Overview
The Hawai‘i Island Beacon Community (HIBC) was established to address the objectives and
requirements of the Beacon Community Cooperative Agreement Program between the U.S. Department of Health & Human Services, Office of the National Coordinator for Health Information Technology (ONC) and the University of Hawai‘i at Hilo (UHH). The Research Corporation of the University of Hawai‘i (RCUH) acted as the fiscal, contracting and staffing agent for the HIBC project. The Hawai‘i Beacon Community Cooperative Agreement was under the direction of Principal Investigator, Daniel E. Brown, Ph.D.
The Hawai‘i Island Health Information Exchange (HIHIE) 501(c)(3) non-profit corporation was formed to engage Hawai‘i Island stakeholders in the governance and operations of collaborative clinical
transformation and health information exchange. An agreement with UHH designated the HIHIE Board of Directors as an advisory body to the University guiding the execution of HIBC project activities. Susan B. Hunt, MHA served as the HIBC Project Director and continues to serve as CEO for the HIHIE non-profit corporation.
Hawai‘i Island, also referred to as Hawai‘i County, is similar in size to the State of Connecticut and is home to approximately 189,000 residents. The HIBC project faced several unique challenges, the primary being geographic isolation as an island community. Access to healthcare services is limited by geography, lack of comprehensive public transportation and critical health professional shortages. Hawai‘i Island has substantial health and economic disparities. Death rates for cardiovascular disease for are the highest in the State. Obesity and smoking rates are higher than the rest of the State and more adults suffer from diabetic complications.1 Populations at higher risk for disease and adverse health outcomes include Native Hawaiians, other Pacific Islanders, the under and uninsured and the elderly. Hawai‘i Island, in comparison to the rest of the State, has the highest percentage of individuals living below 100 percent of the federal poverty level.2 Ethnic and cultural diversity also create special challenges to effectively engaging patients in their care.
The majority of providers are solo practitioners employing only one or two office staff. Others work in one to three person groups. Most lack resources to implement and maintain health information
technology. Internet connectivity in several remote areas on Hawai‘i Island lack bandwidth to connect to a cloud based electronic health record system requiring installation of an on-site network server and/or working with telecommunications companies to increase bandwidth.
In response to these unique challenges and through efforts to improve health and health care on Hawai‘i Island, the following project aims were addressed:
1. Improve access to primary, specialty and behavioral health care.
2. Avert the onset and advancement of diabetes, hypertension and hyperlipidemia. 3. Reduce health disparities for Native Hawaiians and other at-risk populations. 4. Achieve electronic health record (EHR) adoption and meaningful use.
1www.hawaiihealthmatters.org Hawai‘i State Department of Health Diabetes Report 2010 2 State of Hawai‘i Primary Care Needs Assessment Databook 2012
Final Report
Quantitative Information
The Hawai‘i Island Beacon Community (HIBC) was awarded $16,091,390 on May 4, 2010. The project awarded one sub-recipient, North Hawai‘i Community Hospital, $680,000 for the implementation of Alere Accountable Care Solutions’ (Wellogic) Regional Health Information Exchange (HIE) software.
Final Financial Summary
Exhibit 1: Spend Down by Budget Category 3
rdQuarter 2010 to 4
thQuarter 2014
Exhibit 2: Expenditures by Quarter
All major service contracts were executed and underway by the 4th Quarter 2011 with peak activity occurring throughout calendar year 2012 and into the 1st Quarter 2013.
YEAR 1 August 2010 – March 2011
3% of Total Expenditures: $435,860.00
The primary activities within the first year of the cooperative agreement included planning, policy and governance infrastructure development to support health information exchange, and recruitment of five core staff. A Master Plan and Budget was created to guide project management, contracting and additional staffing. Supply costs for office operations included laptop computers. Professional service contracts were executed for legal, technical, and clinical transformation planning. Travel expenditures included education, training and site visits for new staff.
Exhibit 3: Year 1 Expenditures
YEAR 2 April 2011 – March 2012
21% of Total Expenditures: $3,452,011.00
Implementation of the Master Plan began with the hiring of health IT technicians, the Project Director and additional staff experts in the areas of financial management, measurement and evaluation, and clinical practice redesign. An official office location was opened at 1437 Kilauea Avenue in Hilo, Hawai‘i. Travel expenses increased due to the distances traveled island-wide by health IT staff to provide EHR implementation support to the private practices. Major contracts were signed with: 1) Booz Allen Hamilton for assistance with health information exchange (HIE) business modeling, program
management, and measurement and evaluation consultation; 2) DataHouse, a Honolulu based firm, to host and provide software support for Microsoft’s Amalga Unified Intelligence System(UIS); and 3) North Hawai‘i Community Hospital (NHCH) which received a sub-recipient award for implementation of the Alere Accountable Care Solutions’ (Wellogic) software for regional information exchange and clinical decision support. Clinical Transformation requests for proposals were issued for care
coordination, care transitions and patient engagement. Contracts were executed with hospitals, federally qualified health centers and the Native Hawaiian Health Care System. Community wellness service contracts were awarded to 19 local organizations island wide to engage their communities in lifestyle changes involving healthy eating and active living (HEAL).
Exhibit 4: Year 2 Expenditures
Budget Categories Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 TOTAL
Personnel $20,181 $45,921 $48,367 $48,367 $49,585 $51,047 $263,468 Fringe Benefits $1,893 $5,264 $5,498 $4,717 $6,877 $6,252 $30,500 Travel $316 $375 $1,373 $12,432 $3,106 $6,362 $7,518 $5,216 $36,698 Equipment $0 Supplies $15,789 $58 $15,847 Contractual $1,329 $1,329 $938 $2,471 $2,495 $8,561 Other $2,960 $1,108 $2,268 $6,335
Total Direct Costs $1,645 $1,704 $23,447 $63,617 $57,908 $80,666 $67,640 $64,782 $361,409
Indirect Costs $339 $351 $4,830 $13,105 $11,929 $16,617 $13,934 $13,345 $74,450
TOTAL $1,984 $2,055 $28,277 $76,722 $69,837 $97,283 $81,574 $78,127 $435,860
Budget Categories Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 TOTAL
Personnel $51,047 $51,047 $63,902 $78,939 $86,333 $89,386 $91,297 $94,265 $97,765 $104,850 $112,369 $136,605 $1,057,805 Fringe Benefits $6,251 $6,256 $8,187 $10,884 $11,723 $12,329 $13,550 $18,025 $16,842 $20,905 $21,932 $28,598 $175,481 Travel $1,785 $906 $9,156 $4,925 $5,636 $6,307 $6,073 $10,060 $11,268 $4,698 $10,476 $12,673 $83,962 Equipment $0 Supplies $7,789 $2,400 $269 $2,723 $616 $600 $2,219 $301 $14,789 $435 $701 $32,842 Contractual $2,495 $9,000 $24,463 $28,000 $124,071 $93,734 $687,472 $139,001 $37,134 $374,566 $1,519,936 Other $344 $718 $2,440 $1,713 $8,205 $1,861 $9,169 $4,278 $2,416 $3,172 $8,041 $5,495 $47,852
Total Direct Costs $59,426 $69,211 $95,084 $96,730 $139,082 $138,499 $244,759 $222,581 $816,064 $287,415 $190,387 $558,638 $2,917,878
Indirect Costs $12,242 $14,257 $19,587 $19,926 $28,651 $28,531 $50,420 $45,852 $101,159 $59,207 $39,220 $115,079 $534,133
YEAR 3 April 2012 – March 2013
51% of Total Expenditures: $8,228,493.00
The project was in full production during year three. A complete staff was in place supporting HIBC initiatives. All clinical transformation activities were underway. Private practice care coordination services were launched. TransforMED was engaged to facilitate physician practice redesign focused on achieving PCMH status and meaningful use. Community based learning collaboratives were being held for both clinical transformation and practice redesign. Alere Wellogic was fully implemented as a Regional HIE at NHCH and received the first data feeds from community based private practice EHRs – primary care and specialty care. A HISP to HISP connection was successfully tested between NHCH and the State HIE. Private practice physicians received technical support for EHR implementation and
meeting meaningful use requirements in conjunction with the Hawai‘i Pacific Regional Extension Center. Amalga UIS privacy and security policies and protocols were completed and data feeds were under development.
