Development of a Health Information Technology (HIT) Planning Grant – Process and Suggestions Telecommunications Confe

1. Development of a Health Information Technology (HIT) Planning Grant – Process and SuggestionsTelecommunications Conference, Nov. 17, 2005, Springfield, IL Martin MacDowell, DrPH, MBA Assistant Director and Assoc. Professor Univ. of IL Rockford, NCRHP (mmacd@uic.edu) and Randy Hayes, MS Director of Quality Assurance Sinnissippi Centers, Inc, Dixon, IL (RandyHayes@sinnissippi.com)

2. Ultimate Goal of this HIT Project To provide coordination of quality and safe health care services for disparate groups within Lee County to include rural economically disadvantaged, ethnic/racial minority residents as well as older and younger persons with special/complex health care needs.

3. Objectives of Lee County Grant • Development of a comprehensive plan to enable sharing of electronic health information between three HIT partners: a local acute care hospital and associated medical group; the county health department; and the local behavioral health organization; • Development of a central Electronic Health Record (EHR) system that will afford the sharing of health information between the organizations incorporating recently adopted standards-based data sharing; • Submit an HIT implementation grant that would be funded by AHRQ (http://healthit.ahrq.gov/home/index.html ) after the initial planning award.

4. Organizational Structure of Planning Grant Four task force were formed from staff of the three partner organizations: KSB Hospital www.ksbhospital.com Lee County Health Department www.lchd.com Sinnissippi Centers, Inc. www.sinnissippi.com 1) a legal task force to create a HIPAA compliant plan that will permit the transfer of protected health information; 2) a clinical task force to delineate information to be transferred, access parameters, authorization parameters, and staff training plans; 3) an administrative/advisory task force that will develop project funding plans; and 4) a technical project management task force that will develop the specific hardware, software, and networking plans to affect the sharing of information

5. Diagram of HIT Planning Grant Functions

6. Why the grant was submitted • There were special incentives for organizations based in rural counties (RCA code for Lee County is 4) • The partners had established working relationships on other projects in the past and partners were well matched to RFA of grant • The lead organization (KSB Hospital) had a well developed IS and EMR infrastructure that could be built upon • There was a clinical need all recognized for sharing of health information to improve efficiency and clinical care information transfer

7. Why the grant was submitted - continued • The leadership of the three partner organizations had open communication with each other so an effective partnership could be built • A outside party (university faculty) had time to collect information and write planning grant • There were funds offered to help implement the HIT plan after it was developed • Expertise on how to do budget for such a grant was available – is closely examined during review

8. What happened • The federal government (AHRQ) changed the deadline for submission of the HIT implementation grant so only three months were available for plan development instead of six months. Initial grant meeting occurred Dec. 8th, 2004 and 3 year implementation grant was submitted in April 2005 • Each task force met and addressed its area related to plans for a shared Electronic Medical Record (EMR). • The existing Solcom system at KSB for electronic health information was chosen and plans made for how the other 2 organizations could securely access information stored on the KSB servers and setting up a VPN for connecting the organizations was among the connection options discussed. The HL-7 industry standard is preferred over any customized solution for communicating between systems it was agreed that the HL-7 protocol could be supported. Plans were made for scanning records at each organization from a chosen start date to be put on the KSB Solcom System with tabs for each organization for a given patient. • More info regarding the Solcom system KSB uses at http://www.solcominc.com/solcom/solutions/showSolution.asp?ID=4

9. Initial Software Systems Existing At KSB Hospital and Partners + Paper Records SCI Inc. Has 3 Proliant servers with approximately 100 workstations are attached to these three servers.  Unix based CMHC/MIS is used as the information management software.  The CMHC/MIS (http://www.cmhc.com) software produces reports on key decision variables by integrating financial, client, staff, and service data. The CMHC/MIS also includes modules to address concerns specific to these professions such as client information management and individual client maintenance LCHD Has a local area network at their office with 18 desktop PCs or workstations linked to a central server. Backups of data stored on the local area network are taken off-site until another successful back up occurs. The LCHD also is networked with a statewide (Illinois) “Cornerstone” computer system that works separately from their local area network, but in conjunction with the TOTS systemas well as other IDPH connections. ? How to connect

