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HIE Community Meeting 5/2/2012
Topic Start Time Speaker
Food Available 6:00 pm
Welcome &
Introductions Around Table (brief) 6:30 pm
Kathy Ficco
Participants
Need for a Local Organization 6:45 pm Lori Sklar & Robert Moore,
MD
Stage 2 Meaningful Use 7:00 pm Elisa Ashton
Santa Cruz HIE 7:15 pm Bill Beighe
Workplan 7:40 pm Paul Alcala
Incubator Organization 7:55 pm Lyman Dennis
Proposed Dues 8:00 pm Lyman Dennis
Formation of a Not-for-Profit
Corporation 8:10 pm Lyman Dennis
Name of Community Group 8:15 pm-8:30 pm Suzanne Ness
Open Discussion 8:30 pm – 8:50 pm Participants
Agenda North Bay Regional HIE
St. Joseph Health System Paul Sampedro
HIE Program Director
Anna L. Shields
Executive Director Clinical Informatics Services & Information Systems
Kathy Ficco
Executive Director Community Health
We bring people together to provide compassionate care, promote
health improvement and create healthy communities
Northern CA Ministries:
• St. Joseph Eureka & Redwood Fortuna
• Queen of the Valley Napa
• Santa Rosa Memorial Hospital
• Petaluma Valley Hospital
Southern CA Ministries:
• St. Joseph of Orange
• St. Jude Fullerton
• Mission Viejo and Laguna Beach
• St. Mary’s Apple Valley
Texas:
• Covenant Health System
St. Joseph Health System (SJHS)
Health Information
Exchange
SRMH
Annadel Medical Group
PVH
Independent
Physicians Marin-Sonoma IPA
Home Health & Hospice
Community Clinics
Pharmacies
Labs Imaging Centers
St. Joseph Technology Overview
Patients
MEDITECH
Canopy
Care
Mgmt
PACS
Allscripts Homecare
eClinical
works
Allscripts
Enterprise Allscripts Pro/MyWay
HDH
SJHS is committed to a community healthcare strategy that
encourages the sharing of vital clinical data with our partners
SJHS Health Information Exchange (HIE) includes:
Results / Orders:
General Labs, Imaging Reports, Micros, Pathology
Transcriptions (Radiology & Discharge Summaries)
Multi-vendor solutions / Multiple Teams
Orders/Results: Forward Advantage Data Express
HIS: MEDITECH Client Server & Magic
Lab Outreach: Atlas Labworks/EMR (Covenant)
Integration: Sybase eBiz (Neon) Integration Engine
EMR Service Provider Hubs: Emdeon, Allscripts, & eCW
CCD Exchange: MEDITECH & Forward Advantage
Regional HIE Exchange Partners: NCHIN, RWMN and OC Connects
St. Joseph HIE Overview
SJHS Collaborative Efforts with
Cal eConnect funded HIEs
North Coast Health Information Network (NCHIN): St. Joseph Eureka exchanging orders and results across the Humboldt community
OC Connects: OCPHRIOs connection to exchange CCDs between the various hospitals in Orange County including four SJHS hospitals across the community
Redwood MedNet (RWMN): Connecting with RWMN to deliver results, orders and transmit CCDs across the Sonoma community
Summary
Identified alternate paths to support HIE data out to the community and accelerate deployment to practices
Mitigate risks to ensure redundancy / multi vendor alternatives
Maintain lead position in the use of new technologies and exchange approaches to stay in step with evolving environment
Meet or exceed Meaningful Use requirements
Extends our care beyond our hospital walls and into the communities and homes of the patients
Enhance the way people, processes and technology work together to create healthier communities
8
Thank you for your time! For more information, please contact:
Paul Sampedro
HIE Program Director
949-285-5289
Paul.Sampedro@stjoe.org
Anna L. Shields
Executive Director Clinical Informatics Services & Information Systems
(707) 525-5253
anna.shields@stjoe.org
Kathy Ficco
Executive Director Community Health
707-547-4652
Kathy.Ficco@stjoe.org
Need for a Local
Organization Lori Sklar
Robert Moore, MD
Why a Regional, integrated HIE?
Coordination
Economy of scale
Building on existing partnerships and
collaboration
Draft Mission
To improve quality of patient care and
cost-effectiveness of this care through
development of a Regional Integrated
Health Information Exchange.
To connect providers within the region
such that the right data, is available
for the right patient, at the right time,
in the right place.
