Communities and

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Communities and Practice-Based Researchers Succes
s Stories in Collaborative Translation
Susan Chauvie, RN, MPA Chief Clinical
Officer OCHIN
Mark Spofford, PhD Manager, Community-Based
Research KPCHR OCTRI
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A Collaboration Success Story!

• OCHIN and SafetyNetWest

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OCHINPurpose

• OCHIN is a not for profit organization that
  functions as a collaborative or co-op to provide
  health information systems, information, data
  management, clinical and operational quality
  improvement activities, administrative,
  management, consultative services and research
  opportunities to public and community health
  clinics caring for medically vulnerable families
  who live in poverty.

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OCHINMission
T

• o improve the health of the medically underserved
  through the best use of information and
  information technology.

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OCHIN

• Formed 2001
• 501(c)(3) Not for Profit
• Collaborative
• Leverage resources to do together what is not
  possible alone.

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OCHINHealth Center Controlled Network (HCCN)

• Networks controlled and acting on behalf of
  health centers as defined and funded under
  Section 330(e)(1)(C) of the Public Health Service
  Act and must consist of at least 3 collaborator
  organizations. The purpose is to ensure access to
  health care for the medically underserved
  populations through the enhancement of health
  center operations, including health information
  technology.

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OCHIN

• Integrated system of health information
  technology and information for a growing network
  of Community Health Centers
• Single hardware instance
• Enterprise wide Master Patient Index (MPI)
• Practice Management (Registration, Scheduling,
  Billing)
• Electronic Health Record
• Quality improvement, sharing of best practices

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OCHIN

• Integrated system of health information
  technology and information for a growing network
  of Community Health Centers
• Organized Health Care Arrangement (OHCA)
• Quality improvement activities Best Practices
• Member workgroups
• Research - PBRN

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OCHINOrganized Health Care Arrangement

• ...(2) An organized system of health care in
  which more than one covered entity participates,
  and in which the participating covered entities
• (i) Hold themselves out to the public as
  participating in a joint arrangement and
• (ii) Participate in joint activities that include
  at least one of the following
• Utilization review, in which health care
  decisions . . . are reviewed by other
  participating covered entities...
• Quality assessment and improvement activities, in
  which treatment provided...is assessed by other
  participating covered entities... or
• Payment activities, if the financial risk for
  delivering health care is shared, in part or in
  whole,...through the joint arrangement and if
  PHI created or received by a covered entity is
  reviewed by other participating covered
  entities...for the purpose of administering the
  sharing of financial risk....
• 82822 Federal Register / Vol. 65, No. 250 /
  Thursday, December 28, 2000 / Rules and
  Regulations

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OCHINProvider Demographics

• 27 organizations
• Oregon, California, Washington, Illinois
• 600,000 patients
• 200 clinic locations
• 5000 end users
• 1000 providers
• 1.5M annual visits

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OCHINPatient Demographics

• 91 lt200 Federal Poverty Level
• 46 uninsured
• 35 Medicaid-uninsured churn
• 37 racial/ ethnic minority
• 30 rural
• 72 women and children
• 85 of Oregon FQHC patients

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SafetyNetWest

• PBRN of clinics and providers who are members of
  the OCHIN network.
• SNW Mission
• To improve the health of underserved populations,
  enhance their quality of care, and inform health
  policy through research.

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SafetyNetWest A UNIQUE PBRN

• Uniform dataset across all member organizations
• Located in community-based organization vs.
  academia
• Data stewardship complexity
• Board of Directors
• Security, HIPAA adherence
• Business Associate Agreement (BAA)
• Sensitivity related to data control, politics,
  trust

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SafetyNetWest is born

• SNW Steering Committee
• Charter
• Mission purpose
• OCHIN clinic membership- clinical and operational
• OCHIN membership
• Researcher membership
• Communications plan
• Scientific Review Committee
• OCHIN Board oversight /communications
• Researcher recruitment letter

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Other Partners to the Collaboration

• Kaiser Permanente Center for Health Research
  (CHR)
• Part of KPNW Group Model HMO
• Member of HMO Research Network
• Oregon Clinical and Translational Research
  Institute (OCTRI)
• Partnership between OHSU and KPNW
• One of first funded CTSAs
• Other interested parties
• Care Oregon Medicaid HMO
• Portland State University
• State Offices (Health Human Services, Medicaid)

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Early Developments

• Initially OCHIN focused on growing network
• OCHIN growth database growth
• Emergence of research interests
• OCHIN mission supports research, but how, when?

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Drivers of Collaboration Research Community

• Increased research emphasis on representative
  populations (ethnic minority, underserved, rural)
• CTSA
• Unique health dataset of OCHIN
• Number of potential clinics in SafetyNetWest

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Drivers of Collaboration OCHIN/Practice Community

• Sophistication of Kaiser Permanente in using Epic
  for improving care and conducting research
• Could research help fund development/spread of
  EMR in the clinics?
• Health Services Researchers and Bioinformatics
  Researchers can help us figure out how to use EMR
  to improve care and demonstrate quality of care
  delivered in safety net.

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Early Developments Cautions

• OCHIN doesnt own member data. It serves as
  the steward and advocate of the data.
• Everyone wants the data
• But, who gets access, for what purpose, and who
  decides?
• What risks to the clinics and controls over how
  data get interpreted?

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OCHINParticipate in Research?

• Network role
• Board role
• Member Business Associate Agreements
• Infrastructure

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Keys to Collaboration

• Built on Relationships
• EPIC
• Provincialism of Oregon
• Unique health dataset of OCHIN
• Interests of community practitioners

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Facilitators of Collaboration

• CHR and OCHIN partnering to produce legal
  requirements (BAA Amendment FWA)
• CHR, later OCTRI, funding of pilot studies
• ORPRN as mentor
• Funding support from OCTRI
• A few driven researchers

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Barriers to Collaboration

• Lack of research infrastructure (Human Subjects
  protection, FWA, PERCs)
• Lack of community research experience
• Time
• Timing
• Exclusive emphasis on RCT methods
• CHR positional power

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OCHINCurrent Studies

• Asthma Care Quality - AHRQ
• Asthma Surveillance - CDC
• Flu Surveillance - State Public Health Division
• Pesticide Exposure - State Public Health
  Division
• Obesity Care - AHRQ pending
• COPD Study- AHRQ pending
• Opioid and Mood Helper - NIMH pending
• Funded Study

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Opportunities

• EPC
• Eisenberg
• Cross CTSA Networks/Partnerships
• Network of Networks
• Increasing interest/support of HRSA
• Develop additional research collaborations
• Publish

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Thank you Questions?
Susan Chauvie, RN, MPA chauvies_at_ochin.org
Mark Spofford, PhD mark.spoffard_at_kpchr.org