Realizing the Benefits of Health IT For CHCs

November 8, 2005

Ralph Silber, MPH, CEOCommunity Health Center Network1320 Harbor Bay Parkway, Suite 250

Alameda, CA 94502www.chcn-eb.org

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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

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Sex %

Male 37

Female 63

Age %

<15 29

15-24 16

25-34 14

35-44 12

45-54 11

55-64 8

65+ 10

Race/Ethnicity %

Asian 24

African-American 9

Latino 51

Native American 2

White 10

Other 4

Payor %

Uninsured 41

Medi-Cal 34

Medicare 9

Healthy Families 3

Private Insurance 12

Patients with Chronic Diseases N

Cardiovascular Diseases 11,717

Diabetes 5,499

Demographics of CHCN Patients*, 2003 (N=92,054)

* Patients with 1 or more encounters

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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

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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)

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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

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• 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?

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•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

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

50

80

90

0

10

20

30

40

50

60

70

80

90

100

Healthy People 2010Goal

HEDIS Average CHCN Average

Percent

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Frequency of 1 or More HbA1c Tests by Demographics and Insurance Coverage, CHCN, 2001

91

85

93

92

79

84

93

93

92

0 20 40 60 80 100

Medicare

Commercial

Medi-Cal

Uninsured

White

African Am.

Asian/PI

Native Am.

Latino

% of Patients with 1 or More HbA1c Tests, 10/1/00 to 9/30/01

Ethnicity/Race

Insurance Coverage

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Prevalence of Asthma Controller Medication Use by Clinic and Patient Demographics, CHCN, 7/1/02 to 6/30/03

77

85

91

93

64

64

87

0 20 40 60 80 100

White

Latino

Asian/PI

African Am.

HEDIS

CA Dept. of Managed Health Care

CHCN

% 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

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

59%

85%

0

20

40

60

80

100

CHCN 2002 Ave. (N=649) CHCN 2003 Ave. (N=900)

Percent

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Age-Adjusted* Prevalence (%) of Obesity (BMI > 30) in Adults, CHCN, 2003

15%

27%

20%

0 10 20 30 40 50

Helathy People 2010Goal

US Population (1990 -1999)

CHCN Ave. 2003(N=747)

Percent

* Adjusted to the 2000 US Population Standard