presented at the 132nd annual meeting of the american public health association

Presented at the

132nd Annual Meeting of the

American Public Health Association

Scientific Session—APHA—Innovations Project

Building Public Health Infrastructure to Cover the UninsuredMonday, November 8, 2004

by:

Yvonne Claudio, DM(ABD), MS, PMPperotsystems Government Services

Carl W. Wilson, MPHIndependent Consultant

Public Health Infrastructure: Public Health Infrastructure: Utilizing Technology to Assure Effectiveness and EfficiencyUtilizing Technology to Assure Effectiveness and Efficiency

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Presentation

• Presidential and DHHS Directives

• Funding Opportunities

• Industry Focus/Initiatives

• Strategy and Expected Outcomes

• The Case for Public Health and Safety Net Provider Action

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President George W. Bush’s

Health Information Technology Infrastructure PlanOn April 27, 2004, established Office of National Coordinator for Health Information

Technology... “to provide leadership for the development and nationwide implementation of an interoperable health information technology infrastructure...”

An Infrastructure that....• “(a) Ensures that appropriate information to guide medical decisions is available at the time and

place of care; • (b) Improves health care quality, reduces medical errors, and advances the delivery of

appropriate, evidence-based medical care; • (c) Reduces health care costs resulting from inefficiency, medical errors, inappropriate care,

and incomplete information...”

• To have DoD and VA to “work more actively with the private sector to make their health

information systems available as an affordable option for providers in rural and medically underserved communities...”

“Widespread deployment of health information technology within 10 years...”

Source: The White House, Executive Order 13335, April 27, 2004.

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On Utilizing Technology“We’re at the tipping point in utilizing IT in the health care field”

CMS Director, Mark McClellan. HIT Summit, October 2004

On EMR...“Delivering Consumer-centric and Information-Rich Health Care..."

Source: ONCHIT, July 2004

“Adopting the EHR would not only enhance the information, data, and communication systems within the public health infrastructure, but would also increase the capacity of the organizational and system components of the infrastructure.”

“Electronic transmission of standardized data from the patient health record to public health agencies via the EHR is essential to support key public health functions and services...”

Source: PHDSC Ad Hoc Task Force Press Release, May 13, 2004

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Seven Applications of Technology

1. Patient Care Management

2. Population Management

3. Disease State Management

4. Resource Management

5. Utilization Management

6. Financial Management

7. Quality

Cli

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dmin

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Source: Adapted from Streveler, D. Medical Informatics, Univ of Hawaii. Presentation entitled: Case Studies--HIT Around the World, October 2004

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Reduce Administrative Costs

Promote Emergency Preparedness

Reduce Medical Errors

Improved Quality of Care

IT Enabled Healthcare

System

Adopted from L D. Schaeffer (2004, October 21) Transforming to an IT-Enabled Health Care System: Health Plan Role. Presentation at HIT SummitTransforming to an IT-Enabled Health Care System: Health Plan Role. Presentation at HIT Summit

Empower Consumers

Diffuse Knowledge

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DHHS Funding Opportunities

• Health Resources and Services Administration (HRSA)– Seed funds to implement health information exchanges—Connecting Communities for

Better Health – Office for Advancement of Telehealth—support use of videoconferencing, the Internet,

store-and-forward imaging, streaming media, satellite and wireless communications to support long distance clinical health care.

• Office of National Coordinator for Health Information Technology (ONCHIT)– Developing options for low rate loans and Medicare reimbursement for MDs to adopt EMR

• Centers for Disease Control and Prevention (CDC)– Emergency preparedness monies have been used to fund IT enhancements – Initiatives to link health data with environmental data

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DHHS Funding Opportunities• Agency for Healthcare Research and Quality (AHRQ)

– Patient safety and quality enhancement focused IT projects

• Centers for Medicare and Medicaid Services (CMS)– Medicare Modernization Act—has requirement to move to e-prescribing– Medicare Doctors’ Office Quality Information Technology Demo Projects--offering MD

incentives to improve IT systems that lead to improved quality care – Pay for performance initiatives– Medicaid VistA Office—leveraging VAs EMR for private doctor use

Other• EPA. Project to link health data with environmental data• Department of Commerce, Technology Opportunities Program (TOP) Innovative IT

projects.• Private Foundations. Like E-health Initiative’s “Connecting Communities for Better

Health Programs” Projects funding initiatives stressing partnerships.

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Industry Focus and Initiatives

Integrated Information Systems• Establish local health information infrastructure (LHIIs)• Create regional health integrated organizations (RHIOs)• Set the backdrop for the National Health Information Infrastructure (NHII)

Premise is that information is portable and is pulled and made available as consumers move from one point of care to another—through the use of technology.

