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The Learnings of a National Health IT Collaborative. Presented to the Institute of Medicine (IOM) By: Abby Sears CEO of OCHIN April 8, 2014. Who is OCHIN?. Who is OCHIN?.

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the learnings of a national health it collaborative

The Learnings of a National Health IT Collaborative

Presented to the Institute of Medicine (IOM)

By:

Abby Sears

CEO of OCHIN

April 8, 2014

who is ochin1
Who is OCHIN?
  • As a nonprofit organization, healthcareinnovation organization designed to promote access to quality, affordable healthcare for all.
  • One of the nation’s largest and most successful Health Information Networks
    • In 18 states, coast-to-coast
    • Touching over 4,500 physicians
who we serve
Who We Serve
  • Any member of the healthcare continuum requires equal access to the next generation of integrated healthcare delivery
  • We have a history in underserved populations, Federally Qualified Health Centers, Mental/Behavioral Health, Public Health Agencies, Rural Health Clinics, and Critical Access Hospitals
the community as a learning system

Federal

Agencies

Community Members

The Community as a Learning System

Community Organizations

State Public Health

Community Practice

COMMUNITY FOCUSED:

Governance

Engagement

Standards & Trust

Analysis

Dissemination

IntegratedDelivery System

Health Information Organization

8

Academic,

Foundation, and Data Partners

The Community as a Learning System; The National Committee on Vital and Health Statistics, 2011

the obstacles are numerous and are challenging to resolve
The obstacles are numerous and are challenging to resolve
  • Data and Privacy policies need updating
  • Healthcare is highly regulated environment
  • Varied business requirements of different clinical domains and requires time and commitment to capturing the data
  • Payors and Federal agencies have different data needs and requests
  • Challenges of small practices with little to no IT support
  • Economic issues of running small practices
  • Change Fatigue – so many environmental demands at one time
changes are necessary policy and more
Changes Are Necessary: Policy and More
  • Rules at the federal and state level: New rules for technologically sharing data for integration of behavioral and mental health and more
    • Alcohol and drug data is protected from other clinicians
    • Family Planning data
    • Sharing of immunization data across state lines
    • Different narcotic prescription rules by state
  • Increased support in the field
    • Especially for small practices, clinics with 1-10 providers
      • Lack of sophistication, staff, funds, interest
    • They want the help, but have neither the infrastructure, nor the financial support, to get it
    • “what is useful” functionality continues to be unclear
    • Larger practices do this in-house
off the shelf products what can you do with them
Off the Shelf Products: What can you do with them?
  • Adding Technology to “Canned” Solutions
    • Focus is on meeting regulatory requirements: PQRS, HEDIS, Meaningful Use and privacy concerns
    • Social determinants of health
    • HIE
    • Provider Directory issues
    • Major pieces of the software products still are working out the basics
    • Is it standard programming or customer…how does this impact future upgrades
change requires a three pronged approach
Change requires a three pronged approach

Technology Change Training/Documentation Data and reporting on utilization

Needs to be in the workflow and lots of reinforcement and training

  • Alternative Payment methodologies – technology has been deployed but the workflows haven’t changed
  • Building more functionality than the physicians can accommodate
  • It takes time to reinforce new behaviors
  • Constant reinforcement by the environment with continuous education and support
  • Teach at every level in the clinic
follow the money payors and price
Follow the money: Payors and Price
  • Payors are differentiating themselves on quality and cost
    • Need to pay for quality in a slow and incremental way that doesn’t hurt the providers but continues to encourage slow, gradual change
    • Pilot small projects that will look at new ways to pay for quality across the spectrum of providers – ask them to fund projects that bridge organizations
    • Look for reward programs
  • Be willing to consider taking on some risk especially in small amounts
    • Look at PACE program of high risk Medicaid and Medicare patients for good opportunities
  • Encourage the payors to agree on definitions of quality at the community or better yet at the state level
    • Ask to show improvement not an outcome or a target
    • How to use data to impact positive change needs to be part of all education requirements at Medical Schools
sharing and celebrating the achievers
Sharing and Celebrating the Achievers
  • Peer to Peer knowledge sharing creates high leverage learning opportunities especially on a shared system - Sharing knowledge between practices and clinicians
    • Most clinicians want to have provide excellent quality
    • More focus at the medical associations
    • Send comparison data in non-threatening and learning environments to discuss why and what can change
  • Look at the continuing education system for opportunities advanced knowledge
sharing technology knowledge why can t i email or copy it
Sharing technology knowledge: Why can’t I email or copy it?
  • Flexible vs non-flexible systems:
    • Flexible typically means the product is highly configurable which has a direct correlation to cost; manual staff resources to build and maintain
    • Lower cost systems tend to allow less customizability
    • Are we on different versions?
    • Did we buy the same hardware?
    • Are we in the same state? Are the regulations the same?
    • IP confidentiality and non-disclosure issues
breaking barriers innovation and partnership
Breaking Barriers: Innovation and Partnership
  • There is no one answer, but there is an approach – build change packages
  • Innovation at the clinic level – starts with physicians
  • You need to invest, but you can’t do it alone
  • Partnering with groups to build
  • Look for shared learning opportunities help each other – Peer groups
  • Capitalize on continuing education process
  • Use Associations to support new legislation
  • You get what you pay for in Health IT because of regulation requirements
  • Requires a high touch approach
success stories
Success Stories
  • IPAs, safety net clinics, Regional Extension Center and Hospital Deployments to perform group purchasing and support
  • Advocacy to improve legislation and policy to build; potential new legislation around CFR-42
  • More education programs to support more workforce
  • Build an ongoing support mechanism for
  • HIT investments by Foundations for social venture capital in products to help embedded change
thank you
Thank You

OCHIN Inc.

@OCHINinc

Abby Sears

CEO of OCHIN

searsa@ochin.org