Initial Goal
Develop an integrated plan for
accomplishing data exchange
Structure
Community Meetings
Coordinating Committee
Stage 2 Meaningful Use Elisa Ashton
Clinical Faculty, UCSF
California Department of Health and Human Services
Dignity Health
Santa Cruz HIE Bill Beighe
CIO
Physicians Medical Group of Santa Cruz
Board of Cal eConnect
Board of CalHIPSO
January 2012
Bill Beighe, CIO
CaleConnect BOD
CalHIPSO BOD
PMG & Santa Cruz County
Only IPA
Enjoy Excellent Relationship with Santa
Cruz Medical Society
◦ Many members in common
◦ Co-sponsor the Medical Society EHR Demo Day
for 3 years
◦ Collaborate on Health Improvement Projects
Collaborate on care with virtually all in the
community – Exchange is open to all
Sutter / PAMF has a large presence
Point to Point Interfaces $$$
Scanning/Faxing
Re-Keying
Data
Single Bi-directional Interface
Scanning/Faxing
Automated Entry
Structured Data
Connectivity: Community Level Traditional vs HIE
HIE Is Key
HealthCare Reform
“Bending the Cost Curve”
Prevention
Inform
Quality Outcomes
Deliver Information about the patient to the
provider at the point of care
Challenge – How will we Enable, Promote,
Accelerate HIE in the State of CA
• Regional HIO
• Started in 1996
•County Population 270,000
• 95% in Patient Index
•Bi-directional Exchange
130,000 + clinical documents /
month
• Two full-service hospitals
• 367+ MDs – 900+ Users
•Web & EHR Interfaces
• 4 Outpatient Laboratories
• 5 Radiology Centers
• County Health Services & Jail
•Safety Net Clinics
Monterey Bay
California
Timeline of HIE in Santa Cruz
• Community Collaboration
• PMG
• Dominican Hospital
• Unilab (Quest)
1995
• 1st Exchange of Clinical Data
1996
• Web-based HIE interface
• EMR Lite
• County Clinics
2001
• 3 HIE to EMR Interfaces
• NHIN
• Safety Net Clinics
• 4 Additional Labs
2004- 2006
• 1st Partner Connection to HIE
2007
• EMR Lite
• 600+ electronic
• NHIN at Redwood MedNet
2009 • 7 Connected
EMR’s
• 750+ electronic
• NHIN at HIMSS
2010
• 9 Connected EHR’s
• 4 Certified EHR’s
2011
• Lab
• Radiology
• Transcription
2 Hospitals - 8 Feeds
Santa Cruz HIE Stats
• Increase in Data Traffic
• Usage increase over past 6 Years
600%
• Clinical Page Views Monthly
1.3M
• SureScripts per Month Including eRx from EHR and HIE
23,000 Rx
• Referrals
• Transitions of Care per Month
3,400+
• Electronic Lab Results per Month
28,000+
• VHR Views per Month
• Longitudinal Patient Record
17,000+
• EMR / EHR Interfaces to 90+ MD’s
9
Data Types & Features
Lab Results Radiology Reports from Hospitals and Independent ADT feeds Chart Notes Referrals and Authorizations Hospital – Dictations, Op Reports, ED, H&P etc Discharge Summaries Consultant Reports Patient Summary (Print and CCD) EHR / EHR Interface (McKesson Practice Partner and 8 others) Problems, Allergies, Immunizations, Consent Provider to Provider Secure Communications Community Patient Index (MPI) Virtual Health Record
Infrastructure & Resources
HIE ( $2.25 per patient per year – hard costs across
community – Hospitals, Labs, Users Pay)
The SC HIE core infrastructure is hosted by Axolotl
Locally PMG provides
– EMR Interface Implementation, Operational and User Support,
and Reporting
– 2 FTE at PMG
– 1st Line Support, MPI Administration, User Administration and
Training
2 FTE at PMG
Management / Oversight / Marketing / Governance
.5 FTE at PMG
Tech Support, EHR Implementation, Hosting, REC
Services 9 FTE at PMG
PMG Services in Santa Cruz County Insurance and Health Plan Contracting and
Administration
Claims Payment
Case Management
Credentialing
Billing Service
Technology Support
Service Partner to CalHIPSO – ARRA REC Services
Electronic Health Records Deployment and Hosting
Health Information Exchange (SCHIE)
Axesson, LLC
Owned by PMG
Interface & Interoperability Services Nationwide
HIO Operations
HIE Workplan Paul Alcala
Vice President / CIO
NorthBay Healthcare
HIE Critical Success Factors Objectives & Vision
◦ Identify the community to be served
◦ Why do we need an HIE?
