Integrated Health Information Technology Solutions

1. Indiana Rural Health Association Annual Conference Integrated Health Information Technology Solutions June 10th, 2009

2. Presentation Overview • Project Overview of CAH HIT Grant in Indiana • Panel Discussion of CAH HIT Project • Lessons Learned

3. St Vincent Health – Rural Indiana Components . . . . . 1. Critical Access Hospitals in seven (7) markets 2. Two (2) 150 bed ‘secondary care’ hospitals in regional, <50,000 census markets; 3. over 40 employed physicians in rural markets 4. Nine (9) Rural Health Clinics linked to CAH sites

4. St. Vincent Clay St Vincent Jennings St.Vincent Mercy St. Vincent Frankfort St. Vincent Randolph St. Vincent Williamsport

5. Project Overview

6. The Beginning. . . . . • Spring 2007: HRSA (Health Research Services Administration) releases $24 million for rural HIT demonstration projects nationally • HRSA contacts Indiana State Department of Health about possible projects in Indiana • IORH sends out RFP to all State CAH sites • Caveat: CAH must write full HRSA grant proposal (200+ pages) in 30 days, bear writing costs, and turn over project to ISDH for submission to HRSA

7. HRSA Grant Program Scope . . . . . • National Critical Access Hospital – rural technology demonstration projects • Only 16 awards nationally • Average award $1.6 million – no matching requirements • Health Information Technology – electronic connection of primary care, to CAH site, to tertiary care site, to regional health information exchange

8. St. Joseph Lagrange Steuben Elkhart La Porte Porter De Kalb Noble Lake Marshall Starke Kosciusko Whitley Fulton Allen Jasper Pulaski Wabash Newton Cass Huntington Adams Miami White Wells Benton Carroll Grant Howard Blackford Jay Tippecanoe Warren Tipton Clinton Delaware Madison Randolph Fountain Hamilton Boone Montgomery Henry Wayne Vermillion Hancock Hendricks Marion Parke Fayette Putnam Rush Union Shelby Morgan Johnson Vigo Franklin Clay Decatur Owen Bartholomew Dearborn Brown Monroe Ripley Sullivan Greene Jennings Ohio Jackson Lawrence Switzerland Jefferson Daviess Scott Knox Martin Washington Orange Clark Pike Dubois Crawford Gibson Floyd Harrison Perry Warrick Posey Vanderburgh Spencer The Locations & Partners CAH: St. Vincent Mercy Hospital • CAH: St. Vincent Randolph Hospital • Rural Health Clinic Federally Qualified Health Clinic-Elwood St. Vincent Hospital-Indianapolis • CAH: St. Vincent Jennings Hospital • Rural Health Clinic

9. Key Components. . . . . • Allscripts EMR installation in Rural Health Clinics at SV-Jennings, SV-Randolph • Electronic patient record information transfer between RHC via Allscripts, and CAH location (s) • HIT connectivity to SV-Indy for electronic transfer of patient information for Tertiary Care • Allscripts installation in Federally Qualified Health Center (FQHC) partner in Elwood, IN. – affiliated with SV-Mercy

10. Vertical Integration of Care

11. Continuity of Care - Service Configuration Service Distribution Definitions: • Predominantly at St. Vincent-Indy. Highly specialized surgery. Level III neonatal, transplant. • Case weighting > 2.5 severity level • Low frequency, highly specialized cases Level III Tertiary Care Level II Critical Access Hospital • Case weighting between 1.0 and 2.5 severity • Moderate - high frequency cases • Most surgery is secondary. Normal New Born & Children’s services. • Most done at at STV CAH sites. Predominantly medical, but includes some IP surgery. Level I Primary Care RHC - FQHC • Case weighting < 1.0 • Moderate - high frequency, routine cases Flow of Patient Information will occur Electronically Across all Organizations

12. Software Integration- Patient Care Management Systems for CAH – HIT Project Engine: Allscripts EMR Federally Qualified Health Ctr. Rural Health Clinics Primary Care Systems Clinical Systems Billing Systems Clinical Systems Billing Systems Secondary Acute Care Systems HIT – Interface Development to Connect Systems CAH sites “Eclipse Software” Tertiary Acute Care Systems Tertiary Care Center “Eclipse Software”

13. Panel Discussion

14. Today’s Discussion Panel • Tammy Chadd, In. Office of Rural Health HRSA, HIT, and Project Comments 2. Jeff Scott, St. Vincent Health IT, IHIE interface issues 3. Rebecca Royer, RN – Health Care Excel Evaluation, PI & Effectiveness 4. Dr. Alan Snell Quality, Patient Safety, Future of Medical Infomatics 5. Robin Bush, Practice Mgr. Implementing EMR Realities

15. Components of the CAH HIT Project • Allscripts (outpatient) • Eclipsys (inpatient) • Indiana Health Information Exchange • Zynx Evidence Based Medicine

