Working to improve health in the central Appalachian region through the collaborative use of health information

1. Working to improve healthin the central Appalachian region through the collaborative use of health information CareSpark was incorporated as not-for-profit organization in 2005, established as a Regional Health Information Organization to develop and implement a collaborative system for health improvement. CareSpark was incorporated as not-for-profit organization in 2005, established as a Regional Health Information Organization to develop and implement a collaborative system for health improvement.

2. In our region, we have been collaborating on health improvement efforts since 1991. We had an existing coalition of health providers, payers, employers, community leaders working together through a neutral, trusted third-party organization.In our region, we have been collaborating on health improvement efforts since 1991. We had an existing coalition of health providers, payers, employers, community leaders working together through a neutral, trusted third-party organization.

3. Define the medical service area: ours was defined by determining the referrals to our tertiary care hospitals.Define the medical service area: ours was defined by determining the referrals to our tertiary care hospitals.

4. Define the problem(s): ours is poor health, with significant disparities from other regions of the country for diabetes, heart disease, stroke, asthma, certain cancers and premature death for those ages 45-60.Define the problem(s): ours is poor health, with significant disparities from other regions of the country for diabetes, heart disease, stroke, asthma, certain cancers and premature death for those ages 45-60.

5. Being a data-driven effort, our team and our community wants to see facts and numbers.Being a data-driven effort, our team and our community wants to see facts and numbers.

6. Worst Health Status in U.S. Drives Estimated $2,400 Cost PMPY Another problem identified: the higher cost of health care per capita than in other portions of the country.Another problem identified: the higher cost of health care per capita than in other portions of the country.

7. National Health Expenditures per Capita While our region is among the worst in the nation, the entire country does not rate particularly well against other industrialized countries. The high cost of health care makes it difficult for our businesses to remain competitive in a global marketplace.While our region is among the worst in the nation, the entire country does not rate particularly well against other industrialized countries. The high cost of health care makes it difficult for our businesses to remain competitive in a global marketplace.

8. Final part of problem: fragmented delivery system, cross-jurisdictional multi-state authoritiesFinal part of problem: fragmented delivery system, cross-jurisdictional multi-state authorities

9. These partners were engaged financially, with leadership, provided information and expertise, and advocacy. Who is missing? Patients / advocatesThese partners were engaged financially, with leadership, provided information and expertise, and advocacy. Who is missing? Patients / advocates

10. Strategic Planning Process The process was governed by a steering team working under the umbrella of Kingsport Tomorrow, which soon became an interim board, guiding the work of five workgroups which involved 80 people from more than 30 organizations. We also contracted with national leaders in the areas of technology, legal and financial expertise, and were one of nine communities to receive a grant of $100,000 seed monies for health information exchange.The process was governed by a steering team working under the umbrella of Kingsport Tomorrow, which soon became an interim board, guiding the work of five workgroups which involved 80 people from more than 30 organizations. We also contracted with national leaders in the areas of technology, legal and financial expertise, and were one of nine communities to receive a grant of $100,000 seed monies for health information exchange.

11. Develop shared mission, vision, strategy, planDevelop shared mission, vision, strategy, plan

12. We have approached this project differently from most other communities, because we started from the perspective of urgent need to improve regional public health status, then worked backwards to define what we need to do. We worked backwards to identify the components of our strategy.We have approached this project differently from most other communities, because we started from the perspective of urgent need to improve regional public health status, then worked backwards to define what we need to do. We worked backwards to identify the components of our strategy.

13.  Office of the National Coordinator for Health Information Technology (ONCHIT) As it happened, our efforts were converging with discussion and initiatives at federal and state levels.As it happened, our efforts were converging with discussion and initiatives at federal and state levels.

14. Targeted health issues We are targeting the health issues of greatest impact on quality of life and cost: Diabetes Hypertension / stroke Cardiovascular disease Lung disease / asthma Preventive immunizations / screenings Physicians and nurses on the clinical team, along with public health officials, laid the foundation for our planning by determining those health areas with the greatest cost and the greatest impact on the patient�s quality of life.Physicians and nurses on the clinical team, along with public health officials, laid the foundation for our planning by determining those health areas with the greatest cost and the greatest impact on the patient�s quality of life.

