology sensitivity/obsolescence
  21. 21. Next Steps • Rapidly Expanding HISP Marketplace • “Organically” Growing Pilot Markets • Compendium of Use Cases and Linking to Appropriate Technology • Increasing Awareness • Adapting to Change • Documenting Lessons Learned “The real journey of discovery is not in seeking new lands, but seeing what has already been there with new eyes.” - Marcel Proust
  22. 22. The Tipping Point….
  23. 23. Discussion What questions do you have?

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