Transcript Slide 1

Harris County Public Health Task Force
Information Technology Subcommittee
Status Report
Regional Health Information Organizations:
Where Are We Now?
April 19, 2005
April 28, 2005
Agenda
Overview of IT subcommittee charter and
membership
Results of clinician interviews
Regional Health Information Organizations (RHIO)
overview
Go forward action plan
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Charter
Provide recommendations to the Harris County Public Healthcare
Council on how our Community can better use technology to
improve public health care service delivery. The scope of this
group would be to:
 Develop an electronic network to support a more integrated
flow of information between our communities emergency
rooms and public / private clinics
 Review technology offerings that may solve this problem and
be used to build a community infrastructure
 Determine the value proposition to the potential end users
 Identify governance, funding, and operations models to
support the effort
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Membership
David Bradshaw
Charles Bacarisse
Bill Burge
Ron Cookston
Janet Donath
David Fenn
Elena Marks
Robert Murphy, MD
Kathleen Randall
Linda Ricca
Beverly Shelton
Tom Shirley
Manfred Sternberg
Tim Tindle
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Memorial Hermann
Harris County
HealthLink
HCPH
Good Neighbor Healthcare Center
Texas Children’s Hospital
City of Houston
Memorial Hermann
Greater Houston Partnership
HealthLink
Memorial Hermann
CHRISTUS St. Joseph Hospital
Bluegate
Harris County Hospital District
From the Front Lines
Providers Speak on the Need for
Regional Information Sharing
Robert Murphy, MD
Presentation to the Harris County Public Health Council
April 28, 2005
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A system in crisis:
• Growing number
of uninsured
• ED overcrowding
and diversion
• Rising costs of
medical care; welldescribed “waste”
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Caregivers on the front-lines can speak to
problems-and solutions
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Interviews
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David Buck, M.D., President & CMO – Houston Healthcare for the Homeless
Guy Clifton, M.D., Neurosurgeon, Memorial Hermann
Stacie Cokinos, CFRE, San Jose Clinic
Ron Cookston, Ed.D, Director – Gateway to Care
Janet Donath, Executive Director - Good Neighbor Healthcare Clinic
Karin Dunn, Navigation Supervisor, Gateway to Care
Jeremy Finkelstein. M.D., Medical Director ER – Methodist
Tom Flanagan, AVP Emergency Services, Memorial Hermann
Thomas Granchi, M.D., Medical Director ER - Ben Taub
Brent King, M.D., ER Chief – Hermann, University of Texas
Carol Paret, VP Clinical Effectiveness, Memorial Hermann; Vice Chair, Gateway to
Care
Frank Redmond, M.D., Medical Director ER - St. Luke’s
John Riggs, M.D., Medical Director, Harris County Hospital District
Miriam Serrano, Care Navigator, Good Neighbor Health Clinic
Joan Shook, M.D., Medical Director ER - Texas Children’s
Jorge Trujillo, M.D., Medical Director ER - St. Joseph’s
1. Eligibility determination is costly to administer and a
barrier to care
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2. Duplication of care is expensive,
inefficient, and a risk for patients
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Abnormal EKG—new or old?
Even when testing is appropriate, without
comparison  ADMIT
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Many duplicate procedures have risks
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Cardiac catheterization may result in a serious
complication
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3. Barriers to information sharing cause
poor coordination of care
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HIPAA and release of information rules have
hindered access
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“I shuffle way too
much paper…that is
time I would rather
be caring for patients”
--emergency physician
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“We can never get ER
records. We often ask
patients to drive to the clinic
just to sign paperwork.”
—clinic director
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“I had a patient with a red
leg and possibly a blood
clot. With follow-up, we
could have discharged her
home on medication but
instead we admitted her for
observation”
--ED physician
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Currently no access to clinic schedules after
hours
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“ ‘Go to the ER’ becomes the default—that is where the
specialists are. I can’t blame them.”—ED physician
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4. Poorly managed chronic conditions are the
most serious problem
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“The cliché I see is that people
think that the ED is overrun with
inappropriate patients. I don’t see
that to be the case. These
[non-urgent] cases are easy.
