1. Collaboration and IT Systems Linda M. Kinney, MHA Care Share Health Alliance Director, Collaborative Network Development Jennifer Tyner Program Manager Access II Care

2. Introduction Supersonic overview of national and state HIT Collaborative Networks’ need for linked IT systems Lessons learned from Communities Tools and Resources Questions and Answers

3. ARRA, HIT, HITECH, EMR, EHR, HIE…… American Recovery and Reinvestment Act (ARRA) of 2009 Authorized nearly $36 billion in funding for health information technology (HIT) infrastructure over 6 years. The majority of the funding ($34 billion) is set aside for incentive payments for Medicare and Medicaid for incentives to providers who: Adopt certified electronic medical records Demonstrate Meaningful Use of the medical records Provide data for quality reporting

4. ARRA, HIT, HITECH, EMR, EHR, HIE…… Health Information Technology for Economic and Clinical Health (HITECH) provides a framework for how this HIT funding is to be spent. HITECH has 3 major components: 1.Wide adoption of Electronic Medical Records (EMR) 1.Establishment of interoperable systems for health information exchange (HIE) 1.Aggregate data reporting (individual and population)

5. ARRA, HIT, HITECH, EMR, EHR, HIE…… Meaningful Use – federal standards for using EMRs to: Improve clinical care Reduce medical errors Control health care costs Providers will receive incentives to implement meaningful usage through the use of EMRs by 2014, and reduced reimbursement if not in place by 2015 Electronic Health Record (EHR) – contains a subset of information from several health delivery organizations – pulls information from EMRs – to create a cohesive patient record

6. ARRA, HIT, HITECH, EMR, EHR, HIE…… Health Information Exchanges (HIE) are national/state/regional technologies that allow for exchange of health information between providers and other exchanges. Has a master patient index – so a patient has one record with multiple providers contributing (EHR) Information can be exchanged across HIEs as the patient moves from community to community… Patients have access to their EHR/EMR – potential for Personal Health Records (PHR) to connect as well

8. Electronic Health Record Electronic Medical Record Health Information Exchange Health Information Exchange (HIE)

9. John W. Loonsk, MD FACMI

10. Some Things That May Be Available From HIEs Clinical data EHR Utilization data Information about patients seen outside of your network Quality measures Referral management

11. Some information Collaborative Networks need from and IT system A way to count things specific to your network – with the partners you have at the table – Unduplicated patients across providers – the holy grail Patients enrolled in the network and for specific programs – enrollment data Utilization data – visits (by provider) and service (by type: medications, medical visits, ER visits, ….) including community, social, supporting services Quality measures – disease management measures, others Demographic and screening information for patients enrolled in network/programs – that everyone in the network can access Referral Management – where was it made, by whom, and did the patient receive a service Value of services – claims data and other – helps with return on investment measures

12. Some Features to consider as you look for a system Allow you to easily screen patients for eligibility in your network, Medicaid, and other insurance programs – health insurance exchanges in the future Allow you retain the information you gather from the screening Enroll patients in multiple programs (network being one, then other programs) Referral management Track utilization across providers Ability to REPORT ON YOUR OUTCOMES Ability to connect to HIEs in the future – you’ll need some kind of EHR or.. HIPAA compliant

13. Things to Keep in Mind as you look for a system The HIT/HIE world is still under construction – there are many unknowns Minimize duplication of features that may be more robust through EMR/HIEs – ie: clinical data Your partners IT systems are the building blocks for the Collaborative’s system. Connect partners to resources: NC AHEC Extension Center NC Medical Society Foundation – loan repayment program You will need a system or process to manage the Collaborative’s work Your system needs to connect to future systems – will need an EHR

14. Lessons Learned

15. Capital Care Collaborative (Wake County) IT systems are about people and relationships – it’s collaboration Buy-in is essential – communication is key, involve partners The legal documents are a foundation – you can’t move ahead without them Pay for what you need. Define the outcomes you will use to measure progress at the start.

16. Capital Care Collaborative (Wake County) Plan tangible milestones, and keep them coming every four to six months. You need a translator. Triple the timeline. IT is not a magic bullet

17. As you prepare for a linked IT System consider these factors… Legal costs, to build the “foundation” of documents Consulting, to acquire technical expertise and “translator” skills Staff time, from CCC personnel and partner organizations alike

18. What can you do to prepare Put agreements in place: -Patient authorization, Business Partner Agreements, data usage, etc… Map out the patient flow: -How do patients navigate the system now? What do you want it to look like? Determine your business process and the data you need to collect: -driven by your outcomes!!!! Focus on your assets: -Utilize the resources you currently have at your disposal

19. Jennifer Tyner Access II Care

20. Now What? Where are you now? Where do you want to be? What do you need to do to get there?

21. Just START! SSet Goals, Objectives, Measures T Technology Subcommittee AAct R Remember the Patient TTime is Now Health Care Reform Clock is Ticking

22. Technology as a Roadblock to Collaboration Common for collaborations to stall, as we believe we have to have connected IT to start Fantasy of achieving “single entry” system Rapidly changing HIT/HIE environment Implementing IT before understanding workflow Implemented IT does not deliver as promised $$$$ always causes problems!!!! Easy to lose sight of original goal—patient care does not remain the focus

23. What can you do today? Establish Shared Goals (and don’t lose sight of them!) Determine Collaborative Specific Objectives Set Target/Performance Measures Identify Data and Reporting Needs Assess What is Available TODAY for Sharing, Collecting, and Reporting Data Establish Legal Relationship to Share this Information Let IT Committee Work on technology plan

24. Using What You Have Data We all have it!!!! Database(s) Purchased software Homegrown Free products - CMIS, MARP, others Office Software Spreadsheets Internet If you don’t have, this should be #1 priority Data Czar Identify one entity to be responsible for collecting shared information

25. IT Tools for Collaboration google sites – free: https://sites.google.com/site/transcwp/https://sites.google.com/site/transcwp/ Meetingwizard.com – free: See Handout for others

26. Questions?

27. Linda M. Kinney, MHA Care Share Health Alliance Director, Collaborative Network Development lkinney@CareShareHealth.org (919)861-8356 Jennifer Tyner Program Manager Access II Care jtyner@accessiicare-wnc.org (828)259-3879 ext 306 Thank You!

28. Links To Resources National Coordinator for Health Information: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__home/1204 NC HIT website www.ncdhhs.gov/healthIT North Carolina Healthcare Information & Communications Alliance, Inc. (NCHICA) www.nchica.org WNC Health Link (HIE) www.wnchn.org AHEC Extenstion Center www.ncahecrec.net NC Medical Society www.ncmedsoc.org/practice_management/hit.html Capital Care Collaborative www.wakedocs.org/CapitalCareCollaborative.html