The Learnings of a National Health IT Collaborative Presented to the Institute of Medicine (IOM) By: Abby Sears CEO of OCHIN April 8, 2014

Who is OCHIN?

As a nonprofit organization, healthcare innovation organization designed to promote access to quality, affordable healthcare for all. Who is OCHIN? One of the nation’s largest and most successful Health Information Networks In 18 states, coast-to-coast Touching over 4,500 physicians

Any member of the healthcare continuum requires equal access to the next generation of integrated healthcare delivery We have a history in underserved populations, Federally Qualified Health Centers, Mental/Behavioral Health, Public Health Agencies, Rural Health Clinics, and Critical Access Hospitals Who We Serve

What We Do: Breadth and Depth

What Makes Us Different?

8 Community Organizations Community Members Integrated Delivery System Community Practice Health Information Organization Academic, Foundation, and Data Partners Federal Agencies State Public Health COMMUNITY FOCUSED: Governance Engagement Standards & Trust Analysis Dissemination The Community as a Learning System The Community as a Learning System; The National Committee on Vital and Health Statistics, 2011

Member Engagement Along the Adoption Curve

Barriers and Opportunities to New Technologies: Clinical Practice changes via technology

Data and Privacy policies need updating Healthcare is highly regulated environment Varied business requirements of different clinical domains and requires time and commitment to capturing the data Payors and Federal agencies have different data needs and requests Challenges of small practices with little to no IT support Economic issues of running small practices Change Fatigue – so many environmental demands at one time The obstacles are numerous and are challenging to resolve

Rules at the federal and state level: New rules for technologically sharing data for integration of behavioral and mental health and more – Alcohol and drug data is protected from other clinicians – Family Planning data – Sharing of immunization data across state lines – Different narcotic prescription rules by state Increased support in the field – Especially for small practices, clinics with 1-10 providers Lack of sophistication, staff, funds, interest – They want the help, but have neither the infrastructure, nor the financial support, to get it – “what is useful” functionality continues to be unclear – Larger practices do this in-house Changes Are Necessary: Policy and More

Adding Technology to “Canned” Solutions – Focus is on meeting regulatory requirements: PQRS, HEDIS, Meaningful Use and privacy concerns – Social determinants of health – HIE – Provider Directory issues – Major pieces of the software products still are working out the basics – Is it standard programming or customer…how does this impact future upgrades Off the Shelf Products: What can you do with them?

Technology Change Training/Documentation Data and reporting on utilization Needs to be in the workflow and lots of reinforcement and training – Alternative Payment methodologies – technology has been deployed but the workflows haven’t changed – Building more functionality than the physicians can accommodate – It takes time to reinforce new behaviors – Constant reinforcement by the environment with continuous education and support – Teach at every level in the clinic Change requires a three pronged approach

Payors are differentiating themselves on quality and cost – Need to pay for quality in a slow and incremental way that doesn’t hurt the providers but continues to encourage slow, gradual change – Pilot small projects that will look at new ways to pay for quality across the spectrum of providers – ask them to fund projects that bridge organizations – Look for reward programs Be willing to consider taking on some risk especially in small amounts – Look at PACE program of high risk Medicaid and Medicare patients for good opportunities Encourage the payors to agree on definitions of quality at the community or better yet at the state level – Ask to show improvement not an outcome or a target – How to use data to impact positive change needs to be part of all education requirements at Medical Schools Follow the money: Payors and Price

Peer to Peer knowledge sharing creates high leverage learning opportunities especially on a shared system - Sharing knowledge between practices and clinicians – Most clinicians want to have provide excellent quality – More focus at the medical associations – Send comparison data in non-threatening and learning environments to discuss why and what can change Look at the continuing education system for opportunities advanced knowledge Sharing and Celebrating the Achievers

Flexible vs non-flexible systems: – Flexible typically means the product is highly configurable which has a direct correlation to cost; manual staff resources to build and maintain – Lower cost systems tend to allow less customizability – Are we on different versions? – Did we buy the same hardware? – Are we in the same state? Are the regulations the same? – IP confidentiality and non-disclosure issues Sharing technology knowledge: Why can’t I or copy it?

There is no one answer, but there is an approach – build change packages Innovation at the clinic level – starts with physicians You need to invest, but you can’t do it alone Partnering with groups to build Look for shared learning opportunities help each other – Peer groups Capitalize on continuing education process Use Associations to support new legislation You get what you pay for in Health IT because of regulation requirements Requires a high touch approach Breaking Barriers: Innovation and Partnership

IPAs, safety net clinics, Regional Extension Center and Hospital Deployments to perform group purchasing and support Advocacy to improve legislation and policy to build; potential new legislation around CFR-42 More education programs to support more workforce Build an ongoing support mechanism for HIT investments by Foundations for social venture capital in products to help embedded change Success Stories

Thank You Abby Sears CEO of OCHIN OCHIN