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Memphis: Year 5 Report State and Regional Demonstration Projects: 05/14/22 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September, 2009 Mark Frisse, reporter

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Page 1: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 2: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 3: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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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Page 4: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 5: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 5

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

Page 6: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 7: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 8: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 9: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 10: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

Record locator services

04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 10

Page 11: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

A lot like the first transistor radio..

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Page 12: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

LOINC: an example

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Page 13: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

Medication hub

© 2009, Mark Frisse 13

Page 14: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 15: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

04/10/23 Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 15

Page 16: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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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Page 17: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

Potential: surveillance

© 2009, Mark Frisse

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Page 18: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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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Page 19: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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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Page 20: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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

Page 21: Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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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