10. Clinical Data Items That Were Chosen to be Shared Initially • Immunizations - e LCHD • Medications – all share anything prescribed/script given • Presenting problem/presenting list - e KSB and SCI • Lab, Imaging, screening tests - e KSB (SCI in near future, at least scores) • Reportable diseases - e LCHD • Prenatal care/ records – KSB • Service dates by category- e all • Discharge summary- e KSB (SCI probably in near future) • Presenting Diagnosis e-SCI • Referral information • Assessment

11. Possible Benefits of Shared EMR= Increased Patient Safety as well as Decreased Costs Some scenarios: • The shared medical data base will allow a KSBH Emergency Room physician when presented with an infant in anaphylactic shock to instantly obtain that infant’s immunization record from LCHD. Thus the physician would be able to accurately determine which immunization was given that might be the precipitant of the symptomatology. • This system would allow a psychiatrist at SCI to determine whether or not a person presenting with symptoms of depression was receiving pain medications from a KSBH physician in order to determine if the depressive symptoms were related to a psychiatric condition or were a side effect of some prescribed medication that the patient had forgotten to mention. This would lead to improved diagnosis and treatment • The proposed system would reduce the need for a shared patient to repeat the same identifying information two to three times when enrolling in all partner’s services. Once the basic identifying information was obtained, the other needed demographic information required could be accessed from the shared data base and merely confirmed as to currency. A health history, once entered into the data sharing system could be confirmed and updated as needed between the partners, and available to all partners.

12. Plans re Legal Issues • The Legal Task Force has proposed that there be an Affiliation Agreement between the organizations. The basic legal structure of each organization would not change. MUST be HIPPA Compliant as well as IL laws. • The Affiliation Agreement would set forth clearly how the sharing of information would work and the responsibilities of each partner to train and monitor its staff. • The Agreement would make clear that each organization remained independent and responsible for its own employees and their actions. As part of the affiliation, an implementation task force would remain in effect with designated staff from each partner. • The partners would identify the Project Director who would be ultimately responsible for the day to day implementation of the grant and its continued operation once everything is up and running.

13. Plans re Legal Issues - continued • The affiliation agreement will specify the relationship of the parties and allow them to share information, as though part of one entity. • Illinois law is far more restrictive in sharing health information than HIPAA. The consent form will not only comply with HIPAA but also the Illinois Mental Health and Developmental Disabilities Confidentiality Act, 740 ILCS 110, the AIDS Confidentiality Act, 410 ILCS 305, and the law related to Substance Abuse Treatment Records, 20 ILCS 301, as well as various regulations. • The Legal Task Force will also provide the basic training related to legal issues and confidentiality to the staff of the affiliated organizations

14. IT Issues Discussed During Planning – Any Partners Would Encounter These • How to in a HIPPA compliant way connect existing networks for purposes of a shared EMR and yet retain existing systems and networks at each partner ? • How to connect different IT systems with differing complexities? • How to ensure staff will use shared EMR?

15. Pointers for others PlanningInter- Agency EMR Sharing • Organizations should have good prior history of working together • Current leadership must trust each other and be “community minded” • IT staff and consultants at each organization must be have orientation of finding a way to solve connectivity problems

16. Lessons learned and points from Reviewer’s Comments • Creation of a shared EMR was not viewed as “ground breaking” • Wanted more detail re what items were cost sharing and what would be direct costs paid by grant in the budget. Such as consultation was not detailed and seem “excessive” • No mention of AHRQ priority populations • Didn’t mention that most primary care docs were part of KSB Medical group – lead to concern about community impact • Concern that PI was not employee of lead institution • Technical approach “underspecified” re HIT implementation • Wanted more re my background to be evaluator in biosketch • Concern re how project “learnings” would be disseminated • Want more details re project and an outcome/quality impact evaluation • Concern about IT background of new PI