Presentation on theme: "What is VRHA? VRHA is the VT Rural Health Alliance"— Presentation transcript:
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 NetworkVRHA is a program of Bi-StateVRHA 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 PurposeThe 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 SystemsVermont Coalition of Clinics for the Uninsured (VCCU)Vermont’s Area Health Education Center (AHEC) NetworkVermont 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 GoalsPatient data in each FQHC’s Electronic Health Record is structured, reliable, complete and reportable.Clinical Data Repository is populated with data from all FQHCsClinical UDS reporting is automated in EHR or CDRNetwork-wide comparative reporting is available through the CDRHIE connectivity is implemented at each FQHCFQHCs complete EHR implementation and achieve Meaningful UseWorkflow redesign and Continuous Quality Improvement are used to ensure lasting benefits
8 Project ParticipantsEight FQHCs encompassing 36 primary care medical practices100+ providersMore than 100,000 patients
9 Project Funding and Timeline 1/24/2011Project Funding and TimelineProject 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 workData Feed to the VT Health Information Exchange (VHIE) & Clinical Data Repository (CDR) - DocSiteCreation of additional DocSite registry reports for UDS clinical data (beyond the Blueprint)EHR templates, workflow design and training as neededState funds are allocated for Incentive payments to health centers for achieving project goalsHRSA 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 ParticipationCMS Meaningful Use Incentive PaymentsData sharing with hospitals and other health care providersClinical Benchmarking / Network- level QI Activities
11 Vermont Health Information Exchange Data FlowPractice Management/EHR SystemsVermont Health Information Exchange
13 Medical Home /NCQA Recognition Blueprint & UDS Reporting HIT Project PartnersVT Rural Health Alliance (VRHA)Overall Project ManagementClinical Quality Improvement CoordinatorVT Information Technology Leaders (VITL)Building Interfaces/Data MappingConnectivity to the Health Information ExchangeSupport for Meaningful Use & EHR ImplementationDocsite/CovisintBlueprint registry/clinical data repositoryData TranslationDocsite Training/SupportVT Blueprint for HealthGuidance for statewide Health Care ReformMedical Home, Community Care TeamsTupelo Group, LLCAssessment of Current State in each practice – Data/WorkflowWorking to ensure necessary discrete data elements are in the EHRProvide collaborative training sessions & on the ground support for workflow designFQHCData IntegrityMedical Home /NCQA RecognitionBlueprint & UDS ReportingMeaningful UseVHIE Interfaces
15 “Data You Can Trust ” Data integrity: Achieved through: Structured ReliableCompleteReportableAchieved through:Collaborative learningGap analysisWorkflow redesignTechnology optimization
16 High Level Process Overview AdministrativeTechnologyData IntegrityLegal AgreementsTechnical AssessmentData AssessmentHigh Level PlanningProject CharterIdentify Gaps and Develop PlanSigned AttestationsData Feed DesignComplete Learning Collaborative & CoachingData Feed BuildDevelop Data Collection Policies, Workflow DesignData ValidationData Feed Validation
17 A Collaborative Approach 4 Waves2 FQHC organizations in each waveInterdisciplinary teams from each practice/organization4 months of intensive data integrity workFocus during 4-month wavesDiabetesHypertensionChildhood ImmunizationsFocus through May 2012Remainder of UDS/Blueprint measuresClinical Outcomes
22 Data Workbook Collaborative Effort from our partners Purpose of Data WorkbookAn assessment tool for VRHA, VITL, Blueprint and practicesProvides all information about data collection capacity and...Understand what gaps there may beUnderstand where we need to focus our effortsData Elements compiled from:Vermont Blueprint for Health Data Dictionary for the Chronic Disease Registry (Covisint/DocSite)NCQA Patient-Centered Medical Home StandardsFederal Register guidelines for Meaningful UseCMS 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 applicableMultiple Sections (7): Demographics & Scheduling, Core Data Elements, Vital Signs, Prenatal, Screening Tools, Misc. Data Elements, EHR Elements & Processes
23 DEMOGRAPHICS AND SCHEDULING DATA ELEMENT NAMEVALUES/(NOTES)MUMH/NCQAPQRIUDSBPLast NameXFirst NameMiddle NameSuffixTitleDate 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 dayXSelf-management Goal Assessment(BP) No Effort, Some Effort, Successful EffortTobacco Use AssessmentTobacco Cessation Intervention
25 Assessment Questions If data element is in your EHR: Assessment QuestionsIf data element is in your EHR:Status of Element? = Missing = Free Text = Structured, does not match = Structured, Exact MatchIf structured but do not match, list EHR valuesWhich 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 ActivitiesIdentify gaps & issues we need to addressDetermine priorities/possibilitiesQuick wins & easy fixesNew templates, flow sheets, data elementsWorkflow redesignStandardization across the systemTesting begins in pilot sites (PDSA)Ongoing coaching & support providedSite visitsWebinars & Conference CallsParallel workData mapping/translationInterface build/testingSpread changes to additional sitesDevelop policies & proceduresMonthly coordinated work plan meetingsFQHCData IntegrityMedical Home /NCQA RecognitionBlueprint & UDS ReportingMeaningful UseVHIE Interfaces
27 Good NewsThe 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 1/24/2011A Few Lessons Learned…Strong clinical champions & leaders among staffStandardization is key to data integrityEngage EHR vendors earlyMany EHRs are not ready for UDS ReportingMultiple Activities UnderwayMeaningful Use updatesMedical Home/NCQA Scoring ReadinessCart before the horse…Data translation; time consuming now and into the futurePractices benefit from ongoing training on their EHR’s & report writing capabilityMonthly coordinated work plan calls with partnersVRHA HIT Project Update
29 Challenges and Successes ComplexityMultiple EHRsMany playersTechnology ChangeVITL HIE Infrastructure transitionEvolving reporting requirements and data standardsFQHC team members engagedForward momentum maintainedCooperation from partners and technology vendors