Spreading Our Reach

2008 Annual Report

Committed to improving the health of medically underserved through the best use of informationtechnology.

Committed to improving the health of the medically underserved through the best use of information and information technology.

Message from the CEO

One year ago, I accepted the appointment of CEO. We envisioned a company that would continue to support healthcare organizations that serve the underserved and uninsured by building comprehensive, high quality IT tools and consulting services delivered at a price the safety net could afford without compromising quality. In order to dothis, we knew that we would have to grow and become more transparent and inclusive.

In FY 2007-08 we opened our wings to spread our reach by growing our collaborative membership and including more partners that are helping to ease the cost and technology burdens that impact our collaborative members. Our healthcare organizations and patients have complex clinic needs and deserve quality support services and software tools that improve the management of their businesses. OCHIN fills this niche and I am so proud of our progress this year.

We are pleased to present you with our FY 2007-08 Annual Report, which features some of our most important accomplishments. You will also be hearing from our board chairman, John Saultz who shares our passion for the safety net in addition to our groundbreaking electronic medical records efforts in school-based health clinics.

At a time when the dollars are needed most, we believe that if we continue to spread our reach, by being even more inclusive, we can be the catalyst for using health information technology to improve health outcomes and reduce waste and inefficiency. Using the power of numbers in the spirit of collaboration, we will achieve our mission to improve the health of the communities that we serve.

Sincerely,

Abigail Sears

BOARD OF DIRECTORS John SaultzBoard Chair Professor and Chair Family Medicine Oregon Health & Science University

Bob Marsalli Secretary Chief Executive Officer Klamath Health Partnership, Inc.

Glenn Kulm Treasurer Director of AdministrationSanta Cruz Co. Health Services Agency

Vanetta Abdellatif Director of Integrated Clinical ServicesMultnomah County Health Department

Homer Chin Medical DirectorClinical Information Systems Kaiser Permanente, Northwest

Tom Fronk Finance DirectorBenton County Health Center

Bruce Goldberg DHS DirectorState of Oregon

Ruby Haughton-Pitts President R. Haughton-Pitts Communications

Craig Hostetler Executive DirectorOregon Primary Care Association

Margaret Martinez Executive DirectorCommunity Health Alliance of Pasadena

Gil Muñoz Executive DirectorVirginia Garcia Memorial Health Center

Ida Saito Operations DirectorLa Clinica del Valle

Joseph E. Scherger Clinical Professor of Family & Prevention Medicine at theUniversity of California,San Diego School of Medicine (UCSD)

Herrmann Spetzler Chief Executive OfficerOpen Door Community Health Centers

Joel Young Manager Health Systems Planning Oregon Health Division

Abby SearsChief Executive Officer OCHIN

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In February 2007, Multnomah County School-Based Health Centers (SBHC) embarked on a trailblazing journey by becoming one of the first SBHCs in the country to install electronic health records (EHR) for students in K-12 public schools receiving medical care. As the Multnomah County School-Based Health Center Program moves into its second school year using OCHIN’s EHR, Kristin Case, RN, agreed to share her experiences. We are indebted to Kristen, the lead nurse practitioner at the clinics, for her commitment to serving youth and encouraging OCHIN to make continued improvements along the way.

School-Based Health Clinics Give EHR High Marks Based on an interview with: Kristin Case, Lead Nurse Practitioner with Multnomah County School-Based Health Centers

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OCHIN’s EHR was originally developed for primary care health clinic settings. To meet the needs of adolescents in school-based clinics, OCHIN set up the necessary reporting mechanisms to meet the reporting requirements of the Oregon State School-Based Health Center Program. These reports include annual risk assessments focused on age specific risk-related categories, parental involvement and well child data sets. The SBHCs can also request additional data sets if needed.

