1. Realizing the Benefits of Health IT For CHCs November 8, 2005 Ralph Silber, MPH, CEO Community Health Center Network 1320 Harbor Bay Parkway, Suite 250 Alameda, CA 94502 www.chcn-eb.org

2. 2 Asian Health Services Axis Community Health La Clinica de La Raza LifeLong Medical Care Native American Health Center Tiburcio Vasquez Health Center Tri-City Health Center Our Community Health Centers

3. 3 Sex% Male37 Female63 Age% <1529 15-2416 25-3414 35-4412 45-5411 55-648 65+10 Race/Ethnicity% Asian24 African-American9 Latino51 Native American2 White10 Other4 Payor% Uninsured41 Medi-Cal34 Medicare9 Healthy Families3 Private Insurance12 Patients with Chronic DiseasesN Cardiovascular Diseases11,717 Diabetes5,499 Demographics of CHCN Patients*, 2003 (N=92,054) * Patients with 1 or more encounters

4. 4 The Evolution of Clinical IT Community Health Center Network Managed Care MSO-Quality Improvement E-prescribing Hospital Connectivity Data Integration Products Electronic Health Records Chronic Disease Management Registries Practice Management System Support Clinical Measures Data Warehouse P4P

5. 5 CHCN Development of IT Solutions Development of CHCN IT Projects to drive efficiencies and improve patient outcomes –Ezcap Managed Care System –Data Warehouse (all encounters from 1999; lab results from 2000) –Merritt Practice Management: 4 health center collaboration in a single data center –Disease registries –Web Portal as the CHCN “Virtual Home” –E-Checker to electronically check eligibility –One-E-App: One stop application for health programs –Participation in CALINX Lab Standard Development –Data Access to County Health System (ACMC)

6. 6 Clinical IT CHCN’s Vision of developing of Clinical IT “savvy” organizations –Systemic approach towards needs assessment, business analysis, operational impact –Context of rapidly changing market and technologies Support by Tides Foundation and CHCF Outcomes so far: –Central CIT Council and “Local” committees –Educational efforts (e.g. modular approach (chronic disease management systems) with Integration Engine vs. E.H.R.) –Developing an organized approach to decision-making –Pilot projects Upcoming –By the end of year, recommendations on direction of CIT development and the degree of collaboration Noteworthy Observations –With the evolving market, we have come to appreciate the difficulty in selecting a cost-effective solution to our needs –Complexity of integrating data across disparate systems

7. 7 Clinics on different practice management systems We wanted to work with what we had and keep it simple and inexpensive We can look at the quality of care for all our patients We believe that measuring quality makes a difference We had already organized efforts to improve care for patients with diabetes and asthma; smoking as a vital sign Why a Data Warehouse and Clinical Measures Approach?

8. 8 Medical Directors select clinical measures and agree on methodology Extract data from data warehouse Chart reviews Analyze data by insurance status, ethnicity, and clinic Compare our data to state and national benchmarks P4P How We Do It

9. 9 Percentage of Diabetics with 1 or More HbA1c Tests, 7/1/03-6/30/04 Percent

10. 10 Frequency of 1 or More HbA1c Tests by Demographics and Insurance Coverage, CHCN, 2001 % of Patients with 1 or More HbA1c Tests, 10/1/00 to 9/30/01 Ethnicity/Race Insurance Coverage

11. 11 Prevalence of Asthma Controller Medication Use by Clinic and Patient Demographics, CHCN, 7/1/02 to 6/30/03 % of Patients with Documented Controller Medication Based on 338 patients with 3 or more ICDs of 493, 4 or more pharmacy claims for an asthma medication, or 1 or more asthma hospitalizations (7/01/01 to 6/30/02) and not classified as “mild intermittent” asthma in medical chart Ethnicity/Race Medication Use Averages

12. 12 Prevalence (%) of Asking Adults about Tobacco Use During 1 or More Encounters, CHCN, 2002 - 2003 Percent

13. 13 Age-Adjusted* Prevalence (%) of Obesity (BMI > 30) in Adults, CHCN, 2003 Percent * Adjusted to the 2000 US Population Standard