memphis: year 5 report state and regional demonstration projects: 5/31/2014vanderbilt center for...
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Memphis: Year 5 ReportState and Regional Demonstration Projects:
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1
September, 2009Mark Frisse, reporter
The environment (2004)
• No ONC• No HITECH• Two dominant exchange models: Indiana, Santa Barbara• Only one seemed to work• No Medicare Part D• ePrescribing nascent• SureScripts (pharmacies) and RxHub (PBM) competing• Clinical labs competing• Capitation stalled• Intense factionalism among hospitals• No consensus on health care reform
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 2
Pre-dated ONCMentioned NHII, Santa Barbara, IOM
This contract seeks to identify and support statewide data sharing and interoperability activities aimed at improving the quality, safety, efficiency and effectiveness of health care for patients and populations on a discrete state or regional level. It is expected that measurable improvements in the quality, safety, efficiency and/or effectiveness of care shall result from the proposed data sharing and interoperability measures.
AHRQ SRDs (2004)
© 2009, Mark Frisse
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The environment (2009)
• ONC, version 3.0• HITECH – a bill, a plan, but major unresolved issues• Multiple exchange models• Common features and “winners” are slowly emerging• Medicare Part D• ePrescribing on the uptake• SureScripts (pharmacies) and RxHub (PBM) merged• Capitation stalled• Guarded cooperation among hospitals and ambulatory sites• No consensus on health care reform
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 4
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D. McGraw and M. Tripathi, Health Information Exchange Workgroup (PowerPoint). HIT Policy Committee, August 14, 2009
Strength of health exchange objectives in current version of MU rises substantially by 2013
Unrealized potential
REALITY• Comprehensive prescription medication histories largely unavailable• Over-the-counter drugs (e.g., aspirin) have been largely ignored• No systematic allergy reporting• No systematic laboratory information – from office to commercial• Claims data remain the lingua franca• Many state initiatives are not really state-wide• Medicaid systems – few common features across states• Business models are not consistent with the interests of individual
patients and do not support “data liquidity”• Concerns over “ROI” make little sense when the entire “system” is
failing.
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 6
The Memphis Exchange
• Baptist Memorial Health Care Corp. (4 facilities)
• Christ Community Health (4 primary care clinics)
• Methodist Healthcare (7 facilities including Le Bonheur Children’s Medical Center)
• The Regional Medical Center (The MED)• Saint Francis Hospital & St. Francis Bartlett
(Tenet Healthcare)• St. Jude Children’s Research Hospital• Shelby County/Health Loop Clinics (11
primary care clinics)• UT Medical Group (300+ clinicians)• Memphis Managed Care/TLC (MCO)
© 2009, Mark Frisse7
the Memphis SRD - 2009• 34 facilities; over 400 users• 1.2 million unique patients with clinical data• 140,000 monthly encounters• 34,000monthly ICD-9 admission codes (chief complaints)• 2.4 million laboratory tests monthly• 26,000 monthly microbiology reports• 35,000 monthly chest x-ray reports• Total costs: $2.5 million per year
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 8
Met all milestones – was operational in a year; full production in 20 months
Total annual operational costs are less than $2.5 million
The technical model
04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 9
Health CareEntity Internal
SystemsVaults Regional Index
Volunteer eHealth Initiative Data Bank
Identifier Information- Patient Identifier numbers- Facility identifier- Patient name- Date of birth- Gender- Social security number
Data- Demographics- Lab- Orders
“Pharmacy”
Identifier Information- Patient Identifier numbers- Facility identifier- Patient name- Date of birth- Gender- Social security number
Data- Demographics- Lab- Orders
Clinic
Identifier Information- Patient Identifier numbers- Facility identifier- Patient name- Date of birth- Gender- Social security number
Data- Demographics- Lab- Transcribed reports- Pharmacy- Orders
Hospital
Identifier Information- Patient Identifier numbers- Facility identifier- Patient name- Date of birth- Gender- Social security number
Data- Demographics- Lab- Transcribed reports- Pharmacy- Orders
Person 1CompositeInformation
Link 1
Link n
Person 2CompositeInformation
Link 1
Link n
Person 3CompositeInformation
Link 1
Link n
::
Person nCompositeInformation
Link 1
Link n
“Laboratory”
Record Locator S
ervice
Record A
ccess Service
Parsing/Integration E
ngine
Publish Data
Publish Data
Publish Data
Publish Data
Printer
FAXServer
WebUser
Record locator services
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A lot like the first transistor radio..
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LOINC: an example
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Medication hub
© 2009, Mark Frisse 13
Evaluation
Usage• 5% of overall patient visits include detailed access• Usage ranges from 1% to 15%Usability• Extensive workflow evaluation taking placeEconomic Value• Rigorous evaluation shows decreased utilization in the range
of hundreds of thousands of dollars (i.e. can offset less than 50% of system cost); impact on transitions in care not completed.
Disease-specific utilization• Collaborating with TN Hospital Association• Addressing specific areas including abdominal pain, back
pain, and headache04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 14
The impact is very realUSER ANECDOTES:• “Lifesaving” impact on a patient with a ruptured ectopic pregnancy• Untreated active tuberculosis patient who presents for minor care• Terminally-ill patient seeking second opinion• Monitoring treatment of specific chronic conditions• More efficient follow-up when discharged patients present to
ambulatory care clinics for follow-up care
OTHER FINDINGS• Providers have learned that putting the patient first does not adversely
impact their “business”• Data sharing is not a threat to income and only a positive to care
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Potential: transitions in Care
“Real time” query: when and where do patients seen in the Med ED seek follow-up care in a safety net clinic?
© 2009, Mark Frisse
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Potential: surveillance
© 2009, Mark Frisse
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How we did itGovernance:• Coercion & money• Focused inclusion• Minimal burden on participants• Strong data sharing agreements (Markle)
Technology:• Built our approach on the Vanderbilt model- a “Version 1.0”• We assumed standards would evolve• We took data “as we got it”
Evaluation• Quick wins• Meaningful metrics
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Lessons from HIELeadership essentialFeasibleInexpensiveLimited in scopeCan evolveHampered by
Conflicting priorities
Business perceptions
Technical limitations and costs
Privacy concerns
“ROI”
© 2009, Mark Frisse
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Paul David: The dynamo
David, P.A. The Dynamo and the Computer : An Historical Perspective on the Modern Productivity Paradox (Powerpoint presentation). 1990 Available from: http://www.economics.pomona.edu/kuehlwein/Econ164/Dynamo%20and%20Computer%20Presentation.ppt.
The transformation of industrial processes by the new electric power technology was a long-delayed and far from automatic business
© 2009, Mark Frisse 20
Part of a remarkable teamState:
Governor Phil Bredesen, David Goetz, Melissa Hargis, Peter GreavesRegion:
Robert Gordon, Steve Burkett, Al King, Rodney Holmes, Jim Bailey, Rebecca Pope, George Hripcsak (TAP), Ed Hammond (TAP), Betsy Humphreys (TAP), John Quinn (TAP) and many others
Vanderbilt:Vicki Estrin Mark FrisseJanet King Dr. William SteadWill Rice Sarah StewartJameson Porter Michael AssinkLianhong Tang Tim CoffmanKevin Yang Coda DavidsonKevin Johnson Cindy Gadd
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