Nurse Kristen shared her thoughts on the benefits of the EHR during the first year. She cited:

•Standardizationofchartingandworkflowsbetweenthe12MultnomahCountySBHCsites;

•Easeofperformingchartauditselectronically;

•Havingaccesstochartsduringthesummermonthswhenasmallpercentageofthe SBHCs are open and children may receive health services at a clinic other than where theyusuallyattendschool;and,

•Easeofperformingproviderpeerreviews,andtheabilitytoviewchartsandgive immediate feedback

Nurse Kristin also shared her concern for maintaining confidentiality of adolescent patients. Confidential health services are essential to promoting teen health during this critical stage of physical and mental development when teenagers are beginning to establish their own identity and autonomy. Given these and many other factors, it’s critical that providers explain and keep confidential medical records and adhere strictly to all HIPAA regulations. Fortunately, there have been no major issues reported using EHRs, according to Nurse Kristin. During the clinic trainings, OCHIN staff focuses on security and HIPAA regulations. Only clinic staff with security access can view protected health information which gives both the staff and students confidence that security is being maintained.

Going forward, the Multnomah County SBHC group is looking at clinic efficiencies and ways to further optimize the use of the EHR system. The group has also shared their experiences with Virginia Garcia Memorial Health Center, which is using EHR at its new Tigard High School-Based Health Center. Sharing best practices is truly the strength of the OCHIN collaborative.

SOLUTIONS product provides Collaborative with a new quality improvement mechanism

In April 2008, OCHIN went live with the Solutions quality improvement system. Developed by Tomas Moran, senior director of quality and planning at Palo Alto Medical Foundation (PAMF) and his team of programmers, Solutions gathers data from any external source, compiles and aggregates these data, and delivers the information to users in the form of quality improvement metrics. These metrics can be used by clinicians and managers for a myriad of quality improvement initiatives. Solutions is owned by Bizin, Inc., and through a special agreement with OCHIN the Solutions product is offered free of charge to our collaborative.

Solutions is pre-packaged with a large set of clinical and non-clinical metrics, ranging from glycohemoglobin test result analysis for diabetics to appointment access and demand analysis by provider panels. There are over 150 such metrics included in the Solutions system. OCHIN has already implemented nearly 30 metrics and intends to continue with further implementations next year. Data sets are being drawn from the OCHIN Epic PM and EHR system to populate these metrics, and we are rolling out individualized workbooks for each OCHIN collaborative member on a monthly basis.

Below are some of the metrics already available to OCHIN members:

•Clinicalmetrics:Diabetes,CHF,Asthma,HypertensionDiseaseRegistries;Labs-related Metrics(HgA1c,LDL,etc.);BloodPressure;FootExam;BMI;ChlamydiaTesting; PapSmearTesting;VaricellaImmunization

•Non-clinicalmetrics:AdjustedActivePatientList(adjustedforFTE);Appointments Seen;ArrivedAppointmentCounts;AverageDaystoanAppointment;Cancelled Appointments;DemandAverage;NoShowAppointments;SeeYourOwn/Time WithOwn;UniquePatientCount

Through a co-development agreement with PAMF and Bizin, OCHIN plans to customize the Solutions product for safety net clinics.

We envision a web-based delivery system with fast, easy-to-use pre-built metrics to fulfill most if not all of the quality improvement needs of the collaborative. Our goal is for Solutions to become the ideal quality improvement system for safety net healthcare providers.

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2007-08 Fiscal Year Grant Progress

OCHIN was one of a very few U.S. Department of Human Services, office of Health Resources and Services Administration (HRSA) High Impact grantees in the nation that meet the High Impact Grant requirements by installing 15 EHR sites during the first year. In addition, we installed EHR in three sites to meet the HRSA Three Year OHIT EHR Grant objective and also installed Practice Management (PM) at Cowlitz Family Health Center and EHR and PM at Open Door Community Health Clinic’s Del Norte site. Additionally, we fulfilled our first year obligation on the HRSA Innovations Grant with our upgrade to Epic’s spring 2007 version, IU2, and began planning for OCHIN EHR to include mental and oral health components.

