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ONC ‘Deep Dive’ Call

ONC ‘Deep Dive’ Call. Wednesday, October 6. AGENDA. Introductions. Leadership/Stewardship Dr. Christopher Chute. SE MN Beacon Organization. Dept. of Health & Human Services (DHHS). Federal Steering Committee (FSC) - TBN. Office of the National Coordinator of Healthcare IT (ONC).

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ONC ‘Deep Dive’ Call

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  1. ONC ‘Deep Dive’ Call Wednesday, October 6

  2. AGENDA

  3. Introductions

  4. Leadership/Stewardship Dr. Christopher Chute

  5. SE MN Beacon Organization Dept. of Health & Human Services (DHHS) Federal Steering Committee (FSC) - TBN Office of the National Coordinator of Healthcare IT (ONC) Community Interest Groups National Beacon Communities Evaluation MN Congressional Offices SE MN Beacon Governance Approval to Execute SE MN Healthcare REOT Winona Health Leadership Public Health Leadership Olmsted Medical Leadership Mayo & Mayo Health System Leadership CPC CPQOC SE MN Public Health Planning Process Stakeholders Operations Communications Subject Matter Expert WGs Program Management Infrastructure Metrics Comparative Effectiveness SE MN Schools Project Initiation Process Practice Implementation Community & PH Engagement Quality Academy Others Cross Beacon / ONC Projects Project Driven teams Project Execution HIE Connectivity Data Repository Broad- band Mini- deliberative LPH / Schools Asthma Phase 1 Diabetes Phase 1 Immun. Pilot

  6. Infrastructure / Meaningful Use Calvin Beebe

  7. High Level Data Flows A D Sources of A CCD, Action Plans CCD, Action Plans CCD, Action Plans Surveillance Rpts Surveillance Rpts Various Reports Batch Data / HL7 (LIFT managed) B E B C D E C F F G G SE MN Server

  8. Data Flow Mapping PMS: Population Management System

  9. Repository Requirements Correlate patients, students, and PH cases Identified & anatomized patient access Merge & unmerge patient EMR data to accurately identify patient’s for clinical care. Support complex access authorization matrix to protected patient information Easy access to various authorized data sets for reporting and analytics requirements Secure, audited, scalable, cost efficient …

  10. Infrastructure Components • CONNECT 3.1 (Doc. Exchanges) • w/ HIEOS Open Source • MIRTH Connect (Repository Loader) • Interface Engine Open Source • SE MN Beacon Data Repository options: • Regenstrief INPC Open Source • Mirth Results Open Source • Amalga Microsoft Corp • Regenstrief & Mayo are evaluating the use of a common repository data model (A,B)

  11. Activities over 90 Days • CONNECT Code A Thon Rochester, MN • Mayo Health System Population Mgt. • Mayo Clinic Data Trust Mgt. • Public Health Department Review of PH-Doc • Winona Health Service Deep Dive Review

  12. Plans moving forward • Complete assessment of high level functional & technical requirements for School Nurse Portal solution. • Determine solution provider (MN-HIE / Mayo) • Review repository requirements with Regenstrief • Select repository solution for SE MN Beacon project • Specify & acquire server hardware & software assets. • Establish CONNECT implementation timelines for each site, work with MN-HIE to obtain security certificates. • Utilize a mix of SE MN Beacon staff and consulting complete needed development, configuration and implementation of SE MN Repository & CONNECT network

  13. Broadband John Goodman

  14. WCTN Partners Primary Partners wireless Video # of Network Connections Phone Networks Internet Hiawatha Headend Facility - Central Vidyo Servers • Winona Health • - Hospital and Clinics • - Assisted living • Nursing Home • Home Care • Hospice • A-Vu Media • Project Management • Broadband Projects 80-120 Hiawatha Broadband - High Capacity fiber Network - VPN connections • Older Adult • Residential Services • St. Anne of Winona • Sauer Memorial • 260 Residents • 70 Diabetics 8-12 20-40 • Home & • Community Options • - Services to the disabled • Remote residential • management 11-20 7-16 • Education • Winona Public Schools (K-12) • St. Mary’s University • Cotter schools • Other Community • Winona County Services • Winona Housing & Redevelopment • County Jail • Project Fine Community Partners 14

  15. Broadband Technologies Major technologies employed: High capacity community based broadband networks Multimedia pc’s networked with encrypted VPN connections Proprietary video conferencing technology with custom UI’s Shared access telemedicine e-suites and kiosks Key implementation areas requiring assistance in SE MN: Final design and implementation of the telemedicine e-Suites. Security requirements to achieve HIPAA compliance for community broadband locations. EMR data base access from telemedicine sites. Medical protocols for initial Juvenile Asthma and Diabetes program implementation. Research structure for meaningful use assessment. Major vendors involved: Vidyo/Phoenix Systems/ Logitech - Hiawatha Broadband Cerner - A-Vu Media

  16. Broadband Technologies Past 90 days: 1. Implemented Vidyo central server application at HBC. 2. Defined the proposed WCTN and its community partners. 3. HCO State License for Remote Monitoring. 4. HCO designed medication compliance application for Remote Monitoring Next 90 days: 1. Winona health network plan and Phase 1 implementation. 2.Telemedicine prototype with custom UI development project. 3. Define initial medical plan for Diabetes and Juvenile Asthma 4. Implement HCO medication compliance application Major risks: 1. WH staff time needed for program implementation. 2. Unexpected technical issues to develop custom UIs. 3. Delays in hiring additional technical staff funded by Beacon.