Exhibit 5: Year 3 Expenditures
Exhibit 6: Sub-recipient - NHCH Deliverable Schedule and Payments
NCE PERIOD April 2013 – September 2013
25% of Total Expenditures: $3,974,992.00
The Beacon Nation Information Dissemination project under contract with Booz Allen Hamilton was completed during the no cost extension period resulting in six learning guides, webinars, workshops and shared learning (site) visits with innovation partners thus laying the foundation for continued ONC national transformation work. Alere Wellogic, working with the Alliance of Chicago and GE Centricity,
Budget Categories Apr-12 Apr-12 Jun-12 Jul-12 Aug-12 Sep-12 Oct-12 Nov-12 Dec-12 Jan-13 Feb-13 Mar-13 TOTAL
Personnel $130,167 $131,559 $120,409 $128,649 $124,429 $132,073 $137,729 $143,742 $120,555 $125,744 $103,032 $55,464 $1,453,551 Fringe Benefits $23,480 $23,666 $22,982 $26,061 $26,738 $28,305 $28,126 $27,631 $23,394 $25,547 $22,036 $11,311 $289,277 Travel $5,718 $16,257 $13,228 $12,135 $7,157 $6,731 $4,148 $16,490 $10,131 $4,892 $7,267 $6,278 $110,431 Equipment $0 Supplies $266 $4,143 $6,430 $3,498 $467 $202 $800 $1,700 $1,609 $744 $289 $222 $20,371 Contractual $369,714 $811,643 $281,694 $615,555 $213,952 $417,834 $241,043 $471,320 $233,919 $492,725 $600,127 $201,314 $4,950,840 Other $9,366 $5,726 $3,082 $2,013 $4,540 $3,471 $4,537 $4,597 $2,978 $6,442 $6,449 $1,661 $54,862
Total Direct Costs $538,710 $992,994 $447,825 $787,911 $377,282 $588,615 $416,384 $665,480 $392,587 $656,093 $739,200 $276,250 $6,879,332
Indirect Costs $110,974 $204,557 $92,281 $35,476 $33,646 $94,475 $85,775 $307,968 $80,873 $93,955 $152,275 $56,907 $1,349,161
TOTAL $649,684 $1,197,551 $540,106 $823,387 $410,928 $683,090 $502,158 $973,448 $473,459 $750,048 $891,475 $333,157 $8,228,493
North Hawai‘i Community
Hospital was awarded a
sub-recipient agreement for
$680,000.00 to install Alere
Wellogic. Four major
deliverables were achieved
over the course of the project
and paid upon successful
completion.
D1: Project management plan
D2: Go live implementation
D3: Hospital based data feeds
D4: Community-based
physician EHR data feeds
Sub-recipient Award:established an active data feed from Hamakua Health Center/FQHC to NHCH. Clinical transformation and health IT contracts were completed with work accomplished under the HIBC project either absorbed into the daily operations of local partner organizations or transitioned to new entities for further
development and implementation.
Exhibit 7: No Cost Extension Period Expenditures
Exhibit 8: Spending by Project/Category for 36 Month Project Period
The HIBC project funds were allocated as indicated above. Beacon Operations expenses were comprised of salary and fringe benefits, office location and office infrastructure. Subject matter experts were contracted to provide programmatic support for information exchange governance, policy development and technical program management, as well as, guidance with measurement and evaluation. Clinical Transformation and Practice Redesign and Community Wellness allocations consisted of vendor service contracts with community based organizations involved in front line service delivery. Health Information Exchange allocations funded work with software development, hosting, implementation and interfacing agreements for both Amalga UIS clinical/claims data repository and Alere Wellogic Regional HIE. The National Information Dissemination project funds were allocated to ensure that best practices and lessons learned from all 17 Beacon Communities were shared nationwide. HIBC contracted with Booz Allen Hamilton in collaboration with all Beacon Communities and the ONC to produce an overall strategy for disseminating information which included web based resources and working with allied organizations and innovation partners that participated in shared learning visits, webinars and workshops.
Budget Categories Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 TOTAL
Personnel $84,713 $83,713 $64,228 $47,788 $45,346 $34,877 $24,358 $30,711 $415,733 Fringe Benefits $16,248 $15,947 $13,802 $10,078 $9,011 $7,374 $5,170 $8,275 $85,903 Travel $2,897 $8,774 $8,245 $1,114 $197 $3,686 $389 $25,302 Equipment $0 Supplies $436 $571 $92 $38 $1,137 Contractual $490,457 $429,720 $389,388 $419,326 $5,396 $521,063 $165,227 $338,890 $2,759,467 Other $5,047 $3,372 $1,860 $1,397 $1,208 $1,178 $922 $148 $15,131
Total Direct Costs $599,797 $542,097 $477,523 $479,795 $61,157 $568,178 $196,103 $378,024 $3,302,674
Indirect Costs $123,558 $111,672 $98,370 $98,838 $12,598 $117,044 $40,397 $69,842 $672,319
Major Milestones Achieved Over Life of the Program
2010
2011
\
2012
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sept
Oct
Nov
Dec
Hawai‘i Island Health Information Exchange Incorporated 6/22/10
Privacy Policy, Participant Agreement Adopted, Steering Committee Formed
Data use issues resolved Hawai‘i Beacon awarded
5/4/10. Microsoft Amalga predetermined to be the HIE platform by Hawai‘i Medical Service Association (HMSA)
Alere/Wellogic recommended for Regional HIE option at North Hawai‘i Community Hospital
Master Plan for clinical transformation approved.
Project management and technical assistance from BAH initiated. Clinical transformation acknowledged as a necessary component of Beacon Project DataHouse contracted as Amalga UIS host Clinical Transformation plan launched Clinical Transformation Steering Committee launch GO LIVE Alere/Wellogic Deliverables 1 & 2 completed Hawai‘i Beacon Website Launched RFPs Issued Practice Redesign, Care Coordination, Care Transitions Private Practice Care Coordination launch Alere/Wellogic/NCHC internal primary interfaces complete Community Wellness HEAL Project Kick-off Hospital based Project BOOST Kick-off event TransforMED Practice Redesign launch Clinical Transformation Learning Collab #1 TransforMED
Learning Collab #1 TransforMED Learning Collab #2
Alere/Wellogic Phase II interfaces complete Lab, Pharm 60% of MediCARE providers achieve MU Stage 1 Issues with Amalga UIS
software result in reduced scope of work
Clinical Transformation Learning Collab #2 NHCH Sub-recipient Application to expand Alere-Wellogic as regional HIE approved
Alere/Wellogic Deliverable 3 Complete - Progress Notes Core staff hired via RCUH HIT/Technical staff hired
Project Director with Clinical Transformation experience hired HIHIE 501(c)(3) Determination 4/19/12 Amalga UIS Phase II data feed development begins
HMSA decided to retain Amalga UIS license with Microsoft
First secure connection
established to Amalga
Alere/Wellogic test HISP connection with State HIE Proceed with
Alere-Wellogic Regional HIE
2013
Designates start of fiscal year - April 1.