Information Management/HIPAA• Information portability• Information security/privacy• National provider identifier• Adopting electronic transactions

Premise is that we can achieve administrative simplification in processing health claims and information, and thus reduce waste

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Industry Strategy and Outcomes

Strategy• Support partnerships• Create standards based solutions • Certify products• Leverage federal expenditures• Share best practices

Outcome Focused» Improve quality/patient safety» Create efficiency and maximize effectiveness» Reduce costs» Expand coverage

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The Case for Public Health and Safety Net Provider Involvement

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Who are the Safety Net Providers?

Deliver a significant amount of care to the...• Uninsured• Medicaid covered individuals• Vulnerable populations

Types of Institutions Delivering Care as SafetyNet Provider• Local health departments• Public hospitals• Community health centers• Special service providers such as AIDS, school health clinics.• In some cases, teaching and community hospitals, private practitioners, and

ambulatory care sites

Source: Institute of Medicine, 2000 America’s Healthcare Safetynet: Intact but Endangered.

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The Challenge

The SafetyNet serves...

• the poorest of the population

• the sickest individuals

• individuals with reduced access to care

• a mobile population

• a population that experiences disparities in quality of care

The SafetyNet does this with scarce resources/funding

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Institute of Medicine Recommendations on SafetyNet

Enhance and coordinate technical assistance programs targeted to improving the operations and competitive position of safety net providers.

Technical assistance programs should promote rather than prevent the development of partnerships to build safety net capacity and improve the management and operating capabilities of safety net providers.

Source: Institute of Medicine, 2000 America’s Healthcare Safetynet: Intact but Endangered.

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Public Health and SafetyNet Functions/Focus

Safety Net Patients

Health Needs

Quality Care

Coverage Capacity

Health Education/PreventionHealth Maintenance

Treatment

Effective/Efficient Utilization

Cost Control

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Will Public Health and other SafetyNet Providers Continue to Lag in Adopting Technology?

Maybe Not...More and more such providers are taking action...

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US Projects Involving PH and SafetyNet ProvidersSample Listing

Boston HealthNet. Medical. Funded from private organization. Project includes the SafetyNet hospital (Boston Health, with 70 clinics) and 8 health centers--accounting for 800 MDs. Established infrastructure, provided computers. Partners shared the physical and software infrastructure costs.

Bronx, NY. Institute for Urban Family Health. Project includes 6 FQHC, 9 sites for homeless care. Using EpicCare EMR. A self-funded initiative.

Georgia. FQHCs project. Project includes 78 sites throughout the state;14 facilities with own boards of directors. Partners pooled money to buy practice management systems. Share in the $1.47 million cost; some providers are using Federal money.

District of Columbia. Computerized Patient Record System Project. Funded by DOC

TOPs. Project initiated by DOH, includes 3 independent health centers in the District. Project involved the transfer of the VAs VistA/CPRS system to the 3 centers—all of which operate in medically underserved communities. DOH now planning diffusion CPRS to its SafetyNet Project.

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Steps in Initiating ActionStrategy• Create/participate in partnerships• Leverage funding/identify matching funds• Identify and plan for risks • Access technical expertise

Getting ready• Develop IT plans that align with business plans and industry/government

focus• Identify key requirements• Consider role of existing technology• Plan for sustaining enhancements• Identify outcomes/evaluation strategy• Assess readiness

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Implementation Considerations

• Project management professionals are critical

• Consider equipment life cycle

• Understand go live processes/timeline (reduce schedules, additional support, hard copy data entry, accounting effect, holidays)

• Recognize that ROI may not be forthcoming; immediately pursue funding to sustain system

• Consider outsourcing system management; it might be less expensive

• Diffuse knowledge on experience

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Above All Else Remember

It’s about Outcomes!

• efficiencies: better use of resources/$• enhanced quality of care• effectiveness: enhanced health status• improved access/expand coverage

URLs• Community Clinics Initiative, California. www.communityclinics.org

• Self Assessment tool to identify readiness for IT initiatives. Lessons learned to be posted soon.

• http://www.communityclinics.org/files/531_BC_SelfAssessmentTool.xls

• Fact Book. http://www.blueprintrd.com/text/CCI_2002_IT_Fact_Book.pdf

• Framework for Strategic Action. http://www.hhs.gov/onchit/framework/hitframework/framework.html

• E-health Initiative Tools. http://ccbh.ehealthinitiative.org/communities/community.aspx?Section=105

• E-health initiative funded communities. http://ccbh.ehealthinitiative.org/communities/funded.mspx

Summary

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Contact Info

Yvonne Claudio, DM(ABD), MS, PMPperotsystems Government Services

[email protected]

Carl W. Wilson, [email protected]

presented at the 132nd annual meeting of the american public health association

Documents

public health

health administration

electronic information

initiative tools

assessment tool

strategic action