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20/20 Hindsight and Other Perks of Launching an HIE

20/20 Hindsight and Other Perks of Launching an HIE. Arieh Rosenbaum, MD and Amy Berlin, MD Co-chairs, HealthShare Bay Area. Introductions. Arieh Rosenbaum, MD Director of Medical Informatics, Hospitalist at California Pacific Medical Center in San Francisco

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20/20 Hindsight and Other Perks of Launching an HIE

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  1. 20/20 Hindsight and Other Perks of Launching an HIE Arieh Rosenbaum, MD and Amy Berlin, MD Co-chairs,HealthShare Bay Area

  2. Introductions Arieh Rosenbaum, MD • Director of Medical Informatics, Hospitalist at California Pacific Medical Center in San Francisco • Attended CAeHC town hall in San Francisco in May 2009 and the rest is history…

  3. Introductions Amy Berlin, MD • Psychiatrist in private practice in San Francisco • Asked in early 2010 by CEO of San Francisco Medical Society to co-chair governance committee and has not looked back since

  4. San Francisco Healthcare (pre-ARRA) Population: 805,000 Hospitals: 11 Physicians: ~ 3,000 • Significant patient organizational crossover • Substantial safety net population • Multiple large organizations in various stages of technology deployment • Large independent physician population • Two large tertiary/quaternary care organizations • History of fierce competition between large organizations • No predominant non-government payer

  5. Planting the seeds (ARRA –March 2010) ARRA/HITECH the initial spark for early efforts • CAeHC Town Hall (5/28/09) • Stakeholder meeting #1 (8/20/09) • Incorporation into SFMS CSF 501(c)(3) • Development of Governing Committee Structure • Development of use cases/data sharing priorities • Planning funds requirements • Hospital Council presentation (2/10/10) • Governing Committee Kickoff (3/17/10)

  6. Getting the lay of the land (Spring 2010) Initial task of the governance committee was to evolve into a cohesive working group • Much thought went into structure of our initial meetings • Anticipated release of CeC grant application functioned as orienting milestone • Early reconnaissance – meetings with Axolotl (a local vendor), a visit to Santa Cruz HIE, reviewing the literature (KLAS reports, etc.)

  7. Getting the lay of the land (Spring 2010) Lessons learned • Impossible to chart path of an effort as nebulous as launching an HIE more than one step at a time • Give team members time to settle into their new roles and trust the leadership of the group • Face-to-face meetings are crucial to building cohesiveness (conference calls work better later on)

  8. The long road to vendor selection(Spring 2010 to Winter 2011) Generating RFIs & RFPs • Cast a wide net to identify vendors • RFI constructed on shoestring budget • RFI released to 16 vendors -> 11 responses -> short list (6) -> RFP released to 4 -> 2 finalists

  9. The long road to vendor selection(Spring 2010 to Winter 2011) Lessons learned • The national HIE community is small, collaborative, and eager to share • Use seed funding for focused professional services • Delegate detail-intensive processes to sub-committees • RFIs, RFPs have educational value for committee • All HIEs need a healthy dose of serendipity

  10. Show me the money (ongoing) Our approach to funding has evolved significantly • Early days full of financial “brainstorming” • SFMS provided “anchor donation” • Other organizations slowly followed • Key planning grant from MettaFund • Still working on payers

  11. Show me the money (ongoing) THE BUSINESS PLAN • Key to buy-in from stakeholder organizations as we approached the big “ask” for CeC matching funds • Utilized business development consultant services for budget model • Business plan outlined (the mostly indirect) evidence for ROI from HIEs – hard numbers difficult to come by in current HIE literature

  12. Show me the money (ongoing) Lessons learned • Budget for business development from day one • Crucial to business strategy is plan to evolve, in the early years of operations, from strict reliance on grant funding • As we evolve, so will our business plan (we are currently working on version #2) • Value prop for individual organizations can be variable

  13. Our faith is tested (January 2011) Rounding the bend on RFP release, we are closing in the deadline for MOU submission from stakeholder organizations when… • Round robin with committee reps was overwhelmingly positive • Key stakeholder organization falls through, creating a domino effect • Application for Cal eConnect funding aborted

  14. Our faith is tested (January 2011) Lessons learned • HIE is still an abstraction for many executives • Go directly to your customer; representative model must be supplemented • No substitute for face time between C-suite and HIE leaders

  15. A more nuanced strategy emerges (Spring 2011) A comprehensive outreach effort • Direct dialogue with stakeholder decisionmakers • Meetings with local and state civic leaders, leading to favorable Op-Ed in the San Francisco Examiner co-authored by Arieh and a mayoral candidate • Rebranding as HealthShare Bay Area

  16. A more nuanced strategy emerges (Spring 2011) Lessons learned • Plan on an intricate network of point-to-point interfaces (e.g., LOTS OF FACE TIME) to build stakeholder trust and to make sure the “source data” (details of HIE technology, sustainability, and governance) get to the desired recipient (check-writing decision makers) • Anticipate decisionmakers’ priorities, questions, and fears • Understand the history and the culture of each participating organization

  17. The long road to vendor selection continues (Spring & Summer 2011) It’s one thing to release an RFP, it’s another to score it • Tension between desire for purely “democratic” scoring process and the reality of inadequate understanding of HIE vendor differentiators among constituents • Pursued a “salon” style of scoring responses, with technical expert as leader • RFP scoring process enhanced group cohesiveness

  18. The long road to vendor selection continues (Spring & Summer 2011) Demos an opportunity to showcase effort • Comprehensive, clinically driven demo scripts • Webinar, recorded to allow for remote and asynchronous participation • Preparing for reference checks and site visits in coming weeks

  19. The long road to vendor selection(Spring 2010 to present) Lessons learned • “Marathon” salon sessions allowed for deep dive and shared understanding of vendor offerings • Deep technical expertise crucial to evaluations • Use demos as an outreach and educational tool for stakeholder constituents

  20. The momentum builds(Fall 2011) Recent accomplishments & activity • Growing interest from East Bay stakeholders • Preparing for vendor negotiation • Recruiting legal services to draft participation agreements • Networking with Cal eConnect Community of Practice and other groups

  21. 20/20 Hindsight Take home points • Launching an HIE is like launching a start-up • Assemble a multi-disciplinary team • Productive collaborations, learning curves, and trust building require time and face to face meetings • Use planning funds wisely • Study HIE success stories • Get lots of practice answering difficult questions • There is no HIE “roadmap” – learn to love trial and error

  22. Thank you Arieh Rosenbaum, MD RosenbA@sutterhealth.org Amy Berlin, MD amy@amyberlinmd.com

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