Final Results for Beacon Measures
Focus Measures
Clinical Measures:
1. Diabetes Care - HbA1c Control (<9.0): Increase the number/percentage of diabetic patients with HbA1c < 9.0 over the course of the intervention.
2. LDL-C Control (<100 mg/dL): Increase the number/percentage of patients with LDL-C < 100 mg/dL over the course of the intervention.
3. Blood Pressure < 140/90 mm/Hg: Increase the number/percentage of patients with BP < 140/90 mm/Hg over the course of the intervention.
Utilization Measures:
4. Potentially Avoidable Emergency Department (ED) Visits: Reduce potentially avoidable ED visits: measurement is a percentage of total ED visits that involved care or treatment for
ambulatory-sensitive conditions or Primary Care Physician (PCP)-treatable conditions.
5. Potentially Avoidable Hospital Admissions: Reduce potentially avoidable hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs): measurement is chronic condition composite PQI3 per 100,000 (risk adjusted).
6. Potentially Preventable Hospital 30 Day Readmissions: Reduce potentially preventable hospital readmissions: measurement is a percentage of return hospitalizations for any condition within 30 days that is clinically related to the initial hospital admission, or one that may have resulted from the process of care and treatment during the prior admission.
3
The Prevention Quality Indicators (PQIs) were developed by the Agency for Healthcare Research and Quality (AHRQ) and can be used with hospital inpatient data to measure quality of care for conditions sensitive to ambulatory care.
(http://www.qualityindicators.ahrq.gov/modules/pqi_overview.aspx.)
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Beacon Nation Info Dissemination 6 Learning Guides Published; Site Visits, Webinars and Workshops conducted
Alere/Wellogic Deliverable 4 Private Practice data feeds
Amalga UIS hosting and software development acquired by IDEAS Dataworks. Caradigm completes repairs to Amalga UIS software. Alere/Wellogic provides 1 year free license to NHCH. Hamakua Health Center data feed to Alere/Wellogic Beacon Nation Project
launch with BAH TransforMED
Learning Collab #3 TransforMED Learning Collab #4 Wellogic User Group Meeting
Clinical Transformation Project Wrap up.
First grant for HIHIE 501(c)(3) received from County of Hawaii
[No Cost Extention period Apr – Sep]
CARE COORDINATION INTERVENTIONS: CLINICAL MEASURES
Exhibit 9: Federally Qualified Health Center Care Coordination Clinical Outcome Measures
Three FQHCs in HIBC’s Care Coordination initiative – Bay Clinic, Hamakua Health Center and West Hawai‘i Community Health Center reached a collective peak enrollment of 457 patients island-wide in December 2012. 365 of the enrolled were diabetics. The health centers utilized embedded care coordinators and patient navigators working collaboratively within a regional community care network to address care coordination needs for complex, adult patients between the ages of 18 and 74 years, with
frequent hospitalizations and/or ED visits and one or more of the following chronic illnesses – diabetes and cardiovascular disease.
FQHC service contracts began in January 2012 and ended in December 2012 with continuous enrollment throughout the contract service period. Interventions were administered and
improvements recognized over a nine month period from April to December 2012.
The Hawai‘i Island FQHCs each have different EHRs – Intergy, NextGen and GE Centricity. They are currently not connected via health information exchange nor are data shared between health centers. Data was collected for the project from EHR registries and submitted via Excel spreadsheets to HIBC for aggregation. Results 9 months April – December 2012:
• HBA1c < 9.0 improved by 37% • BP < 140/90 mm/Hg improved by 32% • LDL-C < 110 mg/dL improved by 21%
Exhibit 10: Patient Engagement and Support Services/Self-Management Clinical Outcome
Measures
Hui Malama Ola Na ‘Oiwi (HMON‘O) was an integral part of the HIBC regional
community care network working closely with the hospitals, FQHCs, private practice care
coordinators and social service agencies. HMON‘O provided a series of chronic disease self-management education programs and transportation services to and from remote locations for hard to reach diabetics and cardiovascular patients many of whom were referred by the hospitals and FQHCs.
HMON‘O’s service contract with HIBC began in January 2012 and ended in December 2012. They continued to collect and submit data for their target population through the end of June 2013.
HMON‘O enrolled a total of 180 participants in education programs in the West and North regions of Hawai‘i Island. Seventy-eight (78) of the participants were diabetic and highly engaged. HbA1c levels <9.0 were consistently maintained well above the targeted 70% for this group throughout the project period. This
self-motivation carried over to improvements in blood pressure and LDL-C levels.
Interventions included education about the disease, risk factors, self-management, nutrition and physical activity. The project did not utilize health IT to engage patients as many of the participants did not own computers and/or lived in remote areas without internet connectivity. Peer support and culturally sensitive innovations tied to Hawaiian values, such as connection to the land through planting a garden and curriculum
presented in the “local style” were crucial to engaging patients.
Results 12 months July 2012 to June 2013: • HgA1c < 9.0 average of 90% maintained • BP < 140/90 mm/Hg improved by 22% • LDL-C < 110 mg/dL improved by 32%
Exhibit 11: Private Practice Care Coordination Clinical Outcome Measures
Hawai‘i Island Care Coordination Services (HICCS), a joint venture between West Hawai‘i Home Health Services and Ho‘okele Health Innovations, facilitated the integration of
complex care coordination services in partnership with primary care practices which were part of the HIBC practice redesign initiative.
Through placement of innovative in-home self- monitoring technology, HICCS empowered patients to self-manage their chronic conditions and helped providers monitor patient self-care remotely.
HICCS service contract with HIBC began in May 2012 and was extended to June 2013. There were 72 patients enrolled by participating PCPs from May to October 2012. 42 patients received in-home monitoring technology and were monitored over the eight month intervention period. The first care coordination clinical outcome data was submitted in November 2012. The most significant improvement was seen in the percentage of patients with HbA1c levels <9.0 in months six through eight of the intervention. Although not portrayed graphically, HICCS reported that as a group HbA1c levels improved from a mean of 8.0 to a sustained 5.0.
Results 8 months November 2012 to June 2013: • HBA1c < 9.0 improved by 46% • BP < 140/90 mm/Hg improved by 6% • LDL-C < 110 mg/dL improved by 15% Overall mean values for the group improved in the following areas:
• Weight improved from 190 to 174 lbs. • BP improved from 137/81 to 122/70 • Total cholesterol improved from 162 to
CARE COORDINATION INTERVENTIONS: UTILIZATION MEASURES
Hospitalizations and ED utilization for diabetes and cardiovascular conditions were self-reported by the participants for each intervention group. The percentage of patients admitted and/or utilizing the emergency department remained consistent throughout the intervention period for FQHC patients averaging two percent per month for hospital admissions and 4 percent per month for ED utilization. Those patients engaged in the HMONO chronic disease self-management education programs
demonstrated the best results with no admissions or ED utilization reported December 2012 to June 2013. After six months of intervention activity HICCS reported zero admissions and no visits to the emergency department in the final two months of the intervention period. Overall HICCS reported a 29 percent reduction in hospitalizations and a 25 percent reduction in ED visits between November 2012 and June 2013.
