Slide Presentation from the AHRQ 2009 Annual Conference
On September 16, 2009, Mark Frisse made this presentation at the 2009 Annual Conference. Select to access the PowerPoint® presentation (4 MB) (Plugin Software Help).
State and Regional Demonstration Projects:
Memphis: Year 5 Report
Mark Frisse, reporter
The environment (2004)
- No ONC
- No HITECH
- Two dominant exchange models: Indiana, Santa Barbara
- Only one seemed to work
- No Medicare Part D
- EPrescribing nascent
- SureScripts (pharmacies) and RxHub (PBM) competing
- Clinical labs competing
- Capitation stalled
- Intense factionalism among hospitals
- No consensus on health care reform
AHRQ SRDs (2004)
Mentioned NHII, Santa Barbara, IOM
This contract seeks to identify and support statewide data sharing and interoperability activities aimed at improving the quality, safety, efficiency and effectiveness of health care for patients and populations on a discrete state or regional level. It is expected that measurable improvements in the quality, safety, efficiency and/or effectiveness of care shall result from the proposed data sharing and interoperability measures.
The environment (2009)
- ONC, version 3.0
- HITECH - a bill, a plan, but major unresolved issues
- Multiple exchange models
- Common features and "winners" are slowly emerging
- Medicare Part D
- EPrescribing on the uptake
- SureScripts (pharmacies) and RxHub (PBM) merged
- Capitation stalled
- Guarded cooperation among hospitals and ambulatory sites
- No consensus on health care reform
Strength of health exchange objectives in current version of MU rises substantially by 2013
Image: A chart of the Meaningful Use objuectives requiring health exchange.
D. McGraw and M. Tripathi, Health Information Exchange Workgroup (PowerPoint). HIT Policy Committee, August 14, 2009
- Comprehensive prescription medication histories largely unavailable
- Over-the-counter drugs (e.g., aspirin) have been largely ignored
- No systematic allergy reporting
- No systematic laboratory information - from office to commercial
- Claims data remain the lingua franca
- Many state initiatives are not really state-wide
- Medicaid systems - few common features across states
- Business models are not consistent with the interests of individual patients and do not support "data liquidity"
- Concerns over "ROI" make little sense when the entire "system" is failing.
The Memphis Exchange
- Baptist Memorial Health Care Corp. (4 facilities)
- Christ Community Health .(4 primary care clinics)
- Methodist Healthcare .(7 facilities including Le Bonheur Children's Medical Center)
- The Regional Medical Center (The MED)
- Saint Francis Hospital & St. Francis Bartlett (Tenet Healthcare)
- St. Jude Children's Research Hospital
- Shelby County/Health Loop Clinics (11 primary care clinics)
- UT Medical Group (300+ clinicians)
- Memphis Managed Care/TLC (MCO)
the Memphis SRD - 2009
- 34 facilities; over 400 users
- 1.2 million unique patients with clinical data
- 140,000 monthly encounters
- 34,000monthly ICD-9 admission codes (chief complaints)
- 2.4 million laboratory tests monthly
- 26,000 monthly microbiology reports
- 35,000 monthly chest x-ray reports
- Total costs: $2.5 million per year
Met all milestones - was operational in a year; full production in 20 months
Total annual operational costs are less than $2.5 million
The technical model
Record locator services
Image: A screen shot of the Recent Regisration at St. Francis Hospital is shown.
A lot like the first transistor radio..
Image: A screen shot of a patient record is shown.
LOINC: an example
Image: A screen shot of LOINC.
Image: A screen shot of Medication hub.
- 5% of overall patient visits include detailed access
- Usage ranges from 1% to 15%
- Extensive workflow evaluation taking place
- Rigorous evaluation shows decreased utilization in the range of hundreds of thousands of dollars (i.e. can offset less than 50% of system cost); impact on transitions in care not completed.
- Collaborating with TN Hospital Association
- Addressing specific areas including abdominal pain, back pain, and headache
The impact is very real
- "Lifesaving" impact on a patient with a ruptured ectopic pregnancy
- Untreated active tuberculosis patient who presents for minor care
- Terminally-ill patient seeking second opinion
- Monitoring treatment of specific chronic conditions
- More efficient follow-up when discharged patients present to ambulatory care clinics for follow-up care
- Providers have learned that putting the patient first does not adversely impact their "business"
- Data sharing is not a threat to income and only a positive to care
Potential: transitions in Care
"Real time" query: when and where do patients seen in the Med ED seek follow-up care in a safety net clinic?
Image: A graph showing the difference in HealthLoop vs. CCHS is shown.
Image: A graph showing the difference in Influenza A Tests Resulted Vs. Google Search Index for 'Swine Flu' in 2008 and 2009.
How we did it
- Coercion & money
- Focused inclusion
- Minimal burden on participants
- Strong data sharing agreements (Markle)
- Built our approach on the Vanderbilt model- a "Version 1.0"
- We assumed standards would evolve
- We took data "as we got it"
- Quick wins
- Meaningful metrics
Lessons from HIE
Limited in scope
- Conflicting priorities
- Business perceptions
- Technical limitations and costs
- Privacy concerns
Paul David: The dynamo
The transformation of industrial processes by the new electric power technology was a long-delayed and far from automatic business
David, P.A. The Dynamo and the Computer : An Historical Perspective on the Modern Productivity Paradox (Powerpoint presentation). 1990 Available from: http://www.economics.pomona.edu/kuehlwein/Econ164/Dynamo%20and%20Computer%20Presentation.ppt.
Part of a remarkable team
Governor Phil Bredesen, David Goetz, Melissa Hargis, Peter Greaves
Robert Gordon, Steve Burkett, Al King, Rodney Holmes, Jim Bailey, Rebecca Pope, George Hripcsak (TAP), Ed Hammond (TAP), Betsy Humphreys (TAP), John Quinn (TAP) and many others
Dr. William Stead
Current as of December 2009
Memphis: Year 5 Report. Slide Presentation from the AHRQ 2009 Annual Conference (Text Version). December 2009.
Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/annualconf09/Frisse.htm