doug smith, m.b.a

Community Community Partners Partners

HealthNetHealthNetReducing Risk and Enhancing Reducing Risk and Enhancing

Results Through Network ModelsResults Through Network Models

HRSA IT ConferenceHRSA IT ConferenceNovember 5, 2007November 5, 2007

Doug Smith, CEO/CIO

Community Partners HealthNet Data Center

MembersMembers First Choice CHCFirst Choice CHC Greene County Health CareGreene County Health Care Hudson River HealthcareHudson River Healthcare Kinston Community Health CenterKinston Community Health Center NC Office of Rural HealthNC Office of Rural Health Nuestra ClinicaNuestra Clinica Robeson Health Care CorporationRobeson Health Care Corporation Stedman-Wade Health ServicesStedman-Wade Health Services Tri-County Community Health CenterTri-County Community Health Center

CPH Mission StatementCPH Mission Statement

““Community Partners HealthNet, Community Partners HealthNet, through shared resources, serves through shared resources, serves the participating community health the participating community health centers in their commitment to centers in their commitment to provide quality, accessible provide quality, accessible healthcare to the populations in healthcare to the populations in underserved areas.”underserved areas.”

Major Goals of CPH, ICT Pilot Major Goals of CPH, ICT Pilot ProjectProject

EHR/clinical data EHR/clinical data repository/clinical outcomes.repository/clinical outcomes.

Integrated IS services for CHCs Integrated IS services for CHCs and RHCs.and RHCs.

Web portal/distance learning, Web portal/distance learning, teleconferencing.teleconferencing.

Web communityWeb community

PerspectivePerspective

Medicine used to be simple, Medicine used to be simple, ineffective, and relatively safe.ineffective, and relatively safe.

Now it’s complex, effective, and Now it’s complex, effective, and potentially dangerous.potentially dangerous.

Sir Cyril Chantler, MDSir Cyril Chantler, MD

Solution: Redefining Solution: Redefining Health CareHealth Care

ResultResultss

CostsCosts

Based on Porter & Teisberg, 2006

Value =

Information Hierarchy

Patient Results

Experience

Methods

Patient Attributes

Clinical outcomes Risk adjustment Cost of care

Processes Protocols JCAHO focus

Skill efficiencyDemographics Co-occurring conditions Genetic makeup

Categories Of Practice Categories Of Practice Improvement From EHR Improvement From EHR

UsageUsage Administrative Administrative

processes/productivityprocesses/productivity Quality of clinical careQuality of clinical care Information managementInformation management

Within community health Within community health organizationsorganizations

With outside organizationsWith outside organizations

Examples: Cost/Benefit Examples: Cost/Benefit to CHCsto CHCs

1. Improved patient care.1. Improved patient care.2. Reduced transcription costs 50%-100%.2. Reduced transcription costs 50%-100%.3. 10% decrease in FTE’s needed per 3. 10% decrease in FTE’s needed per

provider. provider. (1)(1)

4. 15% increase in patient visits per 4. 15% increase in patient visits per provider. provider. (1)(1)

5. Process redesign savings (see work at 5. Process redesign savings (see work at Johns Hopkins Medical System).Johns Hopkins Medical System).

(1) Linda Zdon & Blackford Middleton, Ambulatory Electronic Records (1) Linda Zdon & Blackford Middleton, Ambulatory Electronic Records Implementation Cost Benefit: An Enterprise Case Study.Implementation Cost Benefit: An Enterprise Case Study.

Examples: Cost/Benefit Examples: Cost/Benefit to CHCsto CHCs

6. Decreased ordering of lab tests. 6. Decreased ordering of lab tests. (2)(2)

7. 33% reduction in Medicare 7. 33% reduction in Medicare disallowance of tests ordered. disallowance of tests ordered. (2)(2)

8. 37% - 50% decrease in days 8. 37% - 50% decrease in days accounts receivable. accounts receivable. (2)(2)

9. Space and supplies savings.9. Space and supplies savings.

(2) GAO: Information Technology: Benefits Realized (2) GAO: Information Technology: Benefits Realized for Selected HealthCare Functions, Oct. 2003.for Selected HealthCare Functions, Oct. 2003.