  17. Public Health / School Engagement Mary Wellik

  18. LPH/School Engagement Key Stakeholders: Public Health Directors, County Boards, School Boards, & School Nurses Goal: Beacon provides a unique opportunity for providers and these extended providers to come together in the region to explore alternative models of care particularly in the areas of childhood asthma and diabetes. Objective: To initiate this relationship, introduce the Beacon program and acquire input into the Beacon provider model network.

  19. LPH/School Engagement Last 90 days: • Letters to Public Health Directors • Ph-Doc Users group presentations • Public Health Directors Teleconferences w/ media Kits • County Board presentations – all 11 counties • LPH participation in all projects (infrastructure, asthma, diabetes, etc.) Next 90 days: • Letters to each school district (~47) • School Board presentations & School Nurse engagement • Refine requirements of school participation & input into provider network model

  20. Deliberative Democracy Dr. Barbara Koenig

  21. Deliberative Community Engagement Overarching Goal: Deliberative community engagement will allow SE Minnesota BEACON leaders to incorporate community values into project design and governance

  22. Considerations • Need to balance scientific and technical gains with social concerns -- not just a technical issue, but a social and political one • Need to address these issues in an open, informed manner, engaging the community before implementation

  23. Deliberative Democracy Examples • Trial by jury (citizens’ jury) • environmental risk • Extended to inquiry into contentious issues in science and technology • CDC & MN Dept of Health on avian flu pandemic planning (resource allocation) • British Columbia, Canada • Voting Methods

  24. Deliberative Democracy Goals • Goal is not just to “inform” or “educate” the community • Not a series of focus groups! • Seeks genuine discussion among representative community members, and, • Citizens make non-binding recommendations about implementation, governance, & long-term community oversight

  25. Deliberative Democracy Goals • Not simply to let different perspectives or points of view be expressed, but, • To make real trade-offs and compromises, encouraging the formulation of recommendations to guide interventions and EHR data use

  26. Large Group Deliberation

  27. Small Group Sessions

  28. Deliberative Community Engagement Past 90 Days: • Dependency: County Board Endorsements • Logistics of engagement activities (2 part structure) • Developing content & speaker guides • Coordination with public affairs/communications Next 90 Days (4 Community Discussions): • Oct 30: Rochester – (Seat of Olmsted County) • Oct 31: Winona – (Seat of Winona County) • Nov 13: Red Wing – (Seat of Goodhue County) • Nov 14: Austin – (Seat of Mower County) • Based on above, plan “full engagement” for spring 2011

  29. Deliberative Community Engagement Key Features of Initial Events: • Representative sample of disinterested lay participants • Involve “local conveners” • Professional moderators • Expert stakeholders available (as consultants) • Privacy, Promise of enhanced EHR, etc.

  30. Asthma Intervention Dr. Barbara Yawn

  31. Asthma Intervention Initiation—Clinical Transformation Milestones: Established cross-region asthma focus project team Identify initial asthma intervention (begin with AAP) Discuss longer term asthma intervention requiring widespread EHI support Next 90 days: Identify schools and health care facilities willing to participate. Identify appropriate AAPs and methods to share Identify champions in schools and healthcare sites

  32. Risks • Lack of time and interest by clinical staff • Failure to identify appropriate contacts such as parent champions • Declaring victory too soon

  33. Asthma Data and performance metrics • Milestones completed • Sent in baseline data from 3 sites • Began discussion with MN Community Measures • Considered patient reported metrics • Milestones next 90 days • Develop intervention related metrics • Develop outcome metrics • Develop community acceptable patient reported metrics

  34. Asthma data and Performance metrics • Risks • MN Community Measure denied request for research exemption • Reluctance to require another clinical endeavor without clear results to suggest this will make a difference in outcomes • People still living in their silos

  35. Diabetes Intervention Dr. Victor Montori

  36. Patient centered diabetes care Goals To know - at any time - what is the quality of life and functional status (along with disease control metrics) of patients (described by their demographic and health literacy characteristics), in SE MN. To implement tailored patient decision aids to enhance patient involvement in clinical decisions about primary and secondary prevention of cardiovascular events.

