The Middle Tennessee eHealth Connect

Nashville Technology Council

August 26th, 2010

www.midtnehealth.com

The Middle TN eHealth Connect (MTeHC)

Historical summary of activities: 2007-2008-2009 Our work in: 2010 Future plans: 2011 and beyond

MTeHC

Mission Middle Tennessee eHealth Connect improves the effectiveness and

efficiency of healthcare delivered to every member of the community without regard to payer by connecting healthcare providers throughout Middle Tennessee.

Vision Middle Tennessee eHealth Connect will improve the amount and

quality of patient health information through secure access leading to measurable improvements in clinical outcomes, quality of care and cost effectiveness to benefit patients, families, providers, payers, employers, and the public health.

History of the Middle Tennessee eHealth Connect - 2007

Informal meetings were held throughout the year to discuss the possibility of data exchange.

Bob Gordon presented to a Middle Tennessee group on the start-up of the Memphis exchange.

Leadership from St. Thomas, Nashville General, TriStar/HCA and Vanderbilt University Hospital signed a Memorandum of Understanding.

History of the Middle Tennessee eHealth Connect - 2008

Reggie Coopwood, MD as convener and later as Chairman of the Board

Regional Informatics as facilitators of the process February 4th planning session Work Groups were established Charge given by the Board to investigate the possibility of

“piggybacking” on the Memphis Exchange 3-4 months of work ensued with a decision to adopt the

governance model

History of the Middle Tennessee eHealth Connect - 2009

Work began to define a sustainability model for Health Information Exchange.

Members of our team developed a proforma modeling tool to look at multiple ways to fund the exchange.

The question is “who receives value from the existence of the exchange?”

Bylaws were adopted and the Middle Tennessee eHealth Connect was incorporated as a non-profit.

ARRA was passed by Congress. MTeHC issued an RFP in July. HIP TN activities began in August/September timeframe. Request came to MTeHC to stop vendor selection process.

History of the Middle Tennessee eHealth Connect – 2010 (Jan-June)

MTeHC re-started the process to build an exchange MTeHC received $150,000 grant from Cigna The MTeHC Board (with assistance from the Tennessee

Hospital Association) studied ED utilization in Davidson County

The Board decided to investigate whether joining with Memphis on the ICA infrastructure would help in keeping costs low.

Dr. Coopwood departs to Memphis (The MED) Larry Kloess (TriStar) becomes the Chairman of the Board

Middle Tennessee eHealth Connect 2010 Currently…

We expect to sign a Community Amendment to Memphis/ICA Core Service Agreement within the next 45 days.

MTeHC will be a second HIE operating on the same infrastructure as Memphis gaining some economies of scale.

Middle TN and Memphis data will not be co-mingled. We will adhere to the idea that we must keep technology

and operational costs low in order to be sustainable. Work Groups are, once again, active in their respective roles.

Looking Ahead to Upcoming Activities

Office of eHealth offers state planning grant to create a business plan

Gives MTeHC the opportunity to engage in a strategic planning process

Plan will also include a goal for expansion of Board membership to be representative of the cross-section of our community

Other HIEs (planned and operational) will also be creating their business plans.

2010 Current Governance & Infrastructure Board of Directors

Larry Kloess – HCA/TriStar Health System, CEO (President & Board Chair)

Wes Littrell – Saint Thomas Health Services, President & CEO STHS Affiliates/Chief Strategy Officer

Jason Boyd – Nashville General Hospital, Interim CEO Larry Goldberg – Vanderbilt University Hospital, CEO Craig Becker – Tennessee Hospital Association, President Kasey Dread – Nashville Academy of Medicine, Executive Director Dr. Clifton Meador – Safety Net Consortium/Meharry-Vanderbilt

Alliance, Executive Director State of TN Metro Government of Nashville & Davidson County

Project Management Office Regional Informatics at Vanderbilt (independent) We operate under strict guidance from the board

Why do this? We have access issues and will continue to have access issues. We have people who move from care setting to care setting

regularly. We have overuse problems across all payer types. We have primary care and non-emergent care being delivered

in high-cost Emergency Department settings. We believe HIE can support care improvements through the

provision of health information required to support measurable improvements and efficiencies in the health of populations.

Our evaluation plan in Memphis is not yet published but will show some benefits.

Initial Stakeholders of the MTeHC

(Patients and their families are the focus of the Middle Tennessee efforts)

These organizations either provide care or support the care delivery process. Ambulatory Providers Safety Net Clinics Hospitals Employers Heath Plans Government (as a payer and an employer)

Initial Work Initially

Availability of information at Hospitals and Safety Net Clinics

ARRA – Medicare & Medicaid Meaningful use incentives

Growth Aggressive expansion of data from other providers with

expanded access Northern border to Southern Border in Middle TN

Other Possibilities Patient Centered Medical Home ACOs Population Health Research

MTeHC HIE General Architecture – Data Handling

Hospital 1

Hospital 2

Clinic 2

Clinic 1

ICA Parsers

Clinical Results, Encounters, and Patient Demographics

Platform Management

Clinical Repository

StarChart/ MySQL

ICA

Demographics Repository

MySQL ICA

Patient Matching

Perl/ Linux ICA

Provider Portal Care Align ICA

Clinical Parsers Perl / Linux ICA

Demographics Parsers

Perl / Linux ICA

Encounter Summaries

Laboratory Results

Discharge Summaries

Examples of data in the Exchange

Potential Benefactors of Exchange Patients

Decreased duplicate testing, Out Of Pocket expenses, Opportunity Costs, Radiation exposure Data can be accessed across multiple providers More opportunity to be informed about their care

Clinicians/Providers Immediate access to patient information from other institutions Reports that obviate the need to order tests Safer transitions in care Lower costs burden of quality reporting

Employers Reduced utilization of services Lower costs to insure employees Reduced medical spending associated with adverse events (such as hospitalizations)

Government Lower costs of Medicare and Medicaid care delivery Public Health Measure and track health improvement initiatives through research and public programs Track influenza outbreaks

Sustainability Strategieso Goal is to have those that benefit, pay in proportion to the

benefit receivedo Areas of potential benefits to payers and employers:

Disease management (e.g. Diabetes, asthma) Specific populations (e.g. Obesity) Pain management Workman’s compensation

o Identify segments of the population where government benefits from the system (e.g. Medicaid, uninsured/safety net, employees)

o Identify non-government payers (large payers, self-funded employers and health plans)

Critical Success Factors – Lessons Learned Maintain and Grow the Coalition

Across delivery settings Northern border-to Southern border

Board Leadership Expanded and Engaged

Ops Management Keep Technology and Operations costs low Low Barrier to participate technically

Strong Community Identity Perception Participation Supporting the right care at the right place

Leverage strong Nashville Healthcare Market identity

www.midtnehealth.com