Growing the collaborative over the last year with 22 installations

September 25, 2007- High Impact GrantMultnomah County Health Department - Homeless Programs • West Side Health Center • New Avenues for Youth • St. Francis • Mobile Van (Nov 19)

November 6, 2007- 3 year OHIT GrantCommunity Health Alliance of Pasadena – Primary Care

February 26, 2008- High Impact GrantMultnomah County Health Department • HHSC Clinic (HIV Clinic)

March 18, 2008- High Impact GrantBenton County Health Department• East Linn Clinic • Monroe High School• Lincoln High School

April 7, 2008-3 year OHIT GrantVirginia Garcia Memorial Health Center• Tigard High School Based Center

April 15, 2008- High Impact GrantWaterfall Community Health Center

May 5, 2008 – Practice Management ImplementationCowlitz Family Health Center• Longview• Kelso• North Beach

June 9, 2008-3 year OHIT GrantVirginia Garcia Memorial Health Center• Beaverton Clinic

July 8, 2008- High Impact GrantTillamook County Public Health Dept • Tillamook• Cloverdale• Rockaway

August 5, 2008- High Impact GrantBenton County Health Department • Public Services Building - Primary Care

August 19, 2008-Practice Management/ EHR ImplementationOpen Door Community Health Center• Del Norte Clinic

August 26, 2008- High Impact GrantLincoln County Community Health Center• Newport Primary Care• Newport Public Health• Lincoln City Primary Care

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Each year the OCHIN Board of Directors provides strategic direction regarding the growth of the company in three areas: Grow the Collaborative, develop Value-based Partnerships and enhance our Customer’s Experience. OCHIN made substantial progress in all categories.

1. Grow the Collaborative: Expand our collaborative network to include healthcare safety-net clinic systems that want high-quality service and products specifically configured to meet their needs.

PMand/orEHRsoftwareimplementationsin23separateclinicsites

Achieved 123% of projected visit growth and 139% of projected revenue growth.

2. Value-based Partnerships: Build partnerships that develop new opportunities, establish OCHIN value for information, capture capabilities for research and quality improvement, and reduce systemic barriers to the adoption of HIT in the safety net.

Grant revenues exceeded FY08 projections, bringing in close to 1 million dollars more than expected

Successratioofgrantssubmittedtoapprovedis50%-4submitted/2approved

In addition to three continuing grants (2 HRSA, 1 AHRQ), OCHIN was awarded several new grants:

HighImpact$1.4M/1yr

PASSIICDCAsthmasurveillance$135,224/2.5yr

ELINCS,CaliforniaHealthCareFoundation2separategrants$30K/1yr

Collaborations on papers and projects with community colleagues are 150% of our established goal

3. Enhance Customer Experience: Great execution to ensure successful growth with optimal efficiency. Add value to member organizations through experience expertise, responsiveness, resourcefulness, and collaboration.

OCHIN developed, gained member approval for and implemented new metrics to establish a baseline using national standards in the area of performance relative to customer experience. Quarterly results will be reported to the board of directors.

FISCAL YEAR ACHIEVEMENTS

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In addition to our high level accomplishments each staff team reported their individual achievements.

Data Services •Clarity upgrade •UDS 2008 clinical metric reports •MGMA certification for one team member •New real-time reporting infrastructure for OCHIN •Solutions installed

Claims •Direct connect to Washington Medicaid

•New clearinghouse connections: – Office Ally – Availity

•New electronic remittance set-ups: – Community Health Plan of Washington – Molina Healthcare – Washington Medicaid – Regence BCBS

