Transcript Development of a Health Information Technology Planning

Development of a Health
Information Technology
(HIT) Planning Grant –
Process and Suggestions
Telecommunications Conference, Nov. 17, 2005,
Springfield, IL
Martin MacDowell, DrPH, MBA
Assistant Director and Assoc. Professor
Univ. of IL Rockford, NCRHP
([email protected])
and
Randy Hayes, MS
Director of Quality Assurance
Sinnissippi Centers, Inc, Dixon, IL ([email protected])
Ultimate Goal of this HIT Project
To provide coordination of quality and safe
health care services for disparate groups
within Lee County to include rural
economically disadvantaged, ethnic/racial
minority residents as well as older and
younger persons with special/complex
health care needs.
Objectives of Lee County Grant
1)
Development of a comprehensive plan to enable
sharing of electronic health information between three
HIT partners: a local acute care hospital and
associated medical group; the county health
department; and the local behavioral health
organization;
2)
Development of a central Electronic Health Record (EHR) system
that will afford the sharing of health information between the
organizations incorporating recently adopted standards-based
data sharing;
Submit an HIT implementation grant that would be funded by
AHRQ (http://healthit.ahrq.gov/home/index.html ) after the initial planning
3)
award.
Organizational Structure of
Planning Grant
Four task force were formed from staff of the three partner
organizations:
KSB Hospital
www.ksbhospital.com
Lee County Health Department www.lchd.com
Sinnissippi Centers, Inc.
www.sinnissippi.com
1) a legal task force to create a HIPAA compliant plan that will permit
the transfer of protected health information;
2) a clinical task force to delineate information to be transferred, access
parameters, authorization parameters, and staff training plans;
3) an administrative/advisory task force that will develop project funding
plans; and
4) a technical project management task force that will develop the
specific hardware, software, and networking plans to affect the
sharing of information
Diagram of
HIT Planning
Grant Functions
Why the grant was submitted
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There were special incentives for organizations
based in rural counties (RCA code for Lee
County is 4)
The partners had established working
relationships on other projects in the past and
partners were well matched to RFA of grant
The lead organization (KSB Hospital) had a well
developed IS and EMR infrastructure that could
be built upon
There was a clinical need all recognized for
sharing of health information to improve
efficiency and clinical care information transfer
Why the grant was submitted - continued
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The leadership of the three partner
organizations had open communication with
each other so an effective partnership could be
built
A outside party (university faculty) had time to
collect information and write planning grant
There were funds offered to help implement the
HIT plan after it was developed
Expertise on how to do budget for such a grant
was available – is closely examined during
review
What happened
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The federal government (AHRQ) changed the deadline for submission of
the HIT implementation grant so only three months were available for plan
development instead of six months. Initial grant meeting occurred Dec. 8th,
2004 and 3 year implementation grant was submitted in April 2005
Each task force met and addressed its area related to plans for a shared
Electronic Medical Record (EMR).
The existing Solcom system at KSB for electronic health information was
chosen and plans made for how the other 2 organizations could securely
access information stored on the KSB servers and setting up a VPN for
connecting the organizations was among the connection options discussed.
The HL-7 industry standard is preferred over any customized solution for
communicating between systems it was agreed that the HL-7 protocol could
be supported. Plans were made for scanning records at each organization
from a chosen start date to be put on the KSB Solcom System with tabs for
each organization for a given patient.
More info regarding the Solcom system KSB uses at
http://www.solcominc.com/solcom/solutions/showSolution.asp?ID=4
Initial Software Systems Existing At KSB Hospital and
Partners + Paper Records
SCI Inc.
Has 3 Proliant servers with approximately 100
workstations are attached to these three
servers. Unix based CMHC/MIS is used as the
information management software. The
CMHC/MIS (http://www.cmhc.com) software
produces reports on key decision variables by
integrating financial, client, staff, and service
data. The CMHC/MIS also includes modules to
address concerns specific to these professions
such as client information management and
individual client maintenance
? How to
connect
LCHD
Has a local area network at their office with 18
desktop PCs or workstations linked to a central
server. Backups of data stored on the local area
network are taken off-site until another successful
back up occurs. The LCHD also is networked with
a statewide (Illinois) “Cornerstone” computer
system that works separately from their local area
network, but in conjunction with the TOTS system
as well as other IDPH connections.
