Creating sustainable system-level community change through Health Information Technology

1. Creating sustainable system-level community change through Health Information Technology November 9, 2012 Liam Bouchier (Presenter) - CIO/Acting Director Louisiana Public Health Institute Dr. Seema Gai (Author) - NO/AIDS task force, New Orleans Author Rahul Jain, MPH (Author) – Business Analyst, Louisiana Public Health Institute

2. Presenter Disclosures Liam Bouchier, Acting Director/CIO LPHI < There are no personal financial relationships with commercial interests relevant to this presentation > (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Learning Objectives Demonstrate the value of community involvement and community led large scale complex HIT system implementations. Describe the value propositions of open source technologies from cost, integration, scalability and sustainability perspectives.

4. Community Change and Open Source • The Opportunity • Identifying Outcomes and Setting Goals • Identify & Engage with Community Needs • Implementing a Sustainable Solution • Community Governance – The Change Agents

5. The Opportunity

6. Beacon Application

7. Beacon Communities! • Cooperative agreement program with the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC). • $13.5 million over three years. • New Orleans was one of 17 awarded Beacon Communities.

9. Identifying Outcomes and setting Goals

10. Establishing the Vision The mission and vision of the Crescent City Beacon Community (CCBC) initiative [was] to establish an accountable and efficient healthcare system that provides high quality, coordinated care to patients.

11. Program Goals defined by the Community A reduction in healthcare costs by decreasing preventable Emergency Department and inpatient hospital admissions through better coordination of care for chronic disease patients Better health outcomes and population health indicators for chronic diseases through HIT enabled Clinical Quality Improvement and Transitions of Care interventions in Patient Centered Medical Homes

12. Identify & Engage with Community needs

13. Community Assessment& Engagement Framework: Year 1 • Community group meetings - First 3 Months • Key informant interviews - First 8 Months Priority Areas Identified!! re-identified, re-examined, refined, redefined, refocused, redrawn, rewritten, reviewed, re-reviewed….finalized…….Maybe.

14. Priorities Identified Chronic Care Management • Population management • Registry • Clinical decision solutions • Care plans Transitions of care (TOC) • Emergency Department • Inpatient • Specialty Referral • Telemedicine

15. Rationale for Transitions of Care •  preventable readmissions and ED/IP visits •  medication errors •  adverse events •  overutilization & duplication of resources •  patient & caregiver clarity as to overall plan of care Care Coordination Communication of information across settings Sources: National Transitions of Care Coalition, National Quality Forum

16. Implementing a Sustainable solution

17. Is this what we need?

18. Priorities established Chronic Care Management • Population management • Registry • Clinical decision solutions • Care plans Transitions of care (TOC) • Emergency Department • Inpatient • Specialty Referral • Telemedicine

19. What is the problem?

20. Year 2: Identifying/Building the solution – keep it iterative • Revisiting the Key Informants again. • Revalidate use cases • RFI and RFP’s – Written, reviewed and scored by community leaders. • Build what the community needs now! • Propriety and Open source technologies examined. • Extensive due diligence on short list of vendors

21. Designing the solution • Successful vendor brought in to revalidate use cases, 1 on 1 interviews with community partners • Implementation planning – Community led implementation team

22. Why an Open Source Solution? Interoperability • Open standards, not a proprietary solution • Greater Control on changes/upgrades to the technology, less risk. • Open source community leads the way adhering and pushing industry standards. Scalability • Customizability of solution, ability to quickly react to community needs.

23. Why an Open Source Solution? Scalability • Iterative Solution, community improves the technology over time. • Individual customer benefits from entire community development. • Shared savings, reallocation of funds • More flexible and continuous quality improvement. • Not reliant on Vendor for day to day operations.

24. ED/IP notification system: Year 3

25. Clinical Intervention Approach

26. Community Governance – the Change Agents

27. Governance is iterative and evolving (even when you don’t want it to be!)

28. GNOHIE Adoption • Sustain-ability • Data Use/ Sharing • Strategic Planning Community leaders are Key! • TOC • Access /Credentials • Intervention Sustain-ability • Patient Align-ment • Physical Infra-structure • Privacy Administrative Committee • HIT Use Optimization • Fiscal • CCM • Analytics & Reporting • Providers • Membership Expansion Criteria • Funding Sources • Payers • Org. Structure/Legal Entity Organizational HIT Clinical QI Sustainability

29. ED/IP Notification system

30. Foundational supporting Policies

31. 1st Key Decision point: Data Elements How much data is too much data?

32. 2nd Key Decision point: PCP alignment Where is my Medical Home? Who should receive ED/ IP notifications?

33. 3rd Key Decision point: Notification Frequency Where, when and to whom should information from another setting be transmitted? Ability to easily distinguish information related to other settings Notification frequency Flexibility for routing and review

34. 4th Key Decision point: Follow up protocols Notification triaging Follow-up types Follow-up timing Communication with other settings

35. What about the other priorities? Chronic Care Management • Population management • Centralized Data repository • 2 years of clinical backfill. • Registry • Data cubes being built using real-time encounter and ICD9 codes. • Clinical decision solutions • Care plans • Chronic care management platform • Community disease registries. Transitions of care (TOC) • Emergency Department • Inpatient • Specialty Referral • Currently being tested using the Direct Protocol • Telemedicine

36. Other abilities • Allows Health Professionals easy access to patient information from across the healthcare system, giving them a single picture of that patient’s medical history. • Provides a way to connect different healthcare systems to share health information securely and in a timely fashion at the point of care. • Drives down cost by eliminating unnecessary procedures and reducing preventable readmissions. • No added costs or visits for the patient.

37. What about the other priorities? Additional benefits: • Provides the ability to analyze and manage population health and trends that can help to improve the system of care. • Allows physicians to communicate securely thus coordinating and improving patient care. • Connection to state and national level health information infrastructure e.g. connection to Louisiana Health Information Exchange (LaHIE).

38. References Louisiana health care redesign concept paper (2006). Submittal to HHS – Center for Medicaid and Medicare Services, http://www.allhealth.org/briefingmaterials/ConceptPaperforaRedesignedHealthCareSystem–CMSConceptPaper-710.pdf Adler-Milstein, J., & Jha, A. K. (2012). Sharing clinical data electronically: A critical challenge for fixing the health care system. JAMA : The Journal of the American Medical Association, 307(16), 1695-1696. doi:10.1001/jama.2012.525; 10.1001/jama.2012.525 DeSalvo, K. B., & Kertesz, S. (2007). Creating a more resilient safety net for persons with chronic disease: Beyond the "medical home". Journal of General Internal Medicine, 22(9), 1377-1379. doi:10.1007/s11606-007-0312-3 Hagland, M. (2013). The Louisiana public health Institute/Crescent city beacon community. in new orleans, a public health consortium takes patient-centered care metro-area wide. Healthcare Informatics : The Business Magazine for Information and Communication Systems, 30(1), 18, 20, 26.

39. Thank you! Liam Bouchier, Acting Director/CIO Division of Information Services Louisiana Public Health Institute (LPHI) Suite 1200, 1515 Poydras New Orleans, LA, 70112 lbouchier@lphi.org504.301.9835 (W) 504.383.5352 (M)