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Population Health: A Sustainability Strategy for a Disease Registry?

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. Outline. The Santa Cruz Story Innovation & Collaboration Vision: Community-wide Diabetes Registry

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Population Health: A Sustainability Strategy for a Disease Registry?

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

  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. Innovation: Clinical Messaging • 1995 IPA partnered with Axolotl Clinical Messaging • 2000 web-based  expansion private physicians • 2004 County clinics including mental health • 2005 Community Health Centers 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 Build on strong history of collaboration and innovation! • Expand current IPA diabetes point of care registry to ALL providers • Test point of care registry 1st step EMR • Build community-wide database • Outcomes: • Higher standard of care consistent across the County • Track diabetes population in the aggregate Dr Wells Shoemaker AHRQ Grant: Santa Cruz County, CA Diabetes Mellitus Registry (DMR), 2004-2007 Name of handshake collaborative.

  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* • Action Reports for individual providers (turf wars) • Community Database for Population Health • Community Patient Lookup • Performance Reports with Benchmarks • Performance Reports for Payers • Point of Care Tool • 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

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