1. VRHA Health Information Technology Project Primary Care Conference May 17, 2011

2. What is VRHA? VRHA is the VT Rural Health Alliance
VRHA is a Health Center Controlled Network
VRHA is a program of Bi-State
VRHA was initially funded as a Network by the Office of Rural Health Policy (with some seed money from the State Office of Rural Health).

3. VRHA Purpose
The primary purpose of VRHA is to work collaboratively on putting state and federal health policy initiatives into practice, leveraging shared resources and expertise for common benefit focused on shared missions of access to high quality health care for the medically underserved, including uninsured and underinsured, regardless of ability to pay.

4. VRHA Membership Bi-State Primary Care Association VT FQHCs (8)
North Country Health Systems
Vermont Coalition of Clinics for the Uninsured (VCCU)
Vermont’s Area Health Education Center (AHEC) Network
Vermont Information Technology Leaders (VITL)
Vermont Program for Quality in Health Care (VPQHC)
Participation in the VRHA HIT Project is limited to the eight VT FQHCs. VRHA is viewed as a “statewide” HCCN because all VT FQHCs are participating in the network.

5. National HIT Initiatives
Expansion of regional and statewide Health Information Exchange (HIE).
Development of a National Health Information Network (NHIN).
ARRA funding to drive Electronic Health Record (EHR) adoption through incentive programs and grants.
Achieve pervasive use of data to support quality improvement and accountability.
Create standards and implementation guides for a robust privacy and security infrastructure

6. Vermont HIT Initiatives
Expanding the Vermont Health Information Exchange (VHIE) to encompass data exchange between hospitals, ambulatory providers, long term care, mental health and home health.
Implementing a statewide Clinical Data Repository (CDR) to support expansion of the Vermont Blueprint for Health medical home payment reform model.
Enabling adoption of Electronic Health Records by primary care providers and critical access hospitals throughout the state through the ARRA funded Regional Extension Center.
Connecting the statewide Immunization Registry to the VHIE.

7. Project Goals
Patient data in each FQHC’s Electronic Health Record is structured, reliable, complete and reportable.
Clinical Data Repository is populated with data from all FQHCs
Clinical UDS reporting is automated in EHR or CDR
Network-wide comparative reporting is available through the CDR
HIE connectivity is implemented at each FQHC
FQHCs complete EHR implementation and achieve Meaningful Use
Workflow redesign and Continuous Quality Improvement are used to ensure lasting benefits

8. Project Participants
Eight FQHCs encompassing 36 primary care medical practices
100+ providers
More than 100,000 patients

9. Project Funding and Timeline
1/24/2011
Project Funding and Timeline
Project is funded by a $2.2M Health Resources and Services Administration (HRSA) grant and with over $500K from Vermont’s HIT Fund.
Federal funds are allocated for:
Data integrity work
Data Feed to the VT Health Information Exchange (VHIE) & Clinical Data Repository (CDR) - DocSite
Creation of additional DocSite registry reports for UDS clinical data (beyond the Blueprint)
EHR templates, workflow design and training as needed
State funds are allocated for Incentive payments to health centers for achieving project goals
HRSA Grant runs through May 2012.
I added info about the HIT Fund money.
VRHA HIT Project Update

10. Project Outcomes Reporting UDS Data without Chart Pulls
Blueprint Medical Home Participation
CMS Meaningful Use Incentive Payments
Data sharing with hospitals and other health care providers
Clinical Benchmarking / Network- level QI Activities

11. Vermont Health Information Exchange
Data Flow
Practice Management/
EHR Systems
Vermont Health Information Exchange

12. Who’s On First, What’s on Second…

13. Medical Home /NCQA Recognition Blueprint & UDS Reporting
HIT Project Partners
VT Rural Health Alliance (VRHA)
Overall Project Management
Clinical Quality Improvement Coordinator
VT Information Technology Leaders (VITL)
Building Interfaces/Data Mapping
Connectivity to the Health Information Exchange
Support for Meaningful Use & EHR Implementation
Docsite/Covisint
Blueprint registry/clinical data repository
Data Translation
Docsite Training/Support
VT Blueprint for Health
Guidance for statewide Health Care Reform
Medical Home, Community Care Teams
Tupelo Group, LLC
Assessment of Current State in each practice – Data/Workflow
Working to ensure necessary discrete data elements are in the EHR
Provide collaborative training sessions & on the ground support for workflow design
FQHC
Data Integrity
Medical Home /NCQA Recognition
Blueprint & UDS Reporting
Meaningful Use
VHIE Interfaces

14. On The Ground Activity

15. “Data You Can Trust ” Data integrity: Achieved through: Structured
Reliable
Complete
Reportable
Achieved through:
Collaborative learning
Gap analysis
Workflow redesign
Technology optimization

16. High Level Process Overview
Administrative
Technology
Data Integrity
Legal Agreements
Technical Assessment
Data Assessment
High Level Planning
Project Charter
Identify Gaps and Develop Plan
Signed Attestations
Data Feed Design
Complete Learning Collaborative & Coaching
Data Feed Build
Develop Data Collection Policies, Workflow Design
Data Validation
Data Feed Validation