Exhibit 12: Hospital Admissions and ED Visits for All Intervention Groups
FQHC FQHC
HICCS HICCS
HMON‘O HMON‘O
CARE COORDINATION INTERVENTIONS: CLAIMS DATA USING AMALGA UIS
Throughout the HIBC project, the Amalga UIS contained member claims data for all Hawai‘i Medical Service Association (HMSA) insurance products. HMSA is a Blue Cross/Blue Shield health plan and Hawai‘i’s largest health insurance company. The Amalga UIS was used to track paid claims for the participants in the FQHC and Private Practice care coordination intervention groups with HMSA PPO, HMO, Medicare Part D and QUEST (Medicaid managed care) insurance coverage for calendar year 2011, the year prior to intervention, and calendar year 2012, the year during intervention.Exhibit 13 shows that for both 2011 and 2012 combined, nine (9) percent of the patients meeting demographic and clinical inclusion criteria4 and receiving care coordination services with HMSA
coverage, comprised 50 percent of the total dollars paid. This is consistent with the significant amount of literature confirming that a high percentage of health care expenditures are associated with a small proportion of the population — those people with complex health care needs.
Exhibit 13: Total Dollars Paid for HMSA Members Receiving Care Coordination
Interventions 2011 and 2012 Combined
The analysis of claims data was also intended to identify whether or not care coordination interventions impacted how patients were accessing services and if changes in access had an impact on overall cost. Use of the Amalga UIS to analyze claims data for selected HMSA members receiving care coordination interventions was helpful in identifying patient utilization frequency by service type. Exhibit 14
provides information on total dollars paid for HMSA members by service type, comparing 2011 to 2012. During the intervention year 2012, there was an increase of $86,720 in total dollars paid, with a 28 percent increase in emergency department payments, an increase of 8 percent in inpatient payments and a 12 percent decrease in outpatient payments. Medication payments remained consistent as a percentage of total payments. Costs were not decreased from 2011 to 2012 however utilization of services did appear to change. Further analysis is necessary to determine whether or not the increase in emergency department
4 Patients selected were
≤ 75 years, receiving care coordination services for one or more chronic conditions - diabetes, cardiovascular disease, mental health, with three or more claims filed in both 2011 and 2012. One outlier, patient with liver transplant, was removed from study population.
payments was due to severe illness in a small number of patients, decreased availability of primary care providers or some other reason.
Exhibit 14: Total Dollars Paid for HMSA Members Receiving Care Coordination
Interventions by Service Type Comparing 2011 Baseline with 2012
Further analysis of the number of claims paid by service type provided a better understanding of the variability in PCP practice patterns. Exhibit 15 shows a significant increase in the number of claims filed for office visits by Bay Clinic and West Hawai‘i CHC for the target population from 2011 to 2012. Hamakua Health Center and the private practice PCPs had higher percentages of claims filed for prescription medications.
When comparing the percent of claims filed by service type (Exhibit 15) with the total dollars paid by service type in Exhibit 16 a greater understanding of utilization and distribution of dollars is obtained. For example: In 2011 at Hamakua Health Center, 2% of the claims filed for inpatient services resulted in 43% of the total dollars paid indicating a costly hospitalization for a small number of patients. There was also a small increase in the number of emergency department claims filed by Hamakua Health Center between 2011 and 2012 but a significant increase in the total dollars paid for emergency services. Additional questions arise regarding private practice outpatient visits. For HICCS East the number of outpatient visit claims remained constant from 2011 to 2012 but the total outpatient dollars paid dropped by 25 percent. For HICCS West the number of outpatient visit claims increased by 22 percent but the total outpatient dollars paid dropped by 47 percent.
Although the Amalga UIS capability for combining clinical and claims data for analytic purposes was still quite immature during the HIBC project period, the claims data provides an opportunity to further explore billing practices, business strategy and variations in methods of managing patients with chronic illness. The data also warrants further study involving application of evidence based clinical practice guidelines and the effectiveness of data in driving standardization across the practice community in an effort to improve population health. What was gleaned from the claims data, even at a very basic level, draws attention to a variety of opportunities to better understand practice and utilization variation in an effort to improve quality and lower costs.
Total Dollars Paid for HMSA Members by Service Type 2011 and 2012 Comparison
Exhibit 15: Percentage of Total Number of Claims Filed for HMSA Members Receiving Care
Coordination Interventions by Service Type
Exhibit 16: Percentage of Total Dollars Paid for HMSA Members Receiving Care
Coordination Interventions by Service Type
Pe rce nt o f T ot al D ol la rs P ai d
Percentage of Total Dollars Paid for HMSA Members by Service Type and Participating Organization – Comparing 2011 and 2012 Percentage of Claims Filed for HMSA Members by Service Type and
HAWAI‘I COUNTY CLINICAL AND UTILIZATION MEASURES BENCHMARK DATA
Exhibit 17: Annual Aggregated Health Plan Benchmark Data from HMSA and AlohaCare
The Hawai‘i Health Information Corporation provided hospital utilization data from the first quarter of 2010 to the fourth quarter 2012. Reports for this benchmark data had, prior to Beacon, not been developed. The lag time for the data prevented any direct comparison to HIBC interventions and the intervention period for HIBC was not long enough, nor was the number of participants large enough to demonstrate any measureable improvement in population health. However, Hawai‘i County now has a baseline for future comparison.
Exhibit 18: Hawai‘i Health Information Corporation Benchmark Data: Utilization Measures
Sources: (Numerator - Hospital inpatient data) Hawaii Health Information Corporation, Inpatient Database [for more information, go to http://hhic.org/inpatient-data.asp]; (Denominator – Population data) U.S. Census Bureau, Population Division, Intercensal Estimates of the Resident Population for Counties of Hawaii: April 1, 2000 to July 1, 2010 (CO-EST00INT-01-15) and Annual Estimates of the Resident Population for Counties of Hawaii: April 1, 2010 to July 1, 2011 (CO-EST2011-01-15). Notes: Census population is annualized over four quarters. Annually reported clinical measure benchmark data from the health plans was provided for comparing outcomes for the participants in the care coordination intervention groups to Hawai‘i County population data.
Diabetes Care Comparison 12/2012
FQHC HMONO HICCS Benchmark 40% >9.0 A1c 9% >9.0 A1c 18% >9.0 A1c 38%>9.0 A1c 29% <100 LDL 60% <100 LDL 47%<100 LDL 46%<100 LDL
Where population estimates have not been updated, the most current previous year estimate is used. 30-day readmission rates are based on 3M's Potentially Preventable Readmissions. The software is licensed from 3M. Data reflects two quarter delay in reporting. Hawaii County Population-CY 2012.
Notes: 30-day readmission rates are based on 3M's Potentially Preventable Readmissions. The software is licensed from 3M. Data reflects a two quarter delay in reporting. Hawaii County Population data - CY 2012. Oct 2012 - Used primary and secondary admission dx of Diabetes to increase sample size.
Source: Hawaii Health Information Corporation Emergency Department Database Source: Hawaii Health Information Corporation Emergency Department Database Notes: Q1 2013 ED data incomplete. Two island hospitals implemented new EHRs
PATIENT CENTERED MEDICAL HOME/PRIVATE PRACTICE REDESIGN
Utilizing a four-pronged approach involving curriculum based learning collaboratives, practice coaches, health IT technical support and payment reform, 16 PCPs participating in the HIBC PCMH/practice redesign initiative achieved improvements in 14 HEDIS clinical process measures over nine months.
Exhibit 19: Private Practice Redesign Clinical Process Measures
The 16 PCPs involved in the practice redesign initiative demonstrated an 11.5% overall improvement for diabetic screening measures in nine months.
The most significant improvement was achieved for diabetic retinal examinations – a direct result of
placement of portable retinal screening cameras in seven of the participating practices.
