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Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,

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Presentation on theme: "Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September,"— Presentation transcript:

1 Memphis: Year 5 Report State and Regional Demonstration Projects: 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 1 September, 2009 Mark Frisse, reporter

2 The environment (2004) No ONC No HITECH Two dominant exchange models: Indiana, Santa Barbara Only one seemed to work No Medicare Part D ePrescribing nascent SureScripts (pharmacies) and RxHub (PBM) competing Clinical labs competing Capitation stalled Intense factionalism among hospitals No consensus on health care reform 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 2

3 Pre-dated ONC Mentioned NHII, Santa Barbara, IOM This contract seeks to identify and support statewide data sharing and interoperability activities aimed at improving the quality, safety, efficiency and effectiveness of health care for patients and populations on a discrete state or regional level. It is expected that measurable improvements in the quality, safety, efficiency and/or effectiveness of care shall result from the proposed data sharing and interoperability measures. AHRQ SRDs (2004) © 2009, Mark Frisse 3

4 The environment (2009) ONC, version 3.0 HITECH – a bill, a plan, but major unresolved issues Multiple exchange models Common features and winners are slowly emerging Medicare Part D ePrescribing on the uptake SureScripts (pharmacies) and RxHub (PBM) merged Capitation stalled Guarded cooperation among hospitals and ambulatory sites No consensus on health care reform 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 4

5 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 5 D. McGraw and M. Tripathi, Health Information Exchange Workgroup (PowerPoint). HIT Policy Committee, August 14, 2009 Strength of health exchange objectives in current version of MU rises substantially by 2013

6 Unrealized potential REALITY Comprehensive prescription medication histories largely unavailable Over-the-counter drugs (e.g., aspirin) have been largely ignored No systematic allergy reporting No systematic laboratory information – from office to commercial Claims data remain the lingua franca Many state initiatives are not really state-wide Medicaid systems – few common features across states Business models are not consistent with the interests of individual patients and do not support data liquidity Concerns over ROI make little sense when the entire system is failing. 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 6

7 The Memphis Exchange Baptist Memorial Health Care Corp. (4 facilities) Christ Community Health (4 primary care clinics) Methodist Healthcare (7 facilities including Le Bonheur Childrens Medical Center) The Regional Medical Center (The MED) Saint Francis Hospital & St. Francis Bartlett (Tenet Healthcare) St. Jude Childrens Research Hospital Shelby County/Health Loop Clinics (11 primary care clinics) UT Medical Group (300+ clinicians) Memphis Managed Care/TLC (MCO) © 2009, Mark Frisse 7

8 the Memphis SRD - 2009 34 facilities; over 400 users 1.2 million unique patients with clinical data 140,000 monthly encounters 34,000monthly ICD-9 admission codes (chief complaints) 2.4 million laboratory tests monthly 26,000 monthly microbiology reports 35,000 monthly chest x-ray reports Total costs: $2.5 million per year 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 8 Met all milestones – was operational in a year; full production in 20 months Total annual operational costs are less than $2.5 million

9 The technical model 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 9

10 Record locator services 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 10

11 A lot like the first transistor radio.. 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 11

12 LOINC: an example 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 12

13 Medication hub © 2009, Mark Frisse 13

14 Evaluation Usage 5% of overall patient visits include detailed access Usage ranges from 1% to 15% Usability Extensive workflow evaluation taking place Economic Value Rigorous evaluation shows decreased utilization in the range of hundreds of thousands of dollars (i.e. can offset less than 50% of system cost); impact on transitions in care not completed. Disease-specific utilization Collaborating with TN Hospital Association Addressing specific areas including abdominal pain, back pain, and headache 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 14

15 The impact is very real USER ANECDOTES: Lifesaving impact on a patient with a ruptured ectopic pregnancy Untreated active tuberculosis patient who presents for minor care Terminally-ill patient seeking second opinion Monitoring treatment of specific chronic conditions More efficient follow-up when discharged patients present to ambulatory care clinics for follow-up care OTHER FINDINGS Providers have learned that putting the patient first does not adversely impact their business Data sharing is not a threat to income and only a positive to care 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 15

16 Potential: transitions in Care Real time query: when and where do patients seen in the Med ED seek follow-up care in a safety net clinic? © 2009, Mark Frisse 16

17 Potential: surveillance © 2009, Mark Frisse 17

18 How we did it Governance: Coercion & money Focused inclusion Minimal burden on participants Strong data sharing agreements (Markle) Technology: Built our approach on the Vanderbilt model- a Version 1.0 We assumed standards would evolve We took data as we got it Evaluation Quick wins Meaningful metrics 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 18

19 Lessons from HIE Leadership essential Feasible Inexpensive Limited in scope Can evolve Hampered by Conflicting priorities Business perceptions Technical limitations and costs Privacy concerns ROI © 2009, Mark Frisse 19

20 Paul David: The dynamo David, P.A. The Dynamo and the Computer : An Historical Perspective on the Modern Productivity Paradox (Powerpoint presentation). 1990 Available from: http://www.economics.pomona.edu/kuehlwein/Econ164/Dynamo%20and%20Computer%20Presentation.ppt.http://www.economics.pomona.edu/kuehlwein/Econ164/Dynamo%20and%20Computer%20Presentation.ppt The transformation of industrial processes by the new electric power technology was a long-delayed and far from automatic business © 2009, Mark Frisse 20

21 Part of a remarkable team State: Governor Phil Bredesen, David Goetz, Melissa Hargis, Peter Greaves Region: Robert Gordon, Steve Burkett, Al King, Rodney Holmes, Jim Bailey, Rebecca Pope, George Hripcsak (TAP), Ed Hammond (TAP), Betsy Humphreys (TAP), John Quinn (TAP) and many others Vanderbilt: Vicki EstrinMark Frisse Janet KingDr. William Stead Will RiceSarah Stewart Jameson PorterMichael Assink Lianhong TangTim Coffman Kevin YangCoda Davidson Kevin JohnsonCindy Gadd 5/31/2014Vanderbilt Center for Better Health :: Accelerating Change in Healthcare 21


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