  37. Patient centered diabetes care Approach – health measures Collect health literacy, health-related quality life and functional status information at the point of care (public health nurse visit, clinics and hospitals) and at the point of existence (home, workplace). Using these data will enable: The SE MN Map of Diabetes Control, Health and Function Stratification of patients by patient-reported and disease-control measures and health literacy for prioritized/tailored interventions

  38. Patient centered diabetes care Approach – decision aids Implement the following patient-tailored decision aids into the Beacon-integrated electronic environment, for use during patient-clinician interactions of different types: - Statin Choice (primary prevention) - Aspirin Choice (primary prevention) - Diabetes medication cards (A1c target + drug selection) - AMI Choice (secondary prevention) Capture use and outcomes in usual clinical settings across the continuum of care

  39. Patient centered diabetes care Deliverables/Milestones (Phase 1) 2010 Sep - Constitute cross-region diabetes group Oct - Resourcing & planning Nov - Design health + literacy metrics (PRO), decision aids (DA) 2011 Feb - Pilot implementation of PRO collection and DAs Mar – Check ease, rate of use; data quality; iterate and scale up Later - Display diabetes map, assess correlations, evaluate impact of DAs and other interventions on health and function

  40. Elements of success (or its opposite) Dependencies Phased technology infrastructure Engagement of public health and other partners Potential Collaborations Center for innovation, KER UNIT, Healthcare delivery research program, Beacon partners Risks Constrained resources, tight timelines, large community. Inadequate evaluation Patient centered diabetes care

  41. Immunization Pilot Dr. Rajeev Chaudhry

  42. Mayo Clinic Immunization PilotData & Performance Measurement Goal: Pilot to utilize HIT to improve Influenza and Pneumonia vaccination delivery for patients with Asthma and Diabetic patients in primary care practices. Baseline data for one primary care practice: Asthma Influenza rate = 53% Asthma Pneumonia vaccination rate = 38% Diabetic Influenza rate = 55% Diabetes Pneumonia vaccination rate = 75% Scope: To test utilization and efficacy of a newly developed population based HIT system ( advanced registry--Amalga) for improving delivery of immunizations for asthma and diabetic patients To test utilization and efficacy of a newly developed point of care Clinical Decision Support System (GDMS) to improve practices to deliver vaccinations for patients seen in the clinic with Asthma and Diabetes To learn from the pilot the primary care practices needs for HIT to advance the care of patients with chronic conditions.

  43. Mayo Clinic Immunization PilotData & Performance Measurement Past 90 days: Identified baseline metrics for asthma and diabetes patients using HIT across SE MN practices Completed development of a point of care decision support system (GDMS) to identify patients with chronic conditions and provide decision support for providers for adult patients who need vaccinations during any visit in practice Completed development of a population management system (Amalga) to identify population of patients who are due for vaccinations for a primary care practice. Integrated the system with state registry. Initiated planning for a pilot with current HIT for vaccination needs for patients with Asthma and Diabetes for 2010 flu season Next 90 days: Initiate pilot at one practice with current HIT Employ PDSA cycles to optimize processes of care and also to enhance the HIT for SE MN Beacon population management Invite all practices in SE MN to initiate pilots during current flu season with their existing HIT Study impact of HIT on delivery of vaccinations to at risk population Identify opportunities to enhance HIT ( SE MN repository for population management and reporting) and processes of care for vaccinations delivery Test utilization of patient portal to notify patients and provide online access for care Study patient preferences for notification, access and vaccination delivery

  44. Mayo Clinic Immunization PilotData & Performance Measurement Risks: Inadequate vaccination supply Lack of adequate access at practices to accommodate the patients who need vaccinations (access for patients, convenience, hours of operation for vaccination administration) HIT unable to serve the needs of practices at both point of care and population level Inability to reconcile vaccination information from other sources (e.g. retail vaccination administration and other practices) Capacity of practice to utilize new HIT and incoporate process redesign Lack of standardization of processes among practices Patient Portal ability to alert patients and provide online access

  45. Clinical Transformation Types of resources are available: Study impact of HIT on care delivery ( Health Care Policy and Research) SE MN Beacon team for sharing pilot results (lessons learned etc.) with partner practices Quality academy for multi disciplinary teams that need training Provider landscape: Group practices ( Mayo Clinic Rochester , Mayo Clinic Health System, Winona Health, Olmsted Medical Center) Public Health Next 90 days: Immediate goals are to apply processes and HIT point of care clinic decision support systems and population management systems in primary care practices that will impact immunization rates

  46. Sustainability/Payment Reform Dr. Douglas Wood

  47. Sustainability & Payment Reform Experience: • Minnesota has now implemented coordination of care payments for practices that have been certified by the state dept. of health as health care homes (started 7/1/2010) • Minnesota has implemented baskets of care, or episode based payment, for several conditions, including pediatric asthma and pediatric preventive services, effective 3/1/2010 • Next Minnesota payment reforms will come in 2012 (in planning now) Engaged partners: • Minnesota has an active effort underway in the Health Care Access Commission (work groups appointed by the legislature) to evaluate additional payment models to incorporate into exchange (s) by 2012; this includes legislators, large systems, health plans, physicians, large businesses Milestones: • No new payment reform implementations have occurred in the past 90 days, nor are planned in the immediate next 90 days. Risks: • Biggest current risk for payment reform in Minnesota is the November election, where all state office holders and the entire legislature are up for election; the outcome could influence direction of state implementation of health care reforms

  48. BEACON WEBSITE www.semnbeacon.org

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