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Volunteer eHealth Initiative Statewide Design Shop Volunteer eHealth Initiative Memphis Tennessee Re


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Title: Volunteer eHealth Initiative Statewide Design Shop Volunteer eHealth Initiative Memphis Tennessee Re

Volunteer eHealth InitiativeStatewide Design
ShopVolunteer eHealth InitiativeMemphis
Tennessee Regional Initiative
October, 2004
Volunteer eHealth Initiative Summary
  • Objectives and Desired Outcomes
  • Why did this project begin?
  • Fragmented health care information particularly
    among TennCare patients is hindering effective
    and efficient patient care
  • What will the project accomplish?
  • Identify the major health care issues in the
    Memphis area that can be addressed by a regional
    health information infrastructure
  • Identify a core set of issues, data elements, and
    institutions and implement a demonstration
    project quickly
  • Extend the issues, data elements and institutions
    as quickly as possible
  • Measure the impact of these new technologies
  • Participate in the national evolution of health
    care data standards.
  • Expected Impact
  • Patient and Family
  • Safer, more timely care Better disease
    management Access to clinical information
    wherever care is delivered More efficient care
    through fewer unnecessary tests and unwarranted
  • Community
  • Broader and simplified data collection more
    accurate regional quality metrics Better public
    health reporting Improvements in emergency
    preparedness due to greater access of regional
    health data More proactive stance toward
    employer and government quality initiatives.
  • Provider
  • Less time searching for information from other
    facilities Greater assurance of complete and
    safe care delivery Potential for broader
    integration of regional information into site
    clinical decision support systems.
  • Overall Financial Impact for Institutions and
  • Lower overall expense for redundant procedures
    Clear understanding of costs and financial
    benefits for HIT investments as new P4P and other
    funding mechanisms are developed.

Volunteer eHealth Initiative Summary
  • Coverage
  • What is the scope of the project?
  • Six-month assessment followed by an
    implementation of a clinical data exchange
  • Create a viable and self-sustaining information
    infrastructure that enables appropriate and
    comprehensive access to all information required
    to provide medical care and to evolve medical
    data standards
  • Establish broad programmatic linkages with public
    health, consumer groups, emergency preparedness,
    agencies and national groups
  • Demonstrate 100 exchange of core data elements
    among core medical facilities by the end of 2007.
  • Perform extensive cost-benefit analysis and
    impact analysis in the final two years of the
    contract period.
  • Constituents
  • What entities including type are involved in the
    scope of this project?
  • All relevant health care delivery organizations
    within Shelby, Fayette and Tipton counties.
  • Governance Structure
  • What is your governance structure?
  • Governors office
  • Program Management Office
  • CEO Oversight Group, National Technical Advisory
  • Workgroups (Clinical, Technical, Privacy and
    Security, Financial)
  • Do you have plans to change this structure in the
  • This structure will evolve possibly to a
    non-for-profit organization

The Clinical Workgroup has established an initial
set of outcomes which have provided a short list
of data elements.
Initial List of Outcomes and Data Elements
Outcomes being evaluated
Data Elements The means used to represent these
data will converge to common approaches over time
  • Asthma
  • Group B Strep
  • Cancer Screenings
  • Diabetes Management
  • Immunizations
  • Hypertension
  • Post MI care
  • Congestive Heart Failure
  • Sickle Cell Pain Management
  • Depression
  • Medication Management
  • Reducing Redundant Testing
  • Well Child Screening
  • ER Utilization
  • Medications
  • Problem list
  • Lab Results
  • Radiology Results
  • Cardiology Results
  • Weight
  • Allergies
  • Encounter data
  • Where was patient seen
  • When was patient seen
  • What was done during visit

Volunteer eHealth Initiative Summary
  • Timeline
  • Six-month assessment and planning effort
    kicked-off August, 2004 with a January, 2005
    completion date
  • AHRQ contract awarded October, 2004. This
    represents a minimal set of constraints on the
    effort and provides capital to achieve early
  • Early demonstrations of feasibility by October,
  • Implement 100 of data sharing October, 2007
  • Evaluation runs throughout the project
  • Project Approach
  • The six-month assessment is being completed over
    three phases (assessment, planning and
  • Operational database technology suitable for a
    demonstration project infrastructure is being
    modified to meet the needs of the Project
  • Tight coupling of clinical and technical groups
    to identify opportunities and demonstrate
    improvement through information technology.

Exchange Architecture
Exchange receives data in tagged document format
manages the parsing indexing
  • Queue Management
  • Parsing indexing

As standards are adopted, interoperability
becomes possible
Data is transferred from participating entities
to the centralized exchange
  • Sustainable business model , Governance
  • Standards
  • Payor/provider linkages, Consumer participation
  • Participation Agreement
  • Patient Data
  • Secure Connection
  • Batch / Real-Time
  • Governance
  • Compilation Algorithm
  • Authentication
  • Security
  • User Access

Volunteer eHealth Initiative Summary
  • Lessons Learned
  • What lessons did the project team discover?
  • Lorenzi Buy-in because of conflicting missions
    and poorly conceived objectives.
  • Lorenzi Perceived loss of control and lack of
    trust in the process.
  • Lorenzi Lack of clear ownership over data
    systems and information.
  • Lorenzi Lack of clarity about how a CHIN would
    be financed.
  • Lorenzi Varying degrees of technology
    sophistication along with the concerns that some
    centralized community-based data repository will
    be created and used inappropriately
  • Short-term gain vs. long-term gain Evolving
    technology approach vs. highly structured data
  • Incentives are not aligned
  • Everyone has a different view of what the early
    steps really are
  • Most have a common view on the ultimate approach
  • What challenges has the team faced?
  • Time Everybody is rightly focused on pressing,
    organizational needs
  • Recognition Many ongoing initiatives
    representing various members of the community
  • History Past differences make full trust more
    difficult to achieve
  • History Memphis CHIN been there, done that
  • NIH Distrust of any new vendor
  • Communication Different statements and
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