16. Outpatient Setting: Allscripts • Nationally recognized as leader in EMR market • Has affordable, individual practice application, as well as large, multi-specialty group model • Incredible reporting functionality • Documented physician acceptance and satisfaction • Stable software; will meet forthcoming ARRA – HITECH standards when they are released

17. Inpatient Setting: Eclipsys • Nationally recognized as leader in EMR market • Expensive, but has wide functionality; not necessarily a good rural EMR solution for stand-alones • Nationally, have documented physician acceptance and satisfaction • Stable software; will meet forthcoming ARRA – HITECH standards when they are released

18. Indiana Health Information Exchange • Will electronically link all parties together for patient results delivery • Near 100% of Madison County providers will be connected to this program (Community Hospital, St. Vincent Hospitals, and MD’s from both comprise very large capture rate of market, and all connected to IHIE) • Federal Government interest in IHIE program demonstration; “national model” discussion

20. What is Zynx? • Provider of referential medical information • Evidence based, “best practice” recommendations • Continuously updated source for MD’s • Web based EHR links for point of care information • Tools for build & maintenance of Order Sets • Build tools w/EHR integration • Review mechanism/tools • Central, platform neutral repository for AH

22. Why Use Zynx - Evidence Based Order Sets?Adventist Health Results Ann. Epidemiol. 2004:14:669-675

23. How does this apply to SV Jennings?Your Top 10 inpatient DRG’s Discharges Source: 2007 IHA discharge data

24. Impact on Quality

25. HIT Goals for Safety Net Providers Bring HIT to America’s safety net providers which will: • Improve quality of care • Reduce health disparities • Increase efficiency in care delivery systems • Increase patient safety • Decrease medical errors • Prevent a digital divide Source: HRSA Office of Health Information Tech.

26. HIT Goals for Safety Net Providers HRSA: “The goal is not only to collect data, but to use the data to track individual and population health outcomes and improve patient care.” Performance Measures HIT Quality Measures Data Reporting

27. Evaluation – Impact on Patient Safety Measure: EMR Implementation: • Percentage downtime for EMR system • Percentage of orders entered into EMR • Physician satisfaction • Association satisfaction Measure: Effectiveness of Chronic Disease Management: • Average HbA1c for diabetic patients • Diabetic patients with B/P <130/80 • Pharmacology therapy for Peds Asthma

28. Evaluation – Impact on Patient Safety Measure: Continuation of Care: • # pt. summary reports generated by IHIE Measure: Performance on Hospital Based Quality of Care Measures: • ACE1 or ARB – Heart Failure • Adult Flu Vaccination Status • Pneumococcal Vaccination Measure: Improved Quality and Patient Safety: • Percentage of unreconciled medications at discharge from CAH facility

29. Lessons Learned At St. Vincent Health USS America

30. The Perfect Storm DRIVING FORCES RESTRAINING FORCES • Technology • Network Technical Capabilities • Physician Acceptance • Negative “ROI” • Capital Funding Markets • Culture / Change Management • Payers • Technology • Quality Mandates • Competition • Physicians • Payers • Improve Rural Access • Increased Referrals • Available Outside Funding • Patients

31. Lessons Learned • Do not underestimate the time needed for technology adoption to occur • Budget training dollars • Budget operational dollars for the “new systems of care” you have purchased • Your costs will not decrease • Start-up Productivity Decreases are significant for both practices and the hospital (lost ancillaries) • Project Management & Practice Management

32. Lessons Learned 7. If Staff or MD resistance occurs; how do you deal with it? 8. You cannot move backward 9. Sort out the roles for Management & Physicians during the process Physicians: Management: Control Behavior Influence Behavior Technical Skill-sets Leadership Skills

33. National Demonstration Project Findings • Technology selection: 6-12 months • Take Time to work on Process Improvement in your hospitals or practices • Do not take short – cuts • Implementation and Training Costs are 20% and 35% of the total investment * • Who is your MD Champion? • Who is your team? Do they have focus? Stamina? * Source: National Association of Rural Health Clinics

34. National Demonstration Project Findings 7. Training & Support: Vendors do not always deliver after the sale is made. Huge issue nationally 8. Project Manager & Practice Manager: • who is losing sleep over the implementation details? • Not the same people, but equally critical to success 9. Interface & Integration issues: get rid of old, outdated systems 10. Reporting: think about budgeting consultant time to re-construct practice & hospital reporting

35. National Demonstration Project Findings 11. Paper does not go away unfortunately but old systems need to be reviewed 12. The entire process is a “marathon”: • over time, develop new policies & procedures, • work with staff to create new, automated processes • improve clinical – financial – administrative reporting to improve your operations

36. Indiana Rural Health Association Annual Conference Integrated Health Information Technology Solutions June 10th, 2009