◦ Building of trust among key stakeholders
◦ Agree on guiding principles
◦ Obtain buy-in from stakeholders
Market Assessment
◦ Market understanding
◦ Community readiness
◦ Inventory HIE relationships
◦ Referral relationships
◦ Patient flow
Strategic Development
◦ Strategic options
◦ Pros and cons
◦ Value proposition
◦ Phasing of services
Implementation
◦ Business model
◦ Technical approach/implications
◦ Financial plans/implications
◦ Technology solutions/options
Workplan
2012 2013
# Activity Duration Apr May Jun Jly Aug Sep Oct Nov Dec Jan Feb Mar
1 Summary Business Plan 15 days
2 Assess Community Support 60 days
3 Complete Dues Pricing Plan 5 days
4 Arrange Incubator 45 days
5 Incorporation (interim governance structure) 15 days
6 Establish Account 10 days
7 Define Desired Services 30 days
8 Detailed Operational Business Plan 30 days
9 Seek Seed Funding (small grant sources) 90 days
10 Develop Governance Structure 90 days
11 Edit Participation Agmt, DURSA, etc. 90 days
12 Develop and Issue RFP (criteria & vendors/HIEs)45 days
13 Select HIE or Vendor 90 days
14 Obtain Provider Commitments 180 days
15 Execute HIE or Vendor Agreement 60 days
16 Vendor/HIE Implements Infrastructure 90 days
17 Go-Live with Initial Providers 120 days
18 Post-Implementation Assessment 90 days
19 First Expansion 120 days
20 Second Expansion Ongoing
21 Seek Grants Opportunistically Ongoing
2013 2014
Activity Duration Apr May Jun Jly Aug Sep Oct Nov Dec Jan Feb Mar
16 Vendor/HIE Implements Infrastructure 90 days
17 Go-Live with Initial Providers 120 days ---->
18 Post Implmentation Assessment 90 days
19 First Expansion 120 days ---->
20 Second Expansion Ongoing ---->
21 Seek Grants Opportunistically Ongoing ---->
Workplan, Part 1 2012
# Activity Duration Apr May Jun Jly Aug Sep Oct Nov Dec
1 Summary Business Plan 15 days
2 Assess Community Support 60 days
3 Complete Dues Pricing Plan 5 days
4 Arrange Incubator 45 days
5 Incorporation (interim governance structure) 15 days
6 Establish Account 10 days
7 Define Desired Services 30 days
8 Detailed Operational Business Plan 30 days
9 Seek Seed Funding (small grant sources) 90 days
10 Develop Governance Structure 90 days
11 Edit Participation Agmt, DURSA, etc. 90 days
12 Develop and Issue RFP (criteria & vendors/HIEs)45 days
13 Select HIE or Vendor 90 days
14 Obtain Provider Commitments 180 days
15 Execute HIE or Vendor Agreement 60 days
16 Vendor/HIE Implements Infrastructure 90 days
17 Go-Live with Initial Providers 120 days
18 Post-Implementation Assessment 90 days
19 First Expansion 120 days
20 Second Expansion Ongoing
21 Seek Grants Opportunistically Ongoing
Incubator Organization Lyman Dennis
Incubator Organization Carl Thomas
Executive Director
Solano Coalition for Better Health
DISCUSSION
Proposed Dues
Background
Need for some funds during organizing ◦ Software for filing as business, not-for-profit
◦ Filing fee for incorporation
◦ Business and DO insurance
◦ Legal review of documents
◦ Website
◦ Managing finances
◦ General administration (registration temp, reproduction)
Anticipate single year of dues for most providers
Criteria
Financially capable organizations pay
more
◦ Hospitals, health plans
Public health departments in middle
Less affluent organization pay least
◦ Medical associations
◦ Hospital associations
◦ Clinic systems
◦ Critical access hospitals
Budget May - July
Item Amount
Software for Incorporation, 501c3 40$
Filing fee for incorporation 30
Business & D&O Insurance 2,000
Legal review of documents 3,000
Website (startup) 10,000
Managing finances 2,000
General administration 2,000
Temp for registration
Reproduction
Misc
Total 19,070$
Dues Schedule
North Bay Regional HIE
Organization Type Annual Dues
Hospital System $5,000
HealthPlan 5,000
Public Health Department 3,000
Medical Association, Hospital Association,
Clinic System, Other
1,000
Critical Access Hospital 1,000
Formation of a not-for-profit
Form a corporation and indicate it will
be a not-for-profit
File with the IRS for 501c3 status
Wait
Nolo Kit
Revised annually
Good discussion of issues
Easy to follow
Works
Name of Community HIE
Group Suzanne Ness
Regional Vice President
Hospital Council of Northern & Central California
North Bay Regional
Health Information Exchange
What’s in a Name?
Goals
Focus on the Patient
Improve Health
Collaborating Care Providers
Increase Healthcare Access
Reduce Healthcare Cost
Other?
Partners
Physicians
Clinics
Hospitals
Home Health
Nursing
Rehabilitation
Public Health
Other?
Descriptors…
Proactive
Consultative
Collaborative
Relational
Interdependent
Equal
Considerations…
Memorable, creative, distinctive
Appealing/Easy to Use
Not geo specific
Possible expanded product/service lines
Get feedback from support network
Possibilities Health Connect
Health eNet
Health Network
Health eConnect
Health Bridge
Health Trust
?? (Your suggestions here)
Discussion
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