Oregon Community Health Information Network

1. Oregon Community Health Information Network

3. Why OCHIN? High-level information services, technical assistance, and administrative services become affordable when group purchasing power is maximized. The infrastructure of the health safety net can be significantly stabilized by applying this principle creatively.

4. Safety Net clinics failing in Oregon Effects of the OHP � financial, political, adverse selection, and section 1115 waiver capping reimbursement below cost Burning IT platforms Market consolidation, Multnomah County Health Department legacy system Little sense of community around the health safety net Lack of State involvement Isolated clinics, little collaboration Many opportunities for shared services, few used What was the Environment?

5. Little sense of community among safety net clinics Sovereign independent agencies Disparate business practices Competition rather than collaboration, mutual benefit, common learning, best practices, etc. Little State involvement and support of safety net e.g. section 1115 waiver actually penalized some community health centers Barriers

6. Evolution - Collaboration

7. Coherent health safety net utilizing shared strengths Allow clinics to focus on and develop full potential rather than �Putting Out Fires� � Reactive and Proactive Improved Health Demographics Better understanding of vulnerable populations Improved resource utilization Improved health outcomes Improved health policy What are our goals?

8. Who is Participating? Oregon Primary Care Association Multnomah County Health Department CareOregon Oregon State Health, Health Planning, and Medicaid Agencies Clackamas County Health Department Tillamook County Health Department Benton County Health Department Virginia Garcia Memorial Health Klamath Health Partnership OCHOCO Family Health Pike Street Medical Clinic - Washington Santa Cruz - California Federally Qualified Community Health Centers throughout Oregon The Coalition of Community Clinics

9. Mission Mission: �To further the cause of assuring access to necessary health services through collaboration among safety net health providers, in meeting common infrastructure needs� Purpose: OCHIN is an Administrative Services Organization. OCHIN exists to meet the need of the safety net community for quality information and management services. As a collaboration, OCHIN can provide these services more efficiently and effectively than would be possible by individual organizations.

10. OCHIN recognizes that individuals and participating organizations are vital members of the communities they serve. OCHIN is an asset of the community clinics, agencies and funding organizations providing safety net health services. OCHIN provides leadership in furthering the collective mission of the safety net system, assuring access to necessary and appropriate health services. OCHIN is an independent body, governed by the needs of the participating organizations. In participating in OCHIN, organizations agree to work toward goals, whose success will be measured collectively. OCHIN will serve as an effective steward of public funds. OCHIN will serve as an effective steward of organization and client information. OCHIN is supported through participant contributions. OCHIN will work to accommodate participants with special needs. OCHIN will foster a climate of mutual trust and respect among participating organizations. OCHIN will respect the business needs of member organizations. Values

11. Integrated Practice Management System Common definitions and business practices Customized for FQHC, Federal and State reporting Significant investment in adequately training safety net users in scheduling, billing, registration and information analysis practice and theory Common patient index across all partners Shared/evolving library of management and business reports Electronic submittal of Claims to; OMAP, BCA, AHLERS, CYDATA, COHIS, CASCADE Electronic Submittal of Statements to clearing house Automatic notification of claims delivery and errors Testing electronic remittance for OMAP Note: OCHIN PM currently contains 380,000 unduplicated patient records Current Services

12. Additional Services Electronic Medical Record Integrated with Practice Management EpicCare best health software per KLAS (HIMSS user Survey) Currently writing a $4.8 M grant to begin process Web Access (MyWeb) � Provider Web Access (MyChart) � Client Master Patient Index, Common for PM and EMR Data Warehouse First Phase � 380K unduplicated patient demographics Second Phase � EMR adds information for statistical reporting of clinical information used in Federal, State and Local Health Dept. for Disease surveillance and Bio-Terrorism in near real-time.

13. Products in Development Centralized Billing Grant proposal has been submitted Better state-level health policy Improve partnership with State & Federal agencies Collaboration with Healthy Disparities Collaboratives (Pecs/Dems) IRIS Electronic Health applications including: Online eligibility application and determination Online Referrals Online Consumer Health Information

14. Economies of Scale Practice Management In next three years OCHIN Practice Management will double in volume and only increase cost by 30%. Per unit cost will therefore decrease by 35% per visit. No single County is big enough to purchase EPIC. Collaboration between Counties and CHC�s enabled the OCHIN partners to buy EPIC, the highest quality health software package in the U.S. Electronic Medical Record In the next three years OCHIN plans to purchase EpicCare, Epic�s Electronic Medical Record (EMR) and implement it in many OCHIN organizations, including various County Health Departments.

15. How we decided on 'EPIC' Intense RPF/RFI process that included all possible partners of OCHIN 85% of the key consultants were certain Epic was the best fit Our Core Group chose Epic as best strategic fit Our OCHIN board and CareOregon concurred

16. Summer 2002

17. Fall 2002

18. Fall / Winter 2002-2003

19. Spring / Summer 2003Multnomah Role Out

20. Full control of access permission at System, Organization, Department, Application and Record Level. Audit trails for add, change and delete of patient data. Automatic session logout and expiration on idle time Secure Session and �Break Glass� controls Workstation to Server 128bit RC5 Encryption All partners and OCHIN staff are filtered through the same firewall rules. All network traffic is logged 7x24 to SQL database Automatic notification of Alerts from firewalls, servers and databases Claims submitted via 3DES VPN, HTTPS, SFTP and FTP(SSL) HIPAA

21. Oregon Community Health Information Network Network Infrastructure and Security

22. Technology

23. Equipment

25. Minimum Client Requirements Thin Client / Terminal Full Citrix ICA client 6.31.1051 Web ICA client 6.31.1051 Windows 9.x or Higher Display 1024x768 @ 256 color TCP/IP Protocol Winsock 2 Terminal support for ICA 6.0 Display 1024x768 @ 256 color Thick Client Windows NT 4.0 or higher Internet Explorer 5.0 or higher PIII 800 or higher 128MB RAM (256MB Recommended) Display 1024x768 @ 256 color TCP/IP Protocol Winsock 2 60MB Free Disk Space for Application Files 20MB Free Disk Space for each Environment

26. Prerequisite Site Information TCP/IP Subnet Addresses for each Clinic If an address space is already in use, OCHIN will assign a subnet for address translation. Router Configuration, Maintenance and Outages are centrally managed by OCHIN. Workstation Security Authorization The NetBIOS name of an EPIC workstation has to be unique across all members. An EPIC ID# will be assigned to each Workstation. This ID# is used to authorize access to the EPIC Databases. On Citrix the NetBIOS name is mapped to the EPIC ID# to uniquely identify an access request. Printer Information TCP/IP Address, Manufacturer, Model. An EPIC ID# will be assigned to each Printer. All printers must be network connected. Partners can choose to utilize a central LPD server (Unix, Windows w/Unix LPR)

27. Network Security

28. Workstation Security / Function

29. Contacts Michael Leahy, OCHIN Executive Director leahym@careoregon.org 503-416-1418 Abby Sears, OCHIN Project Director searsa@careoregon.org 503-416-3646 Paul Matthews, OCHIN Network Architect paulm@techeads.com 503-349-0120