Presentation for

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• Presentation for
• CCBH Learning Forum Exhibition Track 1
• May 25, 2005
• Presenter Mike Skinner

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• Initial Funding Support

California HealthCare Foundation
(www.CHCF.org) Foundation for eHealth Initiative
http//ccbh.ehealthinitiative.org/profiles/SBCCDE
.mspx This project is funded in part through a
contract with the Foundation for eHealth
Initiative (FeHI) and their cooperative
agreement with HRSA, Office for the Advancement
for Telehealth (HRSA/OAT). The contents of
this presentation are solely the responsibility
of the authors and do not necessarily represent
the official view of HRSA/OAT or FeHI.
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• Governance
• 501c3
• Tax Exempt Status
• Funding Opportunities
• Board of Directors representation
• Physician community
• Business community
• Consumers

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Flow-Thru Model
Technology Vendor
Master, K, K1, Ex A to K1, K2 K4 (BAA)
SBCCDE 501c3

• Santa Maria

K5 (BAA) K3
K5 (BAA) K6

• Lompoc

Data Providers
Data User Entities

• Santa Barbara

Data Providers on the hook for acts, errors
omissions regarding data sending breaches.
Exhibit A to K6 Minimum Data User
Acknowledgements
Data Users
Data Users
Note Most Data Providers will have both a Data
Provider Agreement AND a Data User Entity
Agreement (since most data providers are also
data users). Notable exceptions Quest, others
possibly in the future.
Entities on the hook for acts, errors omissions
of its users.
Data Users
Estimated Active participation defined
by User agreement signing Source Santa Barbara
County Medical Society Dept of Finance, Santa
Barbara County
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• Financial Sustainability
• Benefactors still not well understood or measured
• If you build it, they will come ? it still
  needs to be built, and evaulated to understand
  actual benefits benefactors
• Public/grant funding for startup costs (need to
  be a 501c3)
• Large stakeholders and/or data contributors
• Community hospitals
• Reference laboratory
• Community medical groups
• Large companies with high employee base
• Private health plans
• State plans
• University health centers
• Pharmacy companies
• Local tax support

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• Access to Data is the Key
• Content is King
• Timely access to data saves lives
• Above all, orient your RHIO around access to
  current and historical data
• Keeping data access in mind, fashion your mission
  statement then, proceed with RFIs/RFPs and focus
  on solutions that most closely match your mission
• Questions to ask
• Is the goal more ambulatory/point-of-care (as in
  SBCCDE)?
• Is the goal to provide post-encounter functions
  such as outcomes, disease management?
• Is the goal to improve financial operations by
  automating admin functions?
• Or all of the above?
• Have a long-term plan, but start small build to
  your mission

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• Technology
• Peer-to-Peer (P2P)
• NO centralized database
• Not an EMR rather, a switch or broker to EMRs in
  the community
• Think of as highly secured clinical search engine
• ? CDE-OOGLE.com query for patient, then follow
  links (see ILS)
• Look Leave

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• Clinical Data Repository (CDR)
• Dont exclude legacy (non-P2P) sources essential
  to collect expose as much data as possible
• But, dont build centralized databases to
  overcome
• Use separate hosted CDRs to manage HL7-collected
  data, with links to these databases from ILS
• Re-direct the link once the source system is P2P
  compliant

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• Consumer
• Educate so that the risk vs. benefit dialogue can
  begin
• Understand the consumer in your community
• Engage the local university to set up consumer
  focus groups surveys
• Work with local school districts to build
  interest in high schools
• Dont leave out, but dont over-engage
  prematurely
• Win the support of the physician first, let the
  physician be your champion to reach the consumer
• Be prepared to respond to serious concerns from
  consumers and consumer groups have an
  informational tri-fold that physicians can hand
  out to consumers as an educational device
  (specify Privacy Officer, complaint procedures,
  etc)
• At the right time, build consumer user groups
  and co-opt the consumer advocacy groups in your
  community
• UCSB Consumer Investigation/Survey Ms. Kier
  Wallis Dr. Ronald Rice http//www.comm.ucsb.edu
  /faculty/rrice/sbccde.pdf

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• Measuring Success
• Stable and financially-secure operations
• Number of users and inquiries increasing steadily
• Number of lives covered
• Physician Patient testimonials of real-world
  impact
• Consumer support

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• Lessons Learned
• Invite everyone to the table
• Establish governance early, and follow By Laws
  procedures
• If 501c3, apply for federal exemption ASAP it
  takes time energy
• Hire an experienced legal firm, and keep them in
  the loop at all times
• Execute agreements early, especially data
  provider and user agreements
• Dont try to pop all the corn in the field set
  achievable goals march toward them
• Dont let the seemingly impossible list of
  challenges overwhelm you block and tackle
• Spell out all interface data specifications in
  excruciating detail, and hold everyone to them
• Hold your vendor to their obligations, but meet
  your own obligations too