1. 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 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

2. 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

3. 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

4. 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
Visits
Phone Assessments Senior Leader Reports
Ahmed Calvo 4 4 4

5. Evolved Perspective of the HRSA Health Disparities Collaboratives as a National Framework for Change ( )
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
° Regional Infrastructure ° ° Phone TA ° Monthly Measures and Senior Leader Reports ° National Faculty Consultants ° Topical Conference Calls/Webinars
Ahmed Calvo 4 4 4

6. ICT and Policy Change Infrastructure at HHS for ACA Implementation – a National Collaborative Framework ( )
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 ° ° Link with QIOs ° National Measures Massive use of Webinars – and maybe shifting to MOOCs
Ahmed Calvo 4 4 4

7. 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

8. 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

9. 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

10. 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