1. Memphis, TN Thomas Duarte, Executive Director, MSeHA

2.  501(c)3 organization serving the Memphis area of ~1.1 million citizens  25% of Shelby County citizens are at or below the poverty line  Began as a TN funded planning project in August 2004  Awarded an AHRQ Regional Demonstration contract, Sept 2004  Received additional funding from the State of Tennessee MSeHA Background

3.  5 year grant  MSeHA to accomplish in years 1-3:  Data sharing  Interoperability  Documentation of lessons learned  MSeHA to accomplish in years 4-5:  Evaluate the impact on patient treatment and care AHRQ Grant

4. MSeHA Participants  Board was formed in 2005  Baptist Memorial Health Care Corporation (5 facilities including MS)  Methodist Healthcare including Le Bonheur Children’s (7 facilities)  The Regional Medical Center (The MED)  St. Francis Hospital (2 facilities)  St. Jude Children’s Research Hospital  Christ Community Health Clinics (4 facilities)  Shelby County/Health Loop Clinics (11 facilities)  UT Medical Group (400+ clinicians)

5.  Participants identified data elements and agreed to provide clinical and demographic information from inpatient, outpatient and ER encounters  Began in the ER and expanded to include hospitalists and ambulatory sites  No minimum data sets  Participants encouraged to send what they could Early Planning

6. Why the Emergency Department?  Access to data  Ability to impact patient treatment and care  Reduce duplication of tests  Potential to show ROI  Use data to gain sustainability model

7. Data Obtained  Data feeds include IP, OP, ER and Claims information  Data includes:  Patient identification and demographics  Lab results  Encounter data  Medication history (claims)  Dictated reports:  Discharge, imaging, cardio, H&P, Diagnostic codes, etc.  Allergies

8. Data Summary Since May 2006  Patient medical record numbers = 1.14 million  Patient records with clinical data = 874,000  Total records with ICD-9 codes & clinical data = 915,000  Number of text reports:  Imaging = 2.41 million  H&P = 3.35 million  Discharge Summaries = 87,483  Anatomic Pathology = 314,365  Patient encounters/month = 151,910  Clinical lab results/month = 2.97 million

9. How It Happened  Participant costs: ~ $25-35K/year/site (less for subsequent sites)\  Participant resources:  IT staff  Internal QA  Commitment to NOT let the MSeHA interfere with participant initiatives  CEO commitment and champion for RHIO/HIE  Implementation support (Vanderbilt Center for Better Health)  Signing up users  Training/support/site management  Privacy & security  Establishment of “Work Groups”

10.  Make the data easily accessible and secure  Provide ease of search for patients Lessons Learned

11. Lessons Learned - Usability  Provided standardized mapping of lab results (LOINC) to aggregate clinical data from multiple participants

12. Focus  Get the participants to the table  Begin with a narrow focus  Identify data where there is agreement on  Focus on policies and procedures for a single use of information  Diagnosis and treatment  Create a flexible system that can be used in different workflows  Take as much data as you can you may need it later  Early wins are possible  Site visits for feedback, issue resolution and system usage

13.  14 hospital ER’s  Hospitalists in 3 health systems  4 primary care Safety Net clinics  11 primary care Safety Net/Public Health clinics MSeHA Today

14. Sustainability  Obtain funding  Identify population segments that will benefit from implementation  Demonstrate the benefits  Identify the potential customers  Benefits to payors, employers  Disease management  Specific populations  Pain management  Workman’s comp.

15. MSeHA Goals & Focus  Improve outcomes  Reduce hospitalizations  Eliminate unnecessary diagnostic tests  Reduce ER visits  Control costs  Have greater PCP involvement

16. MSeHA Evaluation Goals  Improve the quality of care by improving access to data at point of care  Demonstrate the impact of the MSeHA in the ED  Demonstrate how the MSeHA improves community healthcare delivery

17. Stakeholder Drivers  Incomplete information increases admission rates and length of stay  Lack of data impacts ED efficiency and ambulatory care  Incomplete data at point of care impacts test ordering  Incomplete data at point of care impacts clinical outcomes