1. Presented By William F Pilkington CEO, Cabarrus Health Alliance at the Public Health Data Standards Consortium November 4, 2010 REAL WORLD Learning from Beacon Community on EHR Adoption

2. Beacon Project Office of the National Coordinator (ONC) awarded $15.9 million to SPCCP in May 2010 One of 15 original awards nationwide Program for communities to build and strengthen their health IT infrastructure and exchange capabilities, to demonstrate the vision of a future where hospitals, clinicians, and patients are meaningful users of health IT, and together the community achieves measurable improvements in health care quality, safety, efficiency, and population health

3. Readmissions and ED Visits Diabetes Congestive Heart Failure Population Health Meaningful Use Beacon Measures

4. SPCCP Overview SPCCP is the collaboration of healthcare providers and community agencies to increase the access and quality for the Medicaid recipients and the dually eligible Medicaid/Medicare recipients in Cabarrus, Rowan and Stanly counties. In addition to assisting the Medicaid clients of its counties, SPCCP also has a program for the uninsured in Cabarrus County. The Community Care Plan (CCP) is designed to provide access to routine healthcare, early intervention and remediation of disease conditions, access to dental care, and mental health services for the uninsured indigent.

5. Beacon Community Partners Two large hospital systems – Carolinas Healthcare System, Novant Health Three county health departments – Cabarrus Health Alliance, Rowan County Health Department and Stanly County Health Department Three large practices groups – Cabarrus Family Medicine, NorthEast Partners, Stanly Medical System

6. Beacon Community Partners (cont) Community Care of NC Informatics Center Duke University School of Medicine North Carolina Comprehensive Assessment for Tracking Community Health (NC- CATCH), UNC- Charlotte NC Institute of Public Health, UNC Gillings School of Global Public Health Cecil G. Sheps Center for Health Services Research, UNC – Chapel Hill

7. $2 billion for clinical system meaningful use Public Health IT

8. Lack of visibility for public health in HIT reform Goals for public health reductions in diabetes, obesity, etc. do not equate the clinical goals 50-year food and dietary surplus will not change in the 30-month Beacon period Public Health Issues

9. http://onc-chpl.force.com/ehrcert The vast majority of ONC certified systems are not addressing core public health –Only one system addresses demographics –A large majority ignore surveillance Suggestion: advocate now that Stage 2 criterion do not make public health data needs optional Public Health and Meaningful Use

10. Establish a standard, core set of public health outcome measures and data requirements Develop HIE standards/services to enable the sharing and reporting of communicable and chronic disease information Develop standardized assessment protocols (using the core set of public health outcomes measures) to evaluate the impact of healthcare interventions on community health Clarify public health’s healthcare, disease management, and prevention role and how these do/should compliment role of other healthcare Possible Public Health Phase II Priorities

11. Enhanced Privacy and Security Control Physical and System Access Monitor Workstation Use and Security Audit access and need-to- know Enhance Device and Media Controls Employ Transmission Security

12. EHR Considerations Advantages Improve quality of care Cost reductions Promote evidence-based medicine Record-keeping and mobility Disadvantages Cost Time

13. Stanly County, N.C. Department of Health One EHR does not fit all – each health department functions differently and the ability to select an EHR accordingly is important Reporting functions should be easier and quicker for custom reports (since not required to go through the State HIE system) Assess fees carefully: –Since we are not currently a batch county, there will be a fee to convert to a batch process and a yearly fee to support the interface between our EHR and HIE –Beyond the required support fees for an EHR, there are other support fees for other hardware requirements (storage, servers, etc.)

14. Cabarrus Health Alliance Business process re-engineering is essential. You need a provider champion. Know your business constraints. Know your partners and how their decisions will affect your implementation. Health Information Exchange: Know which data you want to exchange with whom

15. William F Pilkington CEO Cabarrus Health Alliance The Public Health Authority for Cabarrus County ppilkington@cabarrushealth.org (704) 920-1203 Contact