1. Population Health: A Sustainability Strategy for a Disease Registry? AHRQ 2007 Annual Meeting September 27, 2007 Eleanor Littman RN MSN Health Improvement Partnership of Santa Cruz County

2. Outline The Santa Cruz Story Innovation & Collaboration Vision: Community-wide Diabetes Registry Lessons Learned Project History Population Health is Value Proposition Future Chronic Disease Registry and/or Health Information Exchange?

3. Central California Coast 75-miles S. San Francisco 265,000 residents North – Silicon Valley Beach South – Agricultural Isolated Progressive Innovative Collaborative Santa Cruz County, CA

4. Fragmented Private Health Care System Three private hospitals CHW/Dominican – largest Sutter Maternity & Surgery Watsonville – for profit Three Two competing medical groups Physicians Medical Group – IPA Sutter/Santa Cruz Medical Foundation Dominican Medical Foundation (July 2007)

5.  1995 IPA partnered with Axolotl Clinical Messaging  2000 web-based  expansion private physicians  2004 County clinics including mental health  2005 Community Health Centers Innovation: Clinical Messaging A Health Information Exchange?

6. Innovation: EMR Adoption (40%) Private practices (2000) Dominican Hospital Cerner (2006) Santa Cruz Medical Foundation Epic (2007) County Clinics Epic (2006) “Threw Public Health off IT bus”

7. Collaboration: HIP Health Improvement Partnership Founded in 2003 (CAP grant) Incorporated in 2005 Public-private collaboration of health care leaders Common ground issues in competitive environment Accomplishments Healthy Kids (98% children Santa Cruz County) Project Connect (Frequent ED Users 54%  ) Diabetes  IOM Invitation (Jan 2004)

8. Vision – January 2004 Expand current IPA diabetes point of care registry to ALL providers Test point of care registry 1 st step EMR Build community-wide database Outcomes: Higher standard of care consistent across the County Track diabetes population in the aggregate Build on strong history of collaboration and innovation! Dr Wells Shoemaker Name of handshake collaborative. AHRQ Grant: Santa Cruz County, CA Diabetes Mellitus Registry (DMR), 2004-2007

9. Reality - September 2007

10. Project History 2004 - 2005

11. Project History 2006 - 2007

12. Lessons Learned Collaboration Build trust requires neutral entity Business proposition before governance Legal Point of Care Registry built on certifying “provider relationships” Not legal basis for building community-wide registry Adoption  EMRs =  Point of Care X  resources

13. Lessons Learned: Technology Technology Complexity of: Obtaining multiple sources of data (CMS) Combining multiple sources of data Patient matching (MPI) Adapting internal tool for community use Positive Outcome: Public Health back on bus -- 2006 InfoLinks Project (RWJF) Driver?….

14. Lessons Learned: Value Ranking * 1.Action Reports for individual providers (turf wars) 2.Community Database for Population Health 3.Community Patient Lookup 4.Performance Reports with Benchmarks 5.Performance Reports for Payers 6.Point of Care Tool 7.Care Management Tool * Results from October 2006 Business Case Survey (n=12)

15. Population Health Moves Up Santa Cruz County Health Services Agency willing and accepted as neutral public entity Value in community with commitment to collaboration to improve health status County, HIP, Foundations $$ Hospitals funded Community Assessment Survey x 10 years

16. Benefits of Population Health Focus EMRs are friends not foes Demographics (language, residency) Identify Inequities Point of care (smoking, weight, BP) Identify pre-morbid conditions Example: pre-diabetes Integration of Public Health and Clinical Care

17. Next Steps Planning Community Disease Registry Requirements (Population health +) Integrating public health & clinical care Due Diligence on technology Refine Value Propositions Pilot Project – demonstrate & evaluate Wait for EMR adoption before community- wide implementation (60%?) Support EMRs in community health centers and small private practices

18. Chicken or Egg? Is there a value proposition for a disease registry as a first step to health information exchange? OR Is the value proposition for health information exchange that includes a disease registry?

19. www.chroniccarenetwork.org