•NPI compliance conversion for electronic and paper claims

•AIDSWaiverprogrambilling

Technical Services •Dentrixbillinganddemographicinterface •ORCHARDbillinginterface •8bi-directionallabinterfacesincludingnewonetoStanford •PearsonDocusanEncounterinterfaceofregistrationdataandappointmentinformation •Demographicsexportfordictationservices •RadiologyReportfiling •DemographicfeedtoQSIADTfeedtoSantaCruzPharmacySystem •SureScriptsPharmacyordersout,refillrequestsfore-prescribing •MMEFmembershiploadforCalifornia •270-271UpdatesforOregonformoreefficientsearchesandbetterreports/displays •ExecutedEyePACSprojectwithUCBerkleyandsupportedpilotclinics •EpicUpgradetoSpring2007 •PharmacyinterfacewithAxotoltoSureScripts •ScanningoffinancialdocumentsintoPMpatientrecord •Totalnumberofworkordersreceived7826thisFY –26% completed in 8 hours, –16% in 24 hours, –35% in 1 week

Implementation SUCCESSFULLY Trained, implemented and supported 23 new implementationsDeveloped (10) Web-Based Training modulesRevised training strategy to reduce classroom time and maximize in clinic and online alternatives Participated in ~50 separate demos

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REVENUE FY2007 FY2008 Increase %

Implementation fees $1,336,436 $2,001,050 $ 664,614 50%

Users fees 3,060,990 3,249,788 188,798 6%

Grant revenue 1,078,870 2,659,556 1,580,686 147%

Other revenue 443,291 776,921 333,630 75%

Gift in Kind 564,456 314,646 (249,810) -44%

Total 6,484,043 9,001,961 2,517,918 39%

EXPENSES

Salaries and benefits 4,443,271 4,662,573 219,302 5%

Maintenance and support 803,955 1,191,487 387,532 48%

Administrative 1,381,766 2,061,725 679,959 49%

Total 6,628,992 7,915,785 1,286,793 19%

CHANGE IN NET ASSETS (144,949) 1,086,176 1,231,125 849%

EBITDA $ 575,051 $1,752,376 $1,177,325 205%

OCHIN 2008 RESULTS

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EMR VISITS

FY2007 FY2008 Increase %

268,290406,798

138,50852%

PM VISITS

FY2007 FY2008 Increase %

878,130

1,044,182

1,66,052

19%

TOTAL VISITS

1,146,420 1,450,980 304,560

27%

SPEAKING OF THE CHAIRMAN...

“I’m an idealist at heart.” According to Henry David Thoreau,”Success usually comes to those who are too busy to be looking for it.”

OCHIN asked a very busy doctor, teacher and administrator named John W. Saultz, MD to serve on our board because we know we can count on busy people to get the job done. Dr. Saultz is in his second year of board service and his first year as chairman of OCHIN’s board of directors.

When asked about Dr. Saultz, Abby Sears, OCHIN’s chief executive officer, said, “As board chairman, John has been exceptional. He leads by example. He’s living proof thatif you work hard and thoughtfully, you’ll be successful. He also doesn’t leave out fun, family or taking time to encourage the spirit. He runs the board and executive committee meetings with the aim of getting the work done in a way that never ignores our mission. His commitment to our safety net partners proves he can check his university hat at the door, and get down to the business of meeting the needs of the underserved and uninsured in a way that benefits the entire healthcare system.”

In an interview Dr. Saultz was asked about OCHIN and its future.

1. What are your reasons for serving on OCHIN’s board?

“I believe so much in OCHIN that I put two of the family medicine clinics at OHSU (Richmond and Scappoose) on OCHIN-Epic to support their sustainability. Even though we already had Epic at the hospital, I wanted OHSU to rally around this new partner and (believed) if we could get EMR into the safety net we could improve the quality of care andbuildunderstandingofitsvalueinresearch.If2/3rdsofthesafety-netclinics (in Oregon) were to join, we could have a good business model. I was and still am attracted to the long-term opportunity to learn from what OCHIN is doing.”

“After getting involved through the clinics, I was asked to join the board because of my interest in the data set and usefulness to the safety net and the community. I took a moral leap of faith believing this can happen, and I’m still committed.”

“Finally, I don’t view OCHIN as a vendor but am respectful of those who do – I just think that it’s so much more than that – it’s the collaboration.”

