Colorado Associated Community Health Information Exchange

1. 1 Colorado Associated Community Health Information Exchange Lisa Schilling, MD, MSPH AHRQ Annual Conference Sept. 8, 2008

2. 2 CACHIE Participants 14 Colorado federally qualified community health centers Colorado Community Managed Care Network Colorado Community Health Network Others

3. 3 Presentation Objectives

4. 4 CACHIE Goals To promote the use of information technology to support quality reporting and improvement across the CHC networks To design, build, & implement a shared system for quality reporting among 6 CHCs with 4 disparate EMR/PMS To assist CHC with EMR template implementation to improve care provision, documentation & measurement.

5. 5 Data <---> Information Its important to understand the genesis of data. First, providers must provide care and a template may prompt care by prompting questions or tasks. Next, they must document the care provided and optimally it should be documented in a manner that allows it to be easily measured. Once measured the results inform both the provision and the documentation. (Providers tend to do much more than they document, and EMR systems do not always make documentation easy) EMR templates or forms assist with provision by providing static reminders, they assist with codified documentation which improves the accuracy of the measurement as it reflect care. of these improve Its important to understand the genesis of data. First, providers must provide care and a template may prompt care by prompting questions or tasks. Next, they must document the care provided and optimally it should be documented in a manner that allows it to be easily measured. Once measured the results inform both the provision and the documentation. (Providers tend to do much more than they document, and EMR systems do not always make documentation easy) EMR templates or forms assist with provision by providing static reminders, they assist with codified documentation which improves the accuracy of the measurement as it reflect care. of these improve

6. 6 What is a business process?

7. 7 Why Use Business Process Analysis? Everything is not as it appears to be: Unintended internal and external consequences It�s not just a �flip of the switch� Technology must complement workflow Expectancy: Exceeding capacities Fashion: Unnecessary complexity Remaining current Stakeholder interest: Varying levels over time Developing consensus

8. 8 Understanding the business processes and defining system requirements are the most important steps in developing or acquiring any information system. Developing consensus among stakeholders about the work performed by a system requires a disciplined, analytical approach. Output-oriented design starts with the output and works backward. This means focusing on identifying and defining important business processes and their component tasks, changing business process flow or task flow as needed for efficiency, and then defining what the health information system needs to do in order to support these processes. Only at that point can the database design begin. To put it another way: Database structure exists to serve ? Data outputs, which exist to serve ? Business processes, which exist to serve ? Organizational objectives, which exist to serve ? Organizational goals and vision Guiding Principles: 1).Information systems support the work of the organization 2.) Put the logical before the physical 3)Engage all stakeholders 4)Plan for interoperability 5)Look for ways to improve BP to add value 6)Design the system so that data are entered only once 7)Manage for accountability (Project Mgt) 8)Stop analyzing when the incremental progress outweighs incremental gain Understanding the business processes and defining system requirements are the most important steps in developing or acquiring any information system. Developing consensus among stakeholders about the work performed by a system requires a disciplined, analytical approach. Output-oriented design starts with the output and works backward. This means focusing on identifying and defining important business processes and their component tasks, changing business process flow or task flow as needed for efficiency, and then defining what the health information system needs to do in order to support these processes. Only at that point can the database design begin. To put it another way: Database structure exists to serve ? Data outputs, which exist to serve ? Business processes, which exist to serve ? Organizational objectives, which exist to serve ? Organizational goals and vision Guiding Principles: 1).Information systems support the work of the organization 2.) Put the logical before the physical 3)Engage all stakeholders 4)Plan for interoperability 5)Look for ways to improve BP to add value 6)Design the system so that data are entered only once 7)Manage for accountability (Project Mgt) 8)Stop analyzing when the incremental progress outweighs incremental gain

9. 9 BPA Example #1 A method of defining the processes that occur to accomplish a desired outcome. A method of defining the processes that occur to accomplish a desired outcome.

10. 10 Legend, Circles- are entities Customer - triggers the events Business rules- order taker cannot touch unwrapped foodLegend, Circles- are entities Customer - triggers the events Business rules- order taker cannot touch unwrapped food

11. 11 CACHIE BPA Purpose Align the Information system (IS) with the organization�s mission, need a clear model of the desired outcomes and the business processes that result in those outcomes. IS should support and enhance business processes. Creating a shared system required that we understand CHC business process similarities and differences.

12. 12 CACHIE BPA Goals Develop a common definition of quality improvement reporting system Describe and visually document how quality improvement efforts are accomplished Describe how the quality improvement efforts will function with the quality IS Develop a list of functional requirements to drive information system design and implementation

13. On The Road Barriers- geographical, cultural, technicalBarriers- geographical, cultural, technical

15. 15 BPA Example #2 A method of defining the processes that occur to accomplish a desired outcome. A method of defining the processes that occur to accomplish a desired outcome.

16. 16 Provide & Document DM Eye Care Goal: Provide DM pts guideline concordant care Objective: Ensure DM pts receive eye exams Business rules: Electronic referrals are not possible, referrals to both internal and external providers. Trigger: DM pt presents for care (other?) Task Set: Care for any acute needs, refer for DM care Outcome: Provide & document DM eye care

17. 17 Now since health care is much more complex than fast food, this example focused on one small piece of care provision and documentation- the diabetic eye exam. In addition to explaining this slide�Now since health care is much more complex than fast food, this example focused on one small piece of care provision and documentation- the diabetic eye exam. In addition to explaining this slide�

18. 18 BPA- other topics

19. 19 Context diagramContext diagram

20. 20 What We Learned Templates Not uniformly available, Require costly professional support to develop/modify, Require lots of CHC staff time, When available, not always used, Not automatically linked with �forms� -> double data entry, Desire for more & improved

21. 21 What We Learned- con�t Quality Reporting Great variability among CHC capacity Requires professional support ($$) to develop reports Reporting limited by $$$ Reporting limited by system Desire for data (re-)use

22. 22 What We Learned- con�t Quality Reporting-2 Analyze at provider, pod, clinic site, CHC level Analyze discrete specified time periods Track trends for individual patients Provide pre-built reports (UDS, etc) Easily create reports for individual CHC needs Save & share built reports Run �huddle� reports based on scheduled patients Want huddle reports Want to assess Q at a variety of levelsWant huddle reports Want to assess Q at a variety of levels

24. 24 It Takes a Village� CACHIE Steering Committee Ross Brooks, Director Molly Brown, Manager Art Davidson, Co-Medical Director Jason Greer, HIT Director Molly O�Fallon, Clinical Quality Director Lisa Schilling, Co-Medical Director Dan Tuteur, CCMCN Ex. Director HIT Committee David Adamson, Mountain Family HC Kitty Bailey, CCHN Andrew Bienstock, Salud Family HC David Fleurquin, Pueblo Community HC Pete Gutierrez, Denver Health, Committee Chair Annette Kowal, CCHN Pete Leibig, Clinica Family Health Services Konnie Martin, Valley-Wide Health Systems, Inc. Pam McManus, Peak Vista Community HC Mitzi Moran, Sunrise Community Health Paul Olson, Peak Vista Community HC John Santistevan, Salud Family HC Pat Tellez, Metro Community Provider Network Want huddle reports Want to assess Q at a variety of levelsWant huddle reports Want to assess Q at a variety of levels

25. 25 Contacts CACHIE Project Manager Ross Brooks ross@cchn.org CACHIE Medical Directors Lisa Schilling lisa.schilling@ucdenver.edu Arthur Davidson art.davidson@dhha.org Want huddle reports Want to assess Q at a variety of levelsWant huddle reports Want to assess Q at a variety of levels