HRSA Health Disparities Collaboratives: Framed Using Doug Engelbart’s Idea of Networked Improvement Communities Presentation at the “People-Centered Internet” Workshop: Beginning a network of networks @ Stanford, Oct 24-25, 2015 In the context of striving for “Digital Dividends for All” For Wiser Use of Information-Communications-Technology (ICT) Ahmed Calvo, MD, MPH, Director, National Health Leadership and Public Service Fellowship Haas Center for Public Service, Stanford University Medical Officer, Health Resources and Services Administration U.S. Department of Health and Human Services Ahmed Calvo

Key Foundational Definitions Doug Engelbart – concept of “networked improvement communities” – co-evolving improvement of IT systems and human systems – “Augmented Intelligence” (AI) concept in Augmentation Research Center laboratory at SRI International (Stanford Research Institute) – and of “bootstrapping” as a network/center start-up method. FQHCs (Federally Qualified Health Centers) – sites of Community Health Centers (CHCs) ~ 9,000 FQHCs with active patient volume of ~ 23 million patients and over 90 Million patient visits – 170,331 staffers (2014 UDS numbers). Funded by HRSA (Health Resources and Services Administration) – an agency in the US Department of Health and Human Services (HHS). Ahmed Calvo

Breakthrough Series (BTS) Collaborative Model Drawing on a napkin by Paul Batalden 20 years ago – from Don Berwick, Institute for Healthcare Improvement (IHI) Ahmed Calvo

Identify Change Concepts Rudimentary ICT Supports HRSA Health Disparities Collaboratives added ICT support to learning process – as key needed infrastructure (1998) Participants Select Topic Pre-work Time for setting aims, allocating resources, preparing baseline data leading to the first 2 day meeting. Identify Change Concepts P P A D A D S S Planning Group LS 1 LS 2 LS 3 Action period 1: Adapt and test the ideas for improved system of care Action period 2: further develop the system of care at the pilot site and spread the system to other sites Rudimentary ICT Supports E-mail Visits Phone Assessments Senior Leader Reports Ahmed Calvo 4 4 4

Evolved Perspective of the HRSA Health Disparities Collaboratives as a National Framework for Change (1998-2008) Evidence-Base Developed by Partners Establish National Agenda Small scale pilots for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base Pilots Identify Measures, Priorities Adapting Evidence Base-- BTS, Care Model, Model for Improvement Supporting National Learning Community For Best Practices Population Health Mgt. Registry Reporting Executing National Health Policy Partnerships National Vision For Healthcare Transformation National FACULTY Evolved ICT Infrastructure www.healthdisparities.net ° Regional Infrastructure ° www.hdnr.org ° Phone TA ° Monthly Measures and Senior Leader Reports ° National Faculty Consultants ° Topical Conference Calls/Webinars Ahmed Calvo 4 4 4

ICT and Policy Change Infrastructure at HHS for ACA Implementation – a National Collaborative Framework (2009-2015) Evidence-Base Developed by Partners (e.g. PCORI) ACA Passed (Affordable Care Act) Identify Measures, Priorities (NQF Contract) Small scale pilots and demonstrations for the purpose of developing the change package to facilitate rapid deployment of a new evidence-base and massive scale-up via CMMI at CMS CMS Pilots Community Adapting Evidence Base-- via foundations (private $$) Supporting National Learning Communities (Partnership for Patients) EHRs-HIEs Pop Health Mgt. Registries Reporting Analytics Nation’s NQS & NPS – With ONC Standards Incentives Going from Healthcare To Health - as a Vision Networked National FACULTY Further Adapted ICT Infrastructure ° National Leadership Network shifted to CMS ° State Infrastructure ° www.heathycommunities.org ° Link with QIOs ° National Measures Massive use of Webinars – and maybe shifting to MOOCs Ahmed Calvo 4 4 4

Lessons Learned Insights and experience no longer valuable only to the safety net (i.e. the FQHCs with which we first started: 5 CHCs – then thousands of FQHCs – with millions of patients) – there now was real interest in mainstream medicine – Medicare/Medicaid, pvt. It was particularly lucky to have Don Berwick be named Administrator of CMS to implement the Affordable Care Act (ACA) and change culture within CMS – and HHS – and with DOD, VA, etc. Ahmed Calvo

Lessons Learned Front office receptionists community of practice in a 24/7 beehive of communication (without having to ask permission of their CEOs to share/question) Tiered help-desk and ICT support (peer to peer; subject matter experts; national subject experts) Transparency of data and analysis: posting results in the front waiting area for patients to see; studies on the doctors by the front office; studies on the back office medical records by billing staff; etc. Ahmed Calvo

Lessons Learned 100 Million Healthier Lives Campaign Creating Wellbeing Leadership Group Collaborate.org Communities Joined in Action New Breakthrough Collaboratives (Foundations) Healthy Communities Collaborative for America and the AIMM Collaborative Ahmed Calvo

Closing Thoughts HHS CTO Susanna Fox NIH Digital Summit Monday 10/19/15: First wave: connecting documents (Google) Second wave: connecting people (Facebook) Third wave: connecting knowledge (Wikipedia) Can we connect empathy globally? (PCI ?) And how do we best bring in the youth perspective, enthusiasm, and engagement? Crowdsourcing; Apps; Buy-in Ahmed Calvo