The business case for integrating child health information systems Kristin N. Saarlas Alan R. Hinman James Mootrey Karen Torghele EHDI Conference March 26, 2007

Objectives By the end of the session you will be able to: Discuss the rationale/necessity for developing a business case for integrated child health information systems (ICHIS) Identify the elements included in the Business Case Model (BCM) Describe some of the unique characteristics of the BCM

Business Case - Schmidt a tool that supports planning and decision-making, including decisions about whether to buy, which vendor to choose, and when to implement. Business cases are generally designed to answer the question: What are the likely financial and other business consequences if we take this or that action (or decision)?....The business case is not a budget, not a management accounting report, and not a financial reporting statement.

Business case - Leatherman a business case for a health care improvement intervention exists if the entity that invests in the intervention realizes a financial return on its investment in a reasonable time frame, using a reasonable rate of discounting. This may be realized as bankable dollars (profit), a reduction in losses for a given program or population, or avoided costs. In addition, a business case may exist if the investing entity believes that a positive indirect effect on organizational function and sustainability will accrue within a reasonable time frame

Why do we need a business case for ICHIS? States need to justify return on their investment due to limited resources Increasing focus on measuring outcomes Need for sustainable funding A business case provides a model to quantify benefits and costs

Business case for ICHIS must Develop estimates of the costs and benefits of integrated CHIS - not the costs and benefits of individual information systems Demonstrate the value of integrated CHIS to all stakeholders Reflect the fact that the type of benefits may differ between stakeholders (family vs. government) Reflect the fact that the benefits may not accrue until some time in the future whereas the costs are borne in the present

Challenges to developing a business case Added/marginal value of integration vs value of programs and independent systems Lack of data on costs and benefits on individual programs and IS Change in behavior that integration of data bringse.g., data not available now to physicians, whos responsible for follow up? ROI not always basis for decision making

Process for development - 1 Funding provided by HRSA/MCHB/GSB and RWJF Hired Lewin Group health economist Tim Dall in April 2005 Formed workgroup of stakeholders from PH, private physicians, family advocates, health plans Solicited input from expert health economists and program specialists

Process for development - 2 Researched literature Beta tested tool with 4 states and developed training materials early 2006 Conducted initial training of Connections members March 2006 Formed Users Group in Sept 2006 Version 2 expected mid 2007

What is the business case for ICHIS? The business case is a modeling tool to quantify benefits and costs of integrating various child health systems Answers the questions, What benefits can I expect to see if I integrate this system(s) with that system(s)? Are the benefits greater than the costs? Provides results useful for various perspectives: society, providers, parents, and public health programs Flexible tool that is adaptable to various state and local models and future growth of ICHIS

Integration Benefits Focus on improved effectiveness and efficiency of services, quality and coordination of care, health outcomes Areas of benefits: Benefits to families Benefits to physicians/providers Public health decisions Data quality Case management

Benefits to Families Parents have access to child health information in consolidated format Reminders/recalls Convenience when moving/changing providers Time saved (scheduling appts, missing records, reduced data entry) Reduced visits/efficiency and coordination of care Improved health outcomes (reduced lifetime care costs, increased earnings of family/child)

Benefits to Providers Providers have ready, current access to data they didnt have before Saving staff time (pulling charts vs. electronic access) Improved quality of carereduction in duplicative services, timeliness of care, decrease in loss to follow up Increased number of visits? Increased revenues?

Benefits to Public Health Assess factors affecting completeness of care Identify medical home and health care utilization rates Linkage to data sourceshospital discharge, education, social services Long term surveillancepopulation trends Quality assurancepublic health role Changes in policies?

BCM is an Excel TM Spreadsheet Prepopulated with Data Including Population (by age and state) Incidence, outcomes, and costs of specified conditions - days of illness, disability, death, forgone wages, etc. Programmatic areas whose information systems are being integrated Coverage with different interventions and costs of the interventions Actual or projected improvements resulting from integration of individual information systems

Programs Included Vital records Immunizations (immunization registries) Newborn Dried Blood Spot screening systems (NDBS) Early Hearing Detection and Intervention program (EHDI) Lead screening and intervention program Early Periodic Screening, Diagnosis and Treatment (EPSDT) Women, Infants and Children (WIC) program Birth Defects

Step 1 User selects which information systems are currently integrated and which systems will be integrated, as well as indicating who will have access to information (e.g., providers, parents, schools), whether and to whom the system will send reminders, and the anticipated annual realization of benefits from integration. If newborn dried blood spot screening information is to be integrated, the user also selects the conditions screened for in their state.

Step 1A - optional User reviews the various data elements pre-loaded into the model and changes them based on more up-to-date or specific information or change certain values to carry out a sensitivity analysis.

Step 2 Results of automatic calculation using pre- loaded and/or user-leaded values can be viewed.

Step 3 Summary tables resulting from calculation Overall summary of net benefits (and costs) by benefits category Other tables Benefits to individual program areas Costs of integration Summary table of integration scenario Value of integration benefits/cost over 5 years Charts showing projected net benefits by program area

Business Case Model User Group Purpose of Group: 1.Assistance creating state-specific business case for integrated systems 2.Identify problem areas in model and guides to be fixed 3.Provide information on experience using model so Institute can develop case studies for future users

Participants Representatives Lucia Dhooge, IA Jan Jernell, MN Carmen Lozzio, TN Anil Mangla, GA Amber Roche, WA PHII Alan Hinman Jim Mootrey Kris Saarlas Karen Torghele Ellen Wild

Elements, Type Systems STATEELEMENTFUTURE ELEMENTS TYPE SYSTEM WANDBS, EHDI VS, IMZHybrid MNNDBS, EHDI VS, IMZ, BD, Lead Hybrid TNNDBS, EHDI VS, IMZHybrid IAVS, EHDIDecentralized

Summary - 1 Economic modeling presents new concepts for epidemiologists and program managers – model requires training to use Business case models are based on data but have use assumptions about how factors influence other factors and to what degree – need to validate assumptions The model and the results will become more precise over time – some information is better than no information

Summary - 2 The business case model is a representation of the integration of CHISit is not 100% exact for any state The results provide stakeholders with options for the future and the implications of decisions on costs and benefits

Acknowledgements Tim Dall and colleagues at the Lewin Group Workgroup and technical advisors, PHII staff HRSA/MCHB (Genetic Services Branch) and RWJF funding

Business Case Model Essentially, all models are wrong, but some are useful. George E. P. Box Professor of Statistics University of Wisconsin

Further Information BCM v2 to be available mid-2007 BCM v2 will include: Updated pre-populated Excel file Users guide Technical guide Case studies Contacts: Alan Hinman – Karen Torghele –