17. A Collaborative Approach
4 Waves
2 FQHC organizations in each wave
Interdisciplinary teams from each practice/organization
4 months of intensive data integrity work
Focus during 4-month waves
Diabetes
Hypertension
Childhood Immunizations
Focus through May 2012
Remainder of UDS/Blueprint measures
Clinical Outcomes

18. Collaborative Roll-Out
Clinical Outcomes
NOTCH
SMCS
NCHC
CHSLV
CHCRR
CHCB
LRHC
THC
Oct 2010—Jan/Feb 2011
Feb 2011—May/June 2011
Jun 2011—Sept/Oct 2011
Oct Jan/Feb 2012
Continuous Quality Improvement (CQI)
WAVE 1
WAVE 4
WAVE 3
WAVE 2
Member Meeting
March
Member Meetings
Jun & Sept
Nov & Jan
Thru May 2012

19. Conference Call / Webinar
Wave Timeline
Learning
Session 1
face-to-face
Week 4
Session 3
Week 12
Session 2
Week 8
Kick-Off
Week 1
Session 4
Week 16
Coaching
Weeks
9-11
Pre-work
Weeks 2-3
Conference Call / Webinar
Week 6
Week 10
Week 14
13-15
5-7

20. Beware: We will not go away when the 4-month collaborative is over!!!

21. Assessing the Current State: Data Workbook

22. Data Workbook Collaborative Effort from our partners
Purpose of Data Workbook
An assessment tool for VRHA, VITL, Blueprint and practices
Provides all information about data collection capacity and...
Understand what gaps there may be
Understand where we need to focus our efforts
Data Elements compiled from:
Vermont Blueprint for Health Data Dictionary for the Chronic Disease Registry (Covisint/DocSite)
NCQA Patient-Centered Medical Home Standards
Federal Register guidelines for Meaningful Use
CMS Physician Quality Reporting Initiative (PQRI)
Uniform Data System Clinical Measures (Added for Federally Qualified Health Centers mandated reports)
Data Elements are mapped to specific standards as applicable
Multiple Sections (7): Demographics & Scheduling, Core Data Elements, Vital Signs, Prenatal, Screening Tools, Misc. Data Elements, EHR Elements & Processes

23. DEMOGRAPHICS AND SCHEDULING
DATA ELEMENT NAME
VALUES/(NOTES) MU
MH/NCQA
PQRI
UDS BP
Last Name X
First Name
Middle Name
Suffix
Title
Date of Birth

24. CORE DATA ELEMENTS VALUES/(NOTES) DATA ELEMENT NAME MU MH PQRI UDS BP
Over past 2 wks how often bothered by feeling down, depressed, or hopeless
(BP) (quick screen for depression) 0 - Not at all, 1 - several days, 2 - more than half the days, 3 - nearly every day X
Self-management Goal Assessment
(BP) No Effort, Some Effort, Successful Effort
Tobacco Use Assessment
Tobacco Cessation Intervention

25. Assessment Questions If data element is in your EHR:
Assessment Questions
If data element is in your EHR:
Status of Element? = Missing = Free Text = Structured, does not match = Structured, Exact Match
If structured but do not match, list EHR values
Which Staff Enters Data? (F=Front Office, N=Nurse, MA=Med Asst, P=Provider, O=Other)
Where located in the EHR? (e.g., practice mgmt, flowsheet, template)
Reportable? (Y=Yes, N=No, U=Unknown)
Reliable? (Y=Yes, N=No, U=Unknown)

26. Medical Home /NCQA Recognition Blueprint & UDS Reporting
Ongoing Activities
Identify gaps & issues we need to address
Determine priorities/possibilities
Quick wins & easy fixes
New templates, flow sheets, data elements
Workflow redesign
Standardization across the system
Testing begins in pilot sites (PDSA)
Ongoing coaching & support provided
Site visits
Webinars & Conference Calls
Parallel work
Data mapping/translation
Interface build/testing
Spread changes to additional sites
Develop policies & procedures
Monthly coordinated work plan meetings
FQHC
Data Integrity
Medical Home /NCQA Recognition
Blueprint & UDS Reporting
Meaningful Use
VHIE Interfaces

27. Good News
The first phase of grant incentive payments is underway... four FQHCs are ready to receive funds!

28. A Few Lessons Learned… Strong clinical champions & leaders among staff
1/24/2011
A Few Lessons Learned…
Strong clinical champions & leaders among staff
Standardization is key to data integrity
Engage EHR vendors early
Many EHRs are not ready for UDS Reporting
Multiple Activities Underway
Meaningful Use updates
Medical Home/NCQA Scoring Readiness
Cart before the horse…
Data translation; time consuming now and into the future
Practices benefit from ongoing training on their EHR’s & report writing capability
Monthly coordinated work plan calls with partners
VRHA HIT Project Update

29. Challenges and Successes
Complexity
Multiple EHRs
Many players
Technology Change
VITL HIE Infrastructure transition
Evolving reporting requirements and data standards
FQHC team members engaged
Forward momentum maintained
Cooperation from partners and technology vendors

30. Bonnie Walker
Tupelo Group, LLC
(802)
Elise Ames
H.I.S. Professionals, LLC
(413)