Scope of Impact: Interventions, Infrastructure and Innovative Projects
Pillar 1: Build and Strengthen
Approach: HIBC developed an introductory foundation for information exchange on Hawai‘i Island
which enables communication across the health care system and provides tools and data to aid clinical decisions, facilitate chronic illness management, support care coordination and improve efficiency.Health Information Technology (Health IT): HIBC supported primary care providers with selection and implementation of electronic health records. In partnership with the Hawai‘i Pacific Regional Extension Center (REC) HIBC also assisted eligible primary care providers with achieving Stage 1 Meaningful Use.
Health Information Exchange (HIE): HIBC led the first regional HIE pilot in the State with North Hawai‘i Community Hospital and Alere Accountable Care Solutions’ Wellogic software as a service model connecting lab, pharmacy, radiology, hospital inpatient and outpatient EHR clinical data. The second pilot involved the use of Amalga UIS as a clinical and claims advanced data analytics repository combining insurance claim data, hospital admission, discharge and transfer data, and clinical data from FQHC and private practice EHRs.
Impact:
• 122 (83%) of Hawai‘i Island’s 147 primary care providers implemented certified
electronic health records.
• 52 (35%) of eligible PCPs achieved Stage 1 Meaningful Use (HIBC data)
• 17 hospital and community based providers connected to the Regional HIE
• 30 unique and consistent users of the Regional HIE accessing over 20,000 page
views for an average of 200 patients per month
• HISP to HISP connection established between the Regional HIE and the State of
Hawai‘i HIE
• 7,500 Hilo Medical Center hospital admissions and 38,000 emergency department
visits feeding annually to the data analytics repository
• 6 years of historical HMSA claims data available for analysis within the data
analytics repository
Pillar 2: Improve
Approach:
HIBC utilized an integrated, island-wide systems approach to improve quality that involved three rural acute care hospitals, three FQHCs and sixteen private practices. Emphasis on care transitions, care coordination, patient engagement and patient centered medical home practice redesign included meaningful use of patient registries involving both EHR and claims data.
Care Transitions: Three Hawai‘i Island acute care hospitals - Hilo Medical Center, Kona Community Hospital and North Hawai‘i Community Hospital, focused on standardizing patient discharge protocols and tools and improving the handoff between discharge planners and practice based care coordinators. Each hospital followed Project BOOST® methodology and participated in the national Premier Quest Quality and Patient Safety initiative data analysis to identify the target population in each facility.
Care Coordination: Three Federally Qualified Health Centers – Bay Clinic, Hamakua Health Center and West Hawai‘i Community Health Center, and Hawai‘i Island Care Coordination Services serving private practice physicians participated in a 12 month pilot project designed to improve care coordination in the practice setting for complex,
chronically ill patients with diabetes and cardiovascular disease. Each utilized RN Care Coordinators and either patient navigators or health coaches as an important component of the PCMH care team.
Patient Engagement: Value added, culturally based enabling services (e.g.,
self-management education, transportation, financial assistance and translation) were provided to the hospital discharge planners and care coordinators for patients with diabetes and cardiovascular disease through the Native Hawaiian Health Care System – Hui Malama Ola Na ‘Oiwi.
PCMH/Practice Redesign: HIBC partnered with TransforMED to bring a structured approach to achieving PCMH status and meaningful use of practice EHRs for private practice PCPs.
Impact:
•60+ clinicians island wide participated in clinical improvement interventions including hospitalists, private practice specialists and PCPs, FQHCs and clinics.
•550 patients received care coordination and care transition services as participants in the HIBC pilot program.
•16 primary care, private practice physicians participated in the PCHM/Practice Redesign initiative with HIBC
•32,000 patients were impacted by changes in clinical practice
Pillar 3: Innovate
Approach: HIBC facilitated an ongoing partnership between the Retina Institute of Hawai‘i and private
practice physicians participating in the PCMH/Practice Redesign initiative to bring portable digital retina imaging to the PCP office in an effort to increase the number of diabetic patients who receive retinal screenings.HIBC in partnership with Hawai‘i Island Care Coordination Services (HICCS) tested iHealthHome® a remote in-home monitoring system that enables remote in-home telehealth and activity monitoring by care coordinators developed by Ho‘okele Health Innovations, LLC
Impact:
•15 private practices tested 7 retinal cameras placed island wide resulting in an 18 percentage point or 32% improvement in the HEDIS Diabetes eye exam rate for the participating practices.
•42 (58%) of 72 patients participating island wide in the private practice care coordination pilot received iHealthHome® systems.
Meaningful Use Achievement
HIBC’s aim was to achieve Stage 1 Meaningful Use (MU) for 60 percent or more of Hawai‘i Island’s eligible providers by December 31, 2012. According to ONC data through December 17, 2013, 32 percent of the eligible providers had achieved Stage 1 per CMS payment data as of 9/30/2013 and
Hawai‘i Pacific Regional Extension Center (REC) data as of 10/19/2013. HIBC reviewed the SK&A listing and identified 147 of the 164 PCPs who fit the eligible provider definition and were open for business caring for patients on June 30, 2013. Fifty-two of the 147, or 35 percent, had achieved Stage 1 MU according to HIBC and REC records. All of the eligible providers who achieved Stage 1 MU were participating in the Medicare incentive program. Sixty-two percent (62%) of the 84 total eligible Medicare providers achieved Stage 1 MU. All of the 16 providers participating in the HIBC PCMH/Practice Redesign initiative achieved Stage 1 MU.
The remaining providers eligible for the Medicaid MU incentive included pediatricians, family physicians and obstetricians both in private practice, employed by the FQHCs or Kaiser. The State of Hawai‘i became the 50th (last) State in the nation to launch the Medicaid incentive program on September 3, 2013. As a result, none of the Medicaid eligible providers were attested before the end of the HIBC project period. HIBC did not achieve its target of > 60% of eligible providers reaching MU Stage 1.
Exhibit 20: Meaningful Use Stage 1 Attestation
Measure
SK&A (4/30/13)
HIBC (6/30/13)
Total # Primary Care Providers in
Beacon Catchment (PCPs) 164 147 from SK&A April listing who meet EP definition and are actively practicing as PCPs
Total # of Medicare Providers 84 (57% of total eligible PCPs) Total # of Medicaid Providers 63 (43% of total eligible PCPs) Total # of PCPs Beacon Targeted to
Achieving MU (60% of total PCPs) 98 88 Total # of PCPs Achieved MU in Beacon
Catchment 53 52 (all Medicare PCPs; includes 16 providers who participated in the PCMH/Practice Redesign initiative) % MU Achievement in Catchment (of
total # PCPs) 32% 35%
Dissemination Impact
HIBC worked with Olomana Loomis ISC on a local level to disseminate information about HIBC activities and Beacon efforts nationally. Please refer to Appendices A and B for a detailed listing of activities and dissemination impact.
LOCAL DISSEMINATION
Written Materials and Resources:
HIBC published two annual reports in 2011 and 2012. Numerous brochures and instructional pieces were produced, most notable including the HIE Toolkit for providers and a patient oriented brochure titled The Future of Health Care and You: How is Health Information Technology Improving My Care? Both resources are available at www.hibeacon.org
One article resulting from a series of focus groups conducted to gain feedback on the concept of the Patient Centered Medical Home for patients at a rural FQHC providing care coordination services for the HIBC project was published in the Hawai‘i Journal of Medicine & Public Health by the HIBC Project
Director and MPH student Alain Takane.5 A second collaborative article is under development with Academy Health and the Hawai‘i Island, Southeast Michigan and Delta BLUES Beacon Communities. The article titled Community-Based Diabetes Interventions for the Underserved: Lessons and Promising Practices from Three Beacon Communities is targeted for publication in early 2014 in the Journal of Healthcare for the Poor and Underserved.
