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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.

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Presentation on theme: "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."— Presentation transcript:


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). 2

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. 3

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. 3

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 5

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. 6

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 7

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

9 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

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 10

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

12 Who’s On First, What’s on Second… 12

13 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 13 FQHC Data Integrity Medical Home /NCQA Recognition Blueprint & UDS Reporting Meaningful Use VHIE Interfaces

14 On The Ground Activity 14


16 16 Technology Technical AssessmentProject CharterData Feed Design Data Feed BuildData Feed Validation Administrative Legal Agreements High Level PlanningSigned Attestations Data Integrity Data AssessmentIdentify Gaps and Develop Plan Complete Learning Collaborative & Coaching Develop Data Collection Policies, Workflow Design Data Validation High Level Process Overview

17 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 17

18 18 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 Member Meetings Nov & Jan Member Meetings Nov & Jan Thru May 2012

19 19 Learning Session 1 face-to-face Week 4 Learning Session 1 face-to-face Week 4 Learning Session 3 face-to-face Week 12 Learning Session 3 face-to-face Week 12 Learning Session 2 face-to-face Week 8 Learning Session 2 face-to-face Week 8 Kick-Off Week 1 Kick-Off Week 1 Learning Session 4 face-to-face Week 16 Learning Session 4 face-to-face Week 16 Coaching Weeks 9-11 Pre-work Weeks 2-3 Pre-work Weeks 2-3 Conference Call / Webinar Week 6 Conference Call / Webinar Week 10 Conference Call / Webinar Week 14 Coaching Weeks Coaching Weeks 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 22


24 24 CORE DATA ELEMENTS DATA ELEMENT NAME VALUES /(NOTES) MUMHPQRIUDSBP 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 X Self-management Goal Assessment (BP) No Effort, Some Effort, Successful Effort X X Tobacco Use Assessment XXX X Tobacco Cessation Intervention XXXX

25 25 Assessment Questions If data element is in your EHR: Status of Element? 0 = Missing 1 = Free Text 2 = Structured, does not match 3 = 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 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 26 FQHC Data Integrity Medical Home /NCQA Recognition Blueprint & UDS Reporting Meaningful Use VHIE Interfaces

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

28 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 28

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

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

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