Population Health: A Sustainability Strategy for a

Disease Registry?

AHRQ 2007 Annual MeetingSeptember 27, 2007

Eleanor Littman RN MSNHealth Improvement Partnership of Santa Cruz

County

Outline

The Santa Cruz Story Innovation & Collaboration Vision: Community-wide Diabetes Registry

Lessons Learned Project History Population Health is Value Proposition

Future Chronic Disease Registry and/or Health

Information Exchange?

• Central California Coast• 75-miles S. San Francisco• 265,000 residents • North – Silicon Valley Beach• South – Agricultural

• Isolated • Progressive • Innovative• Collaborative

Santa Cruz County, CA

Fragmented Private Health Care System

Three private hospitals CHW/Dominican – largest Sutter Maternity & Surgery Watsonville – for profit

ThreeTwo competing medical groups

Physicians Medical Group – IPA Sutter/Santa Cruz Medical

Foundation Dominican Medical Foundation (July

2007)

1995 IPA partnered with Axolotl Clinical Messaging 2000 web-based expansion private physicians 2004 County clinics including mental health 2005 Community Health Centers

Innovation: Clinical Messaging

A Health Information Exchange?

Innovation: EMR Adoption (40%)

Private practices (2000) Dominican Hospital Cerner (2006) Santa Cruz Medical Foundation Epic

(2007) County Clinics Epic (2006) “Threw Public Health off IT bus”

Collaboration: HIP

Health Improvement Partnership Founded in 2003 (CAP grant) Incorporated in 2005 Public-private collaboration of health care leaders Common ground issues in competitive

environmentAccomplishments

Healthy Kids (98% children Santa Cruz County) Project Connect (Frequent ED Users 54% ) Diabetes IOM Invitation (Jan 2004)

Vision – January 2004• Expand current IPA diabetes point of

care registry to ALL providers• Test point of care registry 1st step

EMR• Build community-wide databaseOutcomes:• Higher standard of care consistent

across the County• Track diabetes population in the

aggregate

Build on strong history of collaboration and innovation!

Dr Wells Shoemaker

Name of handshake collaborative.

AHRQ Grant: Santa Cruz County, CA Diabetes Mellitus Registry (DMR), 2004-2007

Reality - September 2007

Project History 2004 - 2005

Project History 2006 - 2007

Lessons Learned Collaboration

Build trust requires neutral entity Business proposition before governance

Legal Point of Care Registry built on certifying

“provider relationships” Not legal basis for building community-

wide registry Adoption

EMRs = Point of Care X resources

Lessons Learned: Technology Technology

Complexity of: Obtaining multiple sources of data (CMS) Combining multiple sources of data Patient matching (MPI) Adapting internal tool for community usePositive Outcome: Public Health back on bus -- 2006

InfoLinks Project (RWJF) Driver?….

Lessons Learned: ValueRanking*1. Action Reports for individual providers (turf

wars)2. Community Database for Population Health3. Community Patient Lookup4. Performance Reports with Benchmarks5. Performance Reports for Payers 6. Point of Care Tool7. Care Management Tool*Results from October 2006 Business Case Survey (n=12)

Population Health Moves Up

Santa Cruz County Health Services Agency willing and accepted as neutral public entity

Value in community with commitment to collaboration to improve health status County, HIP, Foundations $$ Hospitals funded Community

Assessment Survey x 10 years

Benefits of Population Health Focus

EMRs are friends not foes Demographics (language, residency)

Identify Inequities Point of care (smoking, weight, BP)

Identify pre-morbid conditions Example: pre-diabetes

Integration of Public Health and Clinical Care

Next Steps Planning Community Disease Registry

Requirements (Population health +) Integrating public health & clinical care Due Diligence on technology Refine Value Propositions

Pilot Project – demonstrate & evaluate Wait for EMR adoption before

community-wide implementation (60%?) Support EMRs in community health

centers and small private practices

Chicken or Egg? Is there a value proposition for a

disease registry as a first step to health information exchange?

OR Is the value proposition for

health information exchange that includes a disease registry?

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