Electronic and In-Person Stakeholder Outreach:
Thirteen eNewsletters were published April 2012 – September 2013 and distributed to approximately 1,100 local and national email recipients. The HIBC Project Director presented at two national meetings and to numerous local trade organizations and public officials. Two videos were produced, one
announcing the Alere Wellogic implementation at North Hawai‘i Community Hospital, the second showcasing the care collaboration work conducted at West Hawai‘i Community Health Center. A monthly speakers bureau on a variety of clinical transformation topics for the public was held January through June 2013 in Kamuela, a North Hawai‘i Island community.
Media and Social Media
A 3-part series on health care transformation on Hawai‘i Island written by Andy Levin, HIBC Patient Ombudsman, was published October – December 2012 in the Hawai‘i Tribune Herald, a local Hilo newspaper with island wide circulation. Eleven press releases resulted in over 50 on-line postings by a variety of media outlets. Collaborative public relations work with Alere Accountable Care Solutions also introduced HIBC to an international audience. Advertisements in the local newspapers and their on-line versions, local organization and individual blog sites, as well as, organization newsletters, e.g., Society for Hospital Medicine, University of Hawai‘i and TransforMED showcased activities conducted in partnership with HIBC. Radio interviews and announcements were also part of the dissemination strategy.
NATIONAL DISSEMINATION
The Beacon Nation Information Dissemination project, was funded and overseen by the Hawai‘i Island Beacon Community during the last six months of the HIBC project period in partnership with the ONC and the 16 other Beacon communities nationwide. Beacon Nation promoted innovation in health IT by gathering and disseminating information about successful health IT implementation strategies from the Beacon Communities. Different approaches, resources and interactions resulted in a variety of lessons learned about adopting technology-enabled solutions designed to improve population health, improve the quality of care and reduce cost. These lessons learned were compiled into six Learning Guides which are a set of documents describing promising IT-enabled interventions that can be deployed in a community to accelerate health care transformation. In addition to the Learning Guides, a variety of materials were developed and activities conducted to support the use of the Learning Guides.
Exhibit 21: Beacon Nation Project Outcomes
65
Takane A, Hunt SB, Transforming Primary Care Practices in a Hawai‘i Island Clinic: Obtaining Patient Perceptions on Patient Centered Medical Home. Hawai‘i Journal of Medicine & Public Health. 2012 September; 71(9): 253-258.
6
Credit is given to the Beacon Nation team at Booz Allen Hamilton and HIBC, and the staff at the Office of the National Coordinator for their invaluable contributions to the HIBC national information dissemination effort.
Exhibit 22: Beacon Nation Dissemination Model
Beacon Nation Website:
The Beacon Nation webpages were added to the HIBC website. A description of the Beacon Nation project and supporting materials, as well as a complete overview of the HIBC project initiative, eNewsletters, provider toolkits and annual reports can be accessed at www.hibeacon.org or www.beaconnation.org
Beacon Nation Advisory Committee:
The Beacon Nation Advisory Committee (BNAC) consisted of thirteen nationally recognized leaders representing a broad range of technical expertise and viewpoints related to the Beacon Community program, health IT, and quality improvement. The group provided advocacy, influence and guidance to the project to ensure that content and dissemination work was aligned with the national healthcare landscape.
Members of the BNAC
• Anne Marie Audet, MD, Commonwealth Fund • Amy Berman, John A. Hartford Foundation
• Lisa Bielamowicz, MD, The Advisory Board Company
• Asaf Bitton, MD, MPH, Comprehensive Primary Care Initiative • Susan Dentzer, Robert Wood Johnson Foundation
• Willa Fields, RN, DNSc, San Diego State University and HIMSS • Sachin Jain, MD, Journal of Delivery Science and Innovation
• Harold Miller, MS, Network for Regional Healthcare Improvement • Elizabeth Mitchell, Network for Regional Healthcare Improvement • Michael Painter, MD, Robert Wood Johnson Foundation
• Julie Schilz, BSN, MBA, WellPoint
• Marybeth Sharpe, Gordon and Betty Moore Foundation
• Will Shrank, MD, Centers for Medicare and Medicaid Innovation • Indu Subaiya, MD, MBA, Health 2.0
Six Learning Guides:
A series of six Learning Guides were developed between February 2013 and September 2013 during the HIBC project’s no cost extension period. They are the highlight of the Beacon Nation project filled with actionable information and strategies that can be adapted by hospitals, health systems, individual
practices, clinics and community organizations to assist with advancing community-level health care transformation using health IT. Learning Guides review the challenges and benefits of health IT and essential elements needed for success in multiple markets. Content includes:
• key foundational elements to support successful planning and implementation,
• experiences and lessons learned from the federally-funded Beacon Communities which are presented though strategic and implementation objectives, case studies, process maps and sample documents;
• summary of future opportunities and directions.
Learning Guide Overviews
LG #1: Improve Hospital Transitions and Care Management Using Automated Admission, Discharge and TransferAlerts
The vision of a more coordinated, patient-centered health care delivery system will be driven forward by a more timely exchange of patient information during encounters with the health care system. With an eye toward reducing avoidable hospital readmissions and emergency department (ED) visits and improving care transitions and coordination, several Beacon Communities developed automated alerting programs based on hospital-generated admission, discharge, and transfer (ADT) feeds. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they set goals, planned for implementation, constructed a technical approach, and coached practices on effective workflow redesign to accommodate and use the new alerts to improve patient care. This Learning Guide is designed for communities that have a goal to reduce avoidable ED visits, avoidable hospitalizations, and preventable readmissions and have identified the implementation of ADT-based alerts as a potential strategy to achieve their goals. It is also a useful tool for learning collaborative organizers.
LG#2: Strengthening Care Management with Health Information Technology
By bringing together patient health information from disparate sources coupled with
measurement algorithms and other decision support tools, health IT can play a central role in supporting communities’ efforts to improve the health of patients through care management. With a focus on improving care for patients with chronic disease, several Beacon Communities
invested in new health IT to support care management services across the community. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they set goals, selected appropriate tools, identified the necessary data elements, supported practices
through implementation, and engaged patients in their health. This Learning Guide is designed for communities and learning collaborative organizers that are interested in using health IT to support the integrated and comprehensive delivery of care management services to patients with chronic illness.
LG#3: Capturing High Quality Electronic Health Records Data to Support Performance Improvement
As the industry moves toward value-based reimbursement—reimbursement based on quality and cost measures—improving the quality of the data used for measurement is imperative. With a focus on supporting their performance improvement activities, several Beacon Communities invested in assessing and addressing the quality of data within their EHR systems. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they engaged provider and physician champions, conducted data mapping for selected measures, assessed and improved the quality of data in their EHRs, and established ongoing processes to monitor and address ongoing data quality issues. This Learning Guide is designed for health care providers and learning collaborative organizers that will rely upon EHR data to support performance improvement and new payment models.
LG#4: Enabling Health Information Exchange to Support Community Goals
Electronic health information exchange (HIE) is an important component in improving the quality of care delivered to patients across the country. With the goal of connecting disparate sites and systems to allow information to follow patients, all Beacon Communities strengthened existing or, if required, implemented new technical infrastructure to share health data in pursuit of more coordinated, patient-centered care. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they convened stakeholders, assessed the landscape, created a legal framework for information sharing, developed a technical path forward, and agreed upon metrics to track usage and impact. This Learning Guide is designed for communities and learning collaborative organizers that are interested in using data exchange capabilities to support important goals such as care coordination, care management, quality improvement and aligning payment incentives with value of health care services.
