Development of Health Information Technology to Impact Urban High Risk Populations

Slide Presentation from the AHRQ 2008 Annual Conference

On September 8, 2008, LaRah Payne, ScD, MPH, CIPP/G, made this presentation at the 2008 Annual Conference. Select to access the PowerPoint® presentation (335 KB; Plugin Software Help).

Slide 1

Development of Health Information Technology (Health IT) to Impact Urban High Risk Populations

LaRah Payne, ScD, MPH, CIPP/G
Senior Policy Analyst/Privacy Officer
DC, Department of Health (DOH)/Medical Assistance Administration (MAA)
Washington, D.C

Slide 2

The colored photograph shows the open crater of a snow-covered volcano.

• Not a place you would want to be...

Slide 3

The colored photograph shows the Jefferson Memorial in Washington, D.C.

Slide 4

DC Healthcare System Challenges

• High incidence of chronic disease
• High mortality rates for selected diseases
• Distribution of health care resources
• Variations in the utilization of services

Slide 5

Health Insurance Coverage

• DC has a very high coverage rate
• Medicaid covers 1 out of 4 residents
• Local Only Funding & XIX >1 out of 3

Slide 6

Medicaid Transformation Grant Project Purpose

• Interface currently separate patient data on IT systems across MAA, DOH, six local health centers and three local hospitals.
• The interface will be accomplished through the development and implementation of a Medicaid Patient Hub which will include:
  • Linkages to the providers' electronic health record (EHR) and electronic medical record (EMR) products.
  • A master client index.
  • A physical repository for population-based data.
  • A record locator component.
  • An analytical component for data analysis by MAA.
  • User access control and audit component.

Slide 7

Medicaid Transformation Grant (MTG) Project Goals

• Data Integration: Integrate patient data so DOH can expand its ability to perform analysis on Medicaid populations and individuals served by the Department and those who are served by other organizations participating in this effort (6 neighborhood health centers, 3 hospitals, and DOH programs).
• Coordinate Health Services Delivery: Enable community health centers to coordinate health services delivery with other participating clinics and hospitals.
• Medical Decision Making: Improve the quality of medical decision making through secure exchange of accurate and comprehensive patient health information and through patient-centered and outcome driven analytical capabilities.

Slide 8

MTG Project Goals (continued)

• DC-wide Clinical Informatics and Analysis Capabilities: Available at the point of care for providers with individual level access, and on the desktop for aggregate analyses by program level analysts and administrators in MAA and DOH.
• Patient Care: Medicaid patient's medical information (in linked systems) will be accessible at the point of care including clinics, hospitals, DOH facilities, Medicaid care managers, etc.
• Cost Savings by Management of Care, Outcomes & Costs: Patient and provider data will be analyzed to identify cost savings through the reduction of duplicate services and better coordination of care among the provider participants.
• Potential National Health Information Network (NHIN)-type Linkages: Provide connecting link to larger, regional Health Information Exchange (HIE) and Regional Health Information Organizations (RHIO) efforts in the National Capital Area (NCA).

Slide 9

MTG Project Organization

The diagram shows:

• Executive Sponsor: Robert Maruca, Sr. Deputy Director, Medical Assistance Administration
• MAA Senior Policy Director, John McCarthy and MTG Steering Committee: (Chair: John McCarthy), Medicaid Representatives, DC Dept. of Health Representatives, Office of the Chief Technology Officer Representatives:
  • George Washington University (GWU)—MTG Facilitator
• Program Manager, to be determined (TBD)
• Patient Hub Contractor/Systems Integrator, Vendor, TBD:
  • Subject Matter Experts: Medicaid Administration, Medicaid Operations, Health IT Standards & Interfaces, Health Information Exchange, Privacy/Security/Confidentiality, Local/State Legislation Variation, Policy and Procedure Development, EHR and EMR Interfaces, Medicaid Information Technology Architecture (MITA) Standards & Requirements, Health Care Costs and Outcomes, Business Processing Re-engineering
• Physical Repository
• User Access Control and Audit
• Data Analysis
• Master Client Index
• Record Locator
• Links to EHRs and EMRs