15. Tactical plan To address health issues, we propose to provide technical capability and encourage clinical process improvement in the following areas: Prescription Medication Diagnostic (lab, imaging) Services Preventive Medicine (immunizations / screenings) Chronic disease management After looking at the top health issues for our region, our clinical team then determined what information was needed to improve patient outcomes in those areas. Our technology workgroup then defined ways to deliver that information, even as our finance workgroup was calculating the cost and the potential savings from each.After looking at the top health issues for our region, our clinical team then determined what information was needed to improve patient outcomes in those areas. Our technology workgroup then defined ways to deliver that information, even as our finance workgroup was calculating the cost and the potential savings from each.

16. Medication and Diagnostic Services Improvement Savings Model Projections* One of the first questions asked was, �How will we pay for this?� We had to estimate costs, savings, then funding model as part of our overall strategic plan.One of the first questions asked was, �How will we pay for this?� We had to estimate costs, savings, then funding model as part of our overall strategic plan.

17. Opportunity: Programs Covered In This Model Medication Improvement 1st of several �layers� 3-year cost: $12.6 M Technology required Web-based electronic health record with e-prescribing capabilities Health Information Exchange not required Diagnostic Services Improvement 2nd of several �layers� Small incremental cost: $2.7M Technology Physician Order Entry Module required Health Information Exchange required Beginning with the first two �layers� requested by clinicians, we researched costs, savings and technical requirements for our proposed infrastructure.Beginning with the first two �layers� requested by clinicians, we researched costs, savings and technical requirements for our proposed infrastructure.

18. The proposed technology is envisioned as a central server which carries out three functions: checking for authorization to access the data; finding all the records for an individual across multiple databases in various locations; and reporting the results of the query back to the one who requested the information. The system does NOT put all health records into one central database; it does keep a record of who accessed which records when, a system more secure and more accountable to the patient than paper records currently in use. Providers can access the exchange, so long as they have a computer with broadband access to the internet. A trusted entity (public health, medical school, or other) will be authorized to query �de-identified� patient data for the purpose of monitoring and targeting public health improvement.The proposed technology is envisioned as a central server which carries out three functions: checking for authorization to access the data; finding all the records for an individual across multiple databases in various locations; and reporting the results of the query back to the one who requested the information. The system does NOT put all health records into one central database; it does keep a record of who accessed which records when, a system more secure and more accountable to the patient than paper records currently in use. Providers can access the exchange, so long as they have a computer with broadband access to the internet. A trusted entity (public health, medical school, or other) will be authorized to query �de-identified� patient data for the purpose of monitoring and targeting public health improvement.

19. Cost-Benefit Projections* Our research demonstrated that if we develop and deploy clinical improvement programs, financial incentives in conjunction with technology, we can conservatively expect to become financially viable after in the second year of operation, when 60% of physicians are participating in the system.Our research demonstrated that if we develop and deploy clinical improvement programs, financial incentives in conjunction with technology, we can conservatively expect to become financially viable after in the second year of operation, when 60% of physicians are participating in the system.

20. 3 Year Incentive Scenario Summary Funding model was developed on principle of �shared investment, shared return proportionate to investment�. All benefit: providers, purchasers, community and other investors.Funding model was developed on principle of �shared investment, shared return proportionate to investment�. All benefit: providers, purchasers, community and other investors.

21. Progress to Date Technical inventory and feasibility study completed Strategic business plan developed Non-profit organization formed, board of directors in place Funding commitments of $77,500 (May 2005) We just completed the strategic plan in April 2005, and the new board met in May to begin working on hiring of staff, funding for technical and legal expertise for the next phase. We just completed the strategic plan in April 2005, and the new board met in May to begin working on hiring of staff, funding for technical and legal expertise for the next phase.

22. Next Steps Finalize partnership agreements (May � July 2005) Secure $3M in funding for development and execution through June 2006 ($600K by July 1, 2005; $2.4M by Sept 1, 2005) Secure staffing for development and operations (Executive Director, administrative assistant, project manager) by June 1, 2005 Define technical specifications, conduct vendor selection process (July � Aug 2005) We obviously have lots of work to do in the next few months, so turn our plan into reality. We hope to have adequate funding to begin the medication improvement layer in 2005, even as we are building the technical infrastructure for health information exchange. In the meantime, we are planning for rollout and communication to 250 physicians and 250,000 patients. We obviously have lots of work to do in the next few months, so turn our plan into reality. We hope to have adequate funding to begin the medication improvement layer in 2005, even as we are building the technical infrastructure for health information exchange. In the meantime, we are planning for rollout and communication to 250 physicians and 250,000 patients.

23. Improving health in Central Appalachia www.carespark.com Contact Liesa Jenkins, Project Director 423-246-2017 ljenkins@carespark.com