Benefits of Network Benefits of Network ImplementationImplementation

Economies of scale/cost efficiencyEconomies of scale/cost efficiency Volume (licensing discounts, Volume (licensing discounts,

more experienced trainers etc.)more experienced trainers etc.) Higher performanceHigher performance Sharing of expertise among Sharing of expertise among

collaboratorscollaborators Critical mass/business leveraging Critical mass/business leveraging

(i.e. discounted pricing)(i.e. discounted pricing)

Lab

Hospital

EHR&

Disease Mgmt.

PMS Acct

HR

Dental EHR

Limited Interface

Sample CHC IS Sample CHC IS InterfacesInterfaces

MARP

Mental Health EHR

Lessons LearnedLessons Learned Staff involvement in planning process.Staff involvement in planning process. Reasonable implementation Reasonable implementation

timeframe.timeframe. Adequate training including provider-Adequate training including provider-

to-provider training.to-provider training. Workflow redesign is critical for Workflow redesign is critical for

achieving efficiencies.achieving efficiencies.

Lessons LearnedLessons Learned

Well done is better than well said.Well done is better than well said.

Benjamin FranklinBenjamin Franklin

CPH Network Schematic

Data Warehouse Application Servers Citrix Servers

CPH

Co-Location Facility

FCCHC

TCCHC

SWHS

RHCC

GCHC

Internet Connection

Internet Connection

Internet Connection

Internet Connection

Fiber Connection

Internet Connection

Exact Replica of Servers Above

KCHC NCCHC

NCORHCC Internet Connection

Internet Connection

Internet Connection

Simplified Design of Data Simplified Design of Data Transfer/TransformationTransfer/Transformation

Creates views, groupings, and events Henry Schein Medical System has already added additional functionality to Micro MD EHR to create views, groupings (e.g. diabetics, CVD, etc.) and events (e.g. 2 BPs in last year). This data is exported to the transformation server in the data warehouse, which populates the Cognos Catalog and the data cube.

Data Warehouse

Transformation OLAP CubeServer

Cognos Catalog

SQL Server

Micro MD EHR Database

Micro MD EHR Warehouse

Uses of DataUses of DataTracking clinical outcomes and process measures, feedback to Medical Director and providers for QI purposesAdvocacy, state and federal lobbying (UDS & EHR)Grant reportingBoard reportingMarketing to other stakeholders – JCAHO, hospitals, MCOs, etc.Policy researchMore reports

Community PartnersCommunity Partners HealthNetHealthNet HbAlc Test Range For Diabetes Patients Last HbAlc Test Range For Diabetes Patients Last Year Date: 9/28/06Year Date: 9/28/06

GCHCGCHC

Race: BLARace: BLA Total number who had HbA1c test: Total number who had HbA1c test: 268268

HbA1c test result range: HbA1c test result range: 7.0 or 7.0 or lessless

Number of patients: Number of patients: 153153 Percentage: Percentage: 57.09%57.09%

HbA1c test result range: HbA1c test result range: 7.0-7.97.0-7.9 Number of patients: Number of patients: 8585 Percentage: Percentage: 31.72%31.72%



HbA1c test result range: HbA1c test result range: 9.9 or 9.9 or moremore


Race: HISRace: HIS Total number who had HbA1c test: Total number who had HbA1c test: 125125








Race: WHIRace: WHI Total number who had HbA1c test: Total number who had HbA1c test: 120120








Community Partners HealthNet, Inc.

email: [email protected]

http://www.cphealthnet.org

301 Martin Luther King Blvd. (252) 747-8162Post Office Box 658 Fax (252) 747-8163Snow Hill, NC 28580-0658 Cell (252) 526-8325

mailto:[email protected]

http://www.cphealthnet.org/

doug smith, m.b.a

Health & Medicine