Slide 10

MTG Project Components

• Integration
  • Patient Data Linkages:
    • Providers can receive basic patient record summary data from the Medicaid Management Information Systems (MMIS).
    • Providers access patient data through patient hub.
    • User access control and audit enforces Health Insurance Portability and Accountability Act (HIPAA) compliance.
• Master Index:
  • Identity Reconciliation:
    • Master Client Index provides for accurate identification of patients across MAA, DOH, health centers and hospitals.
    • Reduces medical record errors and duplication.
• Repository:
  • Population-based Data:
    • Physical data repository for population-based data from public health programs.
    • Public Health data can be pushed to remote providers.
    • Informs clinical decision-making at the provider site.
• Locator:
  • Secure Data Exchange:
    • Patient Record Locator for remote access and exchange of necessary medical record data.
    • Provides for future access to larger NHIN exchange efforts.
• Analysis:
  • Data Mining & Analysis:
    • Analytical component to determine true costs of care.
    • Ability to check for duplication of services across provider sites.

Notes:

• Hosting Company is ideally poised to provide this type of service:
  • Core competency is system administration—leverage depth of expertise.
  • Development of laboratory that represents a real-world production environment with all the appropriate applications set up to work together.
  • Access to engineering and R&D from vendors; Multi-million dollar agreements with vendors provide significant leverage; Continuous development cycle can be established to catch problems early.
  • Ability to select many of the management applications with compatibility as a criterion.

Slide 11

Transformation Grant: Project Period

The diagram shows the Transformation Grant during the project period.

• Data Flows Both Ways Through Record Locators.

Slide 12

Post Transformation Grant Vision

The diagram shows the Post Transformation Grant Vision.

• Data Flows Both Ways Through Record Locators.

Slide 13

Relationship MTG to Medical Home-EMR

• Phase I (MTG)
  • Internal:
    • Architecture & Design
    • Build infrastructure
    • Create Master Patient Index
• Interface:
  • Architecture & Design
  • Build API
• EMR:
  • Establish EMR base in clinics
• Phase II (MTG):
  • Internal:
    • Fix Defects
    • Provide Reporting
    • Enhance Capability
  • Interface:
    • Connect to 6 Clinics
    • Connect to 3 Hospitals
  • EMR:
    • Connect to HUB
• Phase III (Post MTG):
  • Internal:
    • Fix Defects
    • Enhance Capability
  • Interface:
    • Connect to Labs
    • Connect to Other Clinics
    • Connect to Other Hospitals
• Phase IV (Post MTG):
  • Interface:
    • Connect to All Providers

Slide 14

MTG Project Chronology

• Centers for Medicare & Medicaid Services (CMS) Approval Letter: February 2007.
• Project Award:
  • First Year funds: $5,459,000
  • Second Year funds: $4,405,000
• Executive Steering Committee formed: March 2007.
• Joined Medicaid Transformation Grant Collaborative (13 States).
• Retained GWU Contractor to Support: Use Case development, Outline Evaluation Framework, and Draft Scope of Work for Request for Proposals (RFP).
• Finalized Draft RFP but procurement process has been slower than originally anticipated.

Slide 15

Where We Want to Be

• A full and active participant in developing statewide HIE efforts.
• A key facilitator of providers' participation, especially for vulnerable populations.
• An effective user of Health IT to improve the quality and health outcomes of Medicaid recipients.

Slide 16

Thanks for Listening

Contact Information:

• LaRah Payne, ScD, MPH, CIPP/G
• Senior Policy Analyst/MAA Privacy Officer
• D.C. Dept. of Health/MAA
• 825 N. Capitol St. NE, Suite 5200
• Washington, DC 20002-4210
• Tel: 202.442.9116
• E-mail: LaRah.Payne@dc.gov