Clinical Data Items That Were
Chosen to be Shared Initially
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Immunizations - e LCHD
Medications – all share anything prescribed/script given
Presenting problem/presenting list - e KSB and SCI
Lab, Imaging, screening tests - e KSB (SCI in near future, at least
scores)
Reportable diseases - e LCHD
Prenatal care/ records – KSB
Service dates by category- e all
Discharge summary- e KSB (SCI probably in near future)
Presenting Diagnosis e-SCI
Referral information
Assessment
Possible Benefits of Shared EMR= Increased Patient
Safety as well as Decreased Costs
Some scenarios:
1)
The shared medical data base will allow a KSBH Emergency Room physician when
presented with an infant in anaphylactic shock to instantly obtain that infant’s
immunization record from LCHD. Thus the physician would be able to accurately
determine which immunization was given that might be the precipitant of the
symptomatology.
2)
This system would allow a psychiatrist at SCI to determine whether or not a person
presenting with symptoms of depression was receiving pain medications from a
KSBH physician in order to determine if the depressive symptoms were related to a
psychiatric condition or were a side effect of some prescribed medication that the
patient had forgotten to mention. This would lead to improved diagnosis and
treatment
3)
The proposed system would reduce the need for a shared patient to repeat the same
identifying information two to three times when enrolling in all partner’s services.
Once the basic identifying information was obtained, the other needed demographic
information required could be accessed from the shared data base and merely
confirmed as to currency. A health history, once entered into the data sharing system
could be confirmed and updated as needed between the partners, and available to all
partners.
Plans re Legal Issues
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The Legal Task Force has proposed that there be an
Affiliation Agreement between the organizations. The
basic legal structure of each organization would not
change. MUST be HIPPA Compliant as well as IL laws.
The Affiliation Agreement would set forth clearly how the
sharing of information would work and the
responsibilities of each partner to train and monitor its
staff.
The Agreement would make clear that each organization
remained independent and responsible for its own
employees and their actions. As part of the affiliation, an
implementation task force would remain in effect with
designated staff from each partner.
The partners would identify the Project Director who
would be ultimately responsible for the day to day
implementation of the grant and its continued operation
once everything is up and running.
Plans re Legal Issues - continued
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The affiliation agreement will specify the relationship of
the parties and allow them to share information, as
though part of one entity.
Illinois law is far more restrictive in sharing health
information than HIPAA. The consent form will not only
comply with HIPAA but also the Illinois Mental Health
and Developmental Disabilities Confidentiality Act, 740
ILCS 110, the AIDS Confidentiality Act, 410 ILCS 305,
and the law related to Substance Abuse Treatment
Records, 20 ILCS 301, as well as various regulations.
The Legal Task Force will also provide the basic training
related to legal issues and confidentiality to the staff of
the affiliated organizations
IT Issues Discussed During Planning – Any
Partners Would Encounter These
How to in a HIPPA compliant way connect
existing networks for purposes of a shared
EMR and yet retain existing systems and
networks at each partner ?
 How to connect different IT systems with
differing complexities?
 How to ensure staff will use shared EMR?
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Pointers for others Planning
Inter- Agency EMR Sharing
Organizations should have good prior
history of working together
 Current leadership must trust each other
and be “community minded”
 IT staff and consultants at each
organization must be have orientation of
finding a way to solve connectivity
problems
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Lessons learned and points from Reviewer’s Comments
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Creation of a shared EMR was not viewed as “ground breaking”
Wanted more detail re what items were cost sharing and what would
be direct costs paid by grant in the budget. Such as consultation
was not detailed and seem “excessive”
No mention of AHRQ priority populations
Didn’t mention that most primary care docs were part of KSB
Medical group – lead to concern about community impact
Concern that PI was not employee of lead institution
Technical approach “underspecified” re HIT implementation
Wanted more re my background to be evaluator in biosketch
Concern re how project “learnings” would be disseminated
Want more details re project and an outcome/quality impact
evaluation
Concern about IT background of new PI