Memphis, TNThomas Duarte, Executive Director, MSeHA

501(c)3 organization serving the Memphis area of ~1.1 million citizens 25% of Shelby County citizens are at or below the poverty line Began as a TN funded planning project in August 2004 Awarded an AHRQ Regional Demonstration contract, Sept 2004 Received additional funding from the State of Tennessee

MSeHA Background

5 year grant MSeHA to accomplish in years 1-3:

Data sharing Interoperability Documentation of lessons learned

MSeHA to accomplish in years 4-5: Evaluate the impact on patient treatment and care

AHRQ Grant

MSeHA Participants

Board was formed in 2005 Baptist Memorial Health Care Corporation (5 facilities including MS) Methodist Healthcare including Le Bonheur Children’s (7 facilities) The Regional Medical Center (The MED) St. Francis Hospital (2 facilities) St. Jude Children’s Research Hospital Christ Community Health Clinics (4 facilities) Shelby County/Health Loop Clinics (11 facilities) UT Medical Group (400+ clinicians)

Participants identified data elements and agreed to provide clinical and demographic information from inpatient, outpatient and ER encounters

Began in the ER and expanded to include hospitalists and ambulatory sites

No minimum data sets Participants encouraged to send what they could

Early Planning

Why the Emergency Department?

Access to data Ability to impact patient treatment and care Reduce duplication of tests Potential to show ROI Use data to gain sustainability model

Data Obtained

Data feeds include IP, OP, ER and Claims information Data includes:

Patient identification and demographics Lab results Encounter data Medication history (claims) Dictated reports:

Discharge, imaging, cardio, H&P, Diagnostic codes, etc. Allergies

Data SummarySince May 2006

Patient medical record numbers = 1.14 million Patient records with clinical data = 874,000 Total records with ICD-9 codes & clinical data = 915,000 Number of text reports:

Imaging = 2.41 million H&P = 3.35 million Discharge Summaries = 87,483 Anatomic Pathology = 314,365

Patient encounters/month = 151,910 Clinical lab results/month = 2.97 million

How It Happened

Participant costs: ~ $25-35K/year/site (less for subsequent sites)\ Participant resources:

IT staff Internal QA

Commitment to NOT let the MSeHA interfere with participant initiatives CEO commitment and champion for RHIO/HIE Implementation support (Vanderbilt Center for Better Health)

Signing up users Training/support/site management Privacy & security

Establishment of “Work Groups”

Make the data easily accessible and secure Provide ease of search for patients

Lessons Learned

Lessons Learned - Usability

Provided standardized mapping of lab results (LOINC) to aggregate clinical data from multiple participants

Focus

Get the participants to the table Begin with a narrow focus Identify data where there is agreement on Focus on policies and procedures for a single use of information

Diagnosis and treatment Create a flexible system that can be used in different workflows Take as much data as you can you may need it later Early wins are possible Site visits for feedback, issue resolution and system usage

14 hospital ER’s Hospitalists in 3 health systems 4 primary care Safety Net clinics 11 primary care Safety Net/Public Health clinics

MSeHA Today

Sustainability

Obtain funding Identify population segments that will benefit from implementation Demonstrate the benefits Identify the potential customers Benefits to payors, employers

Disease management Specific populations Pain management Workman’s comp.

MSeHA Goals & Focus

Improve outcomes Reduce hospitalizations Eliminate unnecessary diagnostic tests Reduce ER visits Control costs Have greater PCP involvement

MSeHA Evaluation Goals

Improve the quality of care by improving access to data at point of care Demonstrate the impact of the MSeHA in the ED Demonstrate how the MSeHA improves community healthcare delivery

Stakeholder Drivers

Incomplete information increases admission rates and length of stay Lack of data impacts ED efficiency and ambulatory care Incomplete data at point of care impacts test ordering Incomplete data at point of care impacts clinical outcomes