LG#5: Health Information Technology Capabilities to Support Clinical Transformation in a Practice Setting
The increase in health IT adoption brings with it opportunities and challenges to transforming primary care delivery. With new access to information about care that occurs beyond their clinic walls, providers are adapting their practice workflows in order to better care for their patients. Clinical transformation and performance improvement as supported and driven by health IT are key areas of focus for several Beacon Communities. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they engaged practices, assessed readiness, considered practice transformation models, and collaborated on the effective deployment and use of health IT in their communities. The Learning Guide is designed for individual practices, communities, and learning collaborative organizers that are interested in using transformation models and health IT to improve practice performance and care management.
LG#6: Building Technology Capabilities for Population Health Measurement at the Community Level The Affordable Care Act and other health reform activities are advancing the health care system toward a greater focus on provider accountability for a population of patients. With the goal of developing a more complete view of patient health and care, several Beacon Communities
invested in new technology capabilities to enable clinical data aggregation and population health measurement. This Learning Guide distills the experiences and lessons learned from Beacon Communities as they confirmed their goals, engaged community partners, invested in a technology infrastructure, and developed a strong foundation for measuring and improving the health of populations of patients. This Learning Guide is designed for communities and learning collaborative organizers that are interested in aggregating and using data from multiple sources to improve the health of populations of patients.
Communication Tools:
To supplement the Learning Guides, additional materials were developed to assist communities, ally organizations, partners and learning collaborative organizers with understanding and disseminating the content. Executive Summaries for each Learning Guide are available for download from the website. Many of the Beacon Communities participated in interviews for IT and care transitions videos. The ONC has posted five videos on the ONC YouTube Channel. They are also available through links at
www.beaconnation.org. The videos were designed to share with stakeholders the value proposition around several of the Learning Guide themes. All of the videos are a succinct two to four minutes long, and serve as an excellent resource to promote and raise awareness for how health IT can be used to improve health and health care.
Additional materials including sample press releases and newsletter articles, social media samples, slide decks and webinar program outlines were created and submitted to the ONC for future use.
Webinars Conducted with Allied Organizations:
Webinars were part of the menu of tactics to introduce and distribute Learning Guide content to a variety of audiences including Beacon Nation Allies. These allies may include but are not limited to:
• Local health alliances and coalitions • National provider groups
• Hospitals and hospital groups • Ambulatory practices
• Patients and patient advocates • Schools
• Payers, including insurance companies and employers • IT vendors
• Departments of Health and other local government entities
The allied organizations helped to strategize on how to improve health and health IT in their communities and nationally. They also helped to promote the work of the Beacon Nation and continue to spread stories of success.
Webinar Presentations
• Learning Guides Overview: for the Network for Regional Healthcare Improvement (NRHI) [8/19/13]
• Care Management LG#2 included ADT LG#1 and HIE LG#4: for Communities Joined in Action (CJA) [9/18/13]
• Population Health LG#6: for Patient Centered Primary Care Collaborative (PCPCC) [9/19/13] • Learning Guides Overview: for Healthcare Information and Management Systems Society
(HIMSS) [9/20/13]
• Population Health LG#6: for PCPCC Executive Committee [9/23/13]
• Care Management LG #2 to include LG #1: ADT and LG #4: HIE for Regional Extension Centers (REC)[9/27/13]
Workshops Conducted with Innovation Partners:
Innovation Partners were identified through their demonstrated commitment to health IT, frameworks of collaboration, and readiness to implement innovative health IT projects. Innovation Partners possess one or more the following qualities:
• They are undertaking projects similar to Beacon Community projects and seeking experience in these topic areas.
• They are interested in expanding their expertise in a certain topic area/theme.
• They have the capacity and staff available to assist with implementation of Learning Guides materials.
Innovation Partners included:
• Alliance of Chicago - Chicago, Illinois
• Metropolitan Chicago Healthcare Council – Chicago, Illinois
• Coastal Connect Health Information Exchange – Wilmington, North Carolina • HealthLINC – Bloomington, Indiana
• Maimonides Medical Center – Brooklyn, New York • New York Hospital Queens – Queens, New York
• Vermont Health Information Exchange – Montpelier, Vermont
Workshops were designed as working sessions that delved deeper into Learning Guide content and facilitated learning and implementation testing through interactive discussion. Workshops brought Innovation Partners, Allies and their interested stakeholders together with Beacon Faculty. The intent in offering workshops was to empower organizations to begin the implementation process in their home communities and to ensure that they were connected to a community of peers who can help accelerate the implementation process.
Workshops Offered
Office of the National Coordinator for Health IT Fellows
The Office of the National Coordinator for Health Information Technology (ONC) held their Health IT Fellows Fall 2013 class kick-off meeting on September 9, 2013. The Beacon Nation project hosted a break-out workshop during the meeting focused on Learning Guide 2, “Strengthening Care Management with Health Information Technology.”
The ONC’s Health IT Fellows are comprised of clinicians and administrative staff champions who have leveraged Meaningful Use (MU) standards to achieve transformation in the areas of efficiency and innovation within their respective practices. The Fellows, in conjunction with the ONC, aim to support
other providers with overcoming challenges through shared learning and dissemination of their own experiences and lessons learned.
Vermont Health Information Exchange
The Beacon Nation team coordinated with the ONC and several Beacon Community leaders to conduct a workshop with the State of Vermont in Winooski, Vermont. This workshop, held on September 19, 2013, augmented a two-day Vermont Shared Learning Visit. During the workshop, Chatrian Kanger, Senior Evaluation Manager from the Crescent City Beacon Community spoke about data quality evaluation efforts in New Orleans, focusing on primary care providers and FQHCs and how they spread data quality efforts from the city to the state. Ms. Kanger shared processes and tools from the Crescent City Beacon Community’s work to improve practice-level EHR data quality.
Shared Learning Visits:
Shared learning visits offered on-site technical assistance to support adoption and implementation of Learning Guide content. Beacon Faculty, ONC staff and other subject matter experts worked with Innovation Partners to explore how Learning Guide content aligned with the goals and capabilities of the adopting organization. Four shared learning visits were conducted with the following Innovation
Partners:
Coastal Connect HIE – Wilmington, North Carolina
Date August 29 – August 30, 2013On-Site Point of Contact
Yvonne Hughes, CEO, Coastal Connect HIE
yhughes@coastalalliance.org
SLV Support Team
Facilitator:
Roger Chaufournier, Institute for Healthcare Improvement (IHI) Speakers:
Keith Hepp, CFO and VP, Business Development, HealthBridge, Greater Cincinnati Beacon Community (GCBC)
David Kendrick, MD, CEO, MyHealth Access Network, Tulsa Beacon Community David Lobach, MD, PhD, Clinical Informatics Advisor, Southern Piedmont Beacon
Community ONC Lead:
Kerri Petrin, Project Officer, Beacon Community Program Beacon Nation Logistics:
Cristen Bates, Booz Allen Hamilton
Focus Learning Guide 6: “Building Technology Capabilities to Aggregate Clinical Data and Enable Population Health Measurement”.
Day One Impact
• CCHIE has strong stakeholder engagement and a solid group of committed users who are funding the infrastructure. The organization has been disciplined in building out only those services that they can pay for and sustain. Presently, this focus includes results delivery – they have replaced phone calls and faxes with seamless integration of lab result delivery directly into the EHR and implemented closed loop referral tracking. They have also begun work piloting Admission, Discharge, Transfer (ADT) alerts.
• The organization is aiming to provide more value for those already using the HIE rather than trying to expand to new users, which includes the addition of population health analytics services. Day Two Impact
• The Beacon Nation team brought three Beacon Community experts to CCHIE. The dialogue consisted of thoughtful questions and valuable discussion between the experts and CCHIE stakeholders with significant interest in continuing the conversation (and conducting site visits to Cincinnati). In addition to strengthening the connection with senior leaders, opportunities exist to interact with Cincinnati Beacon staff around specific topics.