5 minutes and they are out.”
--emergency physician
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“It’s not the non-urgent care that’s killing
us; it the serious complications of
chronic conditions.”
—emergency physician
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“Patients needing acute care (flu, sore throats, etc) are
not the issue; The issue is lack of disease management
for chronic conditions. The chronic conditions are more
of a drain on the ED system because patients continue
to present to ED due to lack of management of these
conditions”
—public health leader
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Patients with (seizure disorder, asthma, diabetes,
high blood pressure) “unable” to get meds.
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Is there a role for a “care facilitator” or care
navigator”?
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1. Better eligibility determination
2. Less duplication of expensive care
3. Improved coordination of care
4. Improved management of chronic conditions
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…CAN be achieved!
Information technology won’t solve all the
problems….
…but the community solutions cannot be delivered
without improved regional information sharing
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Providers are willing to work towards integrated
solutions
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Information Challenges
Identification of patients from multiple providers
Aggregation of patient specific clinical data
Notification system for important events
Data protection - security and confidentiality
Interoperability between existing systems
Value identification and quantification
Operations
Funding and governance
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Framework for Strategic Action
Four goals, 12 strategies (http://www.hhs.gov/healthit/ )
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Inform clinical practice
Interconnect clinicians
Personalize care
Improve population health
Consolidates and coordinates many initiatives currently
underway
Makes the case for “why now” to adopt HIT
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Avoid medical errors
Improve use of resources
Accelerate diffusion of knowledge
Reduce variability of care
Advance consumer role
Strengthen privacy and data protection
Promote public health and preparedness
Current RHIO Activity
Over 140 RHIO efforts underway nationwide
Typically formed by providers, business
coalitions, physicians, health plans, or
government-related entities
42 states have at least one RHIO organized or
planned
24 states have introduced and/or passed
legislation supporting RHIOs or other e-health
initiatives
Congress is considering bills in both Houses
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RHIO Examples
Santa Barbara County Data Exchange – California
Massachusetts Technology Collaborative (MA-SHARE)
Rhode Island Health Improvement Initiative
Taconic Healthcare Community Information Network
(Fishkill, NY)
Indiana Health Information Exchange
Maryland/DC e-Health Initiative
Delaware Health Information Network
MedVirginia – Richmond, VA
Maine Health Information Center
North Carolina Healthcare Information and Communications
Alliance
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What’s Working
Oversight provided by broad-based collaborative
group representing the local healthcare market
(e.g., providers, payers, hospital association, medical society, QIOs,
DOH)
Collaborative group independent of a specific
government agency or a single private entity
Focus is on community benefits, approach is
patient-centric
Benefits are driving technology decisions, not the
other way around
Business model based on subscriptions
Start up funding needed, sources are varied
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Common Challenges
Need for interoperability standards
Money
 Start-up funds
 Sustainable funding model
 Payers will not pick up the full tab
Blueprint for a technology architecture
 Distributed versus centralized data structure
 Low technology user interface
Politics
 Finding a “Switzerland”
Competitive differences
 Lack of trust among parties
 Fear of lost advantage
 Pride of ownership
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Findings - Governance
Most are creating a corporate structure
Some, but not many, are defined by state statute
Independent
LLC incorporation used frequently, some are
pursuing 501(c)(3) status
Boards are broadly representative of the local
healthcare market
Typically have working committees to establish
policies (e.g., mission, governance, financing, technology,
privacy & security, legal, communication & marketing)
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Go Forward Action Plan
Complete impact analysis to size the dollar value of
solving this problem
Hire acting “Executive Director” from consulting firm to
provide day to day leadership for the subcommittee
Establish 3 Work Groups:
 End user
 Technical
 Governance
Develop solution model (time, scope, and money)
Develop proposed governance models
Report back to the Council in 90 to 120 days from project
kickoff
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