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What is VRHA? VRHA is the VT Rural Health Alliance

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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 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

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

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)

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