• Roger Chaufournier’s health system expertise, leadership background and facilitation skill were a perfect fit for the CCHIE group. He contributed significantly to the overall success of the visit.
Metropolitan Chicago Healthcare Council – Chicago, Illinois
Date September 10 – September 11, 2013
On-Site Point of Contact
Chuck Cox, Director, MCHC
ccox@mchc.com
SLV Support Team
Facilitator:
Marie Schall, Director, Institute for Healthcare Improvement (IHI) Speakers:
Craig Brammer, CEO, Healthbridge, Greater Cincinnati Beacon Community (GCBC)
Anjum Khurshid, MD, Director, Health Systems Division, Louisiana Public Health Institute (LPHI)/Greater New Orleans HIE (GNOHIE), Director, Crescent City Beacon Community (CCBC)
Scott Afzal, Program Director, Maryland’s Chesapeake Regional Information System for Our Patients (CRISP)
ONC Leads:
Alex Baker, Project Officer, Beacon Community Program
Erica Galvez, Community of Practice Director, State Health Information Exchange Cooperative Agreement Program
Rhonda Poirier, Sr. Advisor to Deputy National Coordinator for Policy & Programs
Beacon Nation Logistics:
Cristen Bates, Booz Allen Hamilton
Focus Learning Guide 4: “Enabling Health Information Exchange to Support Community Goals.”
Day One Impact
• MCHC explained their technical, financial, and strategic challenges. A pressing immediate concern is the relationship with the Illinois state HIE. Both Beacon Community faculty experts faced the same challenges and had successful experiences with navigating relationships with their state HIE. They strongly encouraged MCHC to differentiate itself and identify how to coexist productively.
• MCHC elaborated that their organization needs to ensure that IT architecture is not short-sighted and emphasized that exchange is most meaningful when built around the region’s needs.
• Erica Galvez (ONC) spoke about MU Stage 2 regulations and how these relate to HIE. Specifically, she reviewed three topic areas of interest: secure messaging, view download transmit, and transitions of care (TOC). Within these topics, she provided further detail around regulations, and addressed questions related to care coordination summaries, the Health
Information Systems Program (HISP), Video Display Terminal (VDT) and non-eligible MU providers.
• Craig Brammer from The Greater Cincinnati Health Collaborative (HealthBridge) indicated that their approach is driving consensus around aims and strategy, enabling connectivity, providing market intelligence for the community and accelerating innovation and creativity. He noted that HealthBridge also faced challenges with the role of the State HIE and the lack of trust between the State and providers.
Day Two Impact
• Stakeholders discussed expectations for HIE implementation. HIE is not solely about technology but also involves cultural and behavioral change at the provider practice level requiring changes to their business processes (e.g., patient consent, data quality).
• A sustainable business model requires operating income and HIE offers many opportunities. All agreed that ADT notifications are valuable enough to providers that they will pay for them, making the feeds an excellent initial offering. Another revenue stream is selling data for public health or research purposes.
• Most of the struggles related to HIE are the same in every state. The discussion was encouraging in that most of the challenges can be overcome.
• MCHC’s thoughtful evaluation of their organization highlighted the following:
− Need to differentiate ourselves and the product we want to deliver - back away from competing with the state and rather focus on what we provide.
− Partnerships are the foundation for success.
− Keep it simple, find a place to begin and be successful. It is easier to sell a product when value can be demonstrated.
− Health system CEOs and COOs need to join the conversation. − Must have a clear value message to physicians.
− The site visit validates MCHC is heading in the right direction.
− There is power in providers coming together to leverage trust in our market.
Alliance of Chicago – Chicago, Illinois
Date September 12, 2013
On-Site Point of Contact
Fred Rachman, MD, CEO, Alliance of Chicago
Frachman@alliancechicago.org
Shared Learning Visit Team
Facilitator:
Barbara Balik, Institute for Healthcare Improvement (IHI) Speakers:
Susan Hunt, CEO and Project Director, Hawai’i Island Beacon Community
Anjum Khurshid, MD, Director, Louisiana Public Health Institute/GNOHIE, Director, Crescent City Beacon Community
Keith Winfrey, MD, MPH, Noela Community Health Center
Jean Wright, Project Director, Southern Piedmont Beacon Community ONC Leads:
Alex Baker, Project Officer, Beacon Community Program
Rhonda Poirier, Sr. Advisor to Deputy National Coordinator for Policy & Programs Beacon Nation Logistics:
Focus Learning Guide 1: “Improve Hospital Transitions and Care Management Using Automated Admission, Discharge and Transfer Alerts”; Learning Guide 2: “Strengthening Care Management with Health Information Technology”; and Learning Guide 4: “Enabling Health Information Exchange Strategies to Support Community Goals”.
Impact
• The Alliance of Chicago has been grounded in bringing EMRs to the Federally Qualified Health Centers (FQHC), and the organization recognizes the need for focused, centralized resources in Chicago.
• The Chicago Health Information Technology Regional Extension Center has a Usability Lab, is working in conjunction with the University of Chicago, performing practice research, and has developed an IT internship program. They are interested in introducing interns to the Learning Guides as part of their experiential training.
• Other interesting programs include HealtheRx and the Qvera interface with the Alliance of Chicago, and Together4Health, LLC contracting with the State Medicaid office for care management services and coordination.
• Knowledge transfer is an important, universal goal for these organizations.
• A challenge facing the larger community is the significant undocumented population not eligible for some services.
• The Alliance of Chicago invested in high-touch coaching interventions, using the TransforMED model. Lessons learned from a practice coach who worked in physician offices include:
− Know how to read the culture and readiness of the practice to transform;
− Use technology to support the coaching effort (e.g. patient registries, scheduling); and − Engage payers in the effort from the start.
Vermont State HIE – Montpelier, Vermont
Date September 19 – September 20, 2013
On-Site Point of Contact
Terry Bequette, State Health IT Coordinator
Terry.Bequette@state.vt.us
Craig Jones, Director, Blueprint for Health
Craig.Jones@state.vt.us
Steve Maier, HCR/HIT Integration Manager
steven.maier@state.vt.us
SLV Support Team
Facilitator:
Roger Chaufournier, Institute for Healthcare Improvement (IHI) Speakers:
Patrick Gordon, Colorado Beacon Consortium (Beacon expert)
Chatrian Kanger, Louisiana Public Health Institute, Crescent City Beacon Community (Beacon expert)
David Kendrick, MyHealth Access Network, Tulsa Beacon Community (Beacon expert) (virtual)
Lynda Rowe, HIT SME (Booz Allen Hamilton) ONCLeads:
Kelly Cronin, Health Reform Coordinator (virtual)
Kevin Larsen, Medical Director of Meaningful Use (virtual) Kerri Petrin, Project Officer, Beacon Community Program Beacon Nation Logistics:
Focus Learning Guide 3: “Capturing High Quality Electronic Health Records Data to Support Performance Improvement” and Learning Guide 4: “Enabling Health Information Exchange to Support Community Goals.”
Day One Impact
• The site visit served as a validation for much of the pathway Vermont has taken with its architecture, roll-out of technology and engagement of stakeholders. The site visit also highlighted similarities with other Beacon and non-Beacon communities with respect to
challenges. The landscape for HIE and interoperability is still evolving and maturing in Vermont and opportunities are available for shared learning from other communities
• Key stakeholders in Vermont appreciate that data integrity management most often r