2. Where do you believe HIT for the safety net is going in the future and why?

“In the long run, the health of Oregon is tied to HIT, and our needs and ability to provide services. If we can provide 10 percent more efficiency by using HIT, we can deliver more for the money, increase productivity and service delivery, while providing quality care at a lower cost. The safety net is a special subset of the primary care system. Private practice is more dysfunctional than the safety net. OCHIN needs a strategy for small private practices to join the OCHIN collaborative.”

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3. What are OCHIN’s outstanding attributes?

“I’m impressed with (OCHIN’s) perseverance and tenacity. This organization adapts and remains optimistic in spite of worries and setbacks. That’s terrific! In spite of all of the financial issues with safety net clinics, OCHIN has been able to capture their trust and idealism. It’s not faith in an individual. It’s more about the quality of the idea and an idealistic link to the vision, along with resilience and adaptation.”

4. If you can help OCHIN to achieve one thing during your stay on the board – what would that be?

“The ability to have a sense of permanence – a financial and structural model that can be sustained with a long-term future. I think we’re getting close to a critical mass.”

“I’m also passionate about building a rich data set on the safety net that’s unrivaled in the US, and I think it’s possible in the future.”

5. Any closing remarks?

“I’m surprised at those who sit on the sidelines and second guess what’s going on in the playing field. I’m proud of the board and staff who have staked their careers on this organization. State government and the private sector should become involved. I’m very proud of the people who are trying to make it (OCHIN) successful. The safety net clinics have a stake in it, but we need greater public interest. The board members and employees at OCHIN are real heroes. I’m honored to be among them.“

Dr. Saultz is chairman of the Department of Family Medicine at Oregon Health & Science University where he’s responsible for 65 primary faculty members and 62 residents in three separate residency programs. For the last two decades, Dr. Saultz has been a dedicated OHSU faculty member. To his credit, in 2008, US News and World Report ranked OHSU in the top three American medical schools in primary care. Dr. Saultz teaches residents, students, fellows and faculty members. A dedicated physician, he also practices medicine and carves out time to do research, writing and lecturing. Dr. Saultz manages an annual budget of over $6 million as chairman of the Department of Family Medicine. He’s also an accomplished lecturer, having been published in over 100 peer reviewed journal articles, and has authored several books on healthcare. OCHIN is honored to have him serving on our board and as a member of the collaborative.

OCHIN introduces Epic’s Tapestry with beta project in 2009

OCHIN will implement a Tapestry beta project with Placer County Health and Human Services inlatespring2009.Tapestryautomateskeyworkflowsandtasksassociatedwithmanaged care administration by helping provider organizations manage risk and maintain strong, collaborative relationships with payors. For providers, the system helps manage authorizations;comparescapitationreceiptsagainsteligibilityhistory,andreconcilesclaim payments against contracts. A comprehensive benefits engine makes it easy to handle co-pays, co-insurance deductibles, MOOP, tiered benefits, riders, etc., allowing users to make informed decisions and minimize errors.

OCHIN is currently contracted for a number of Tapestry modules and services. We plan to add additional services after the beta site is up and running.

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OCHIN MEMBERS

WASHINGTON:

Cowlitz Family Health Center

OREGON:

Asher Community Health Center Benton Health Services Clackamas County PHDDeschutes County Health Department Klamath County Health Department Klamath Open DoorLa Clinica del Valle Family HCLane County Community Health Lincoln Community HHSMultnomah County Health DepartmentOchoco Community ClinicOHSUTillamook County Health DepartmentVirginia Garcia Memorial HCWaterfall Community Health Center

CALIFORNIA:Community Health Alliance-CHAPMonterey County Health Department Open Door Community Health CentersPasadena Public Health DepartmentSanta Cruz County Santa Cruz Women’s Health Center

707 SW Washington St. Suite 1200 Portland OR 97205-3529 503.943.2500 Fax 503.943.2501 www.ochin.org