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Population Health: A Sustainability Strategy for a
Disease Registry?
AHRQ 2007 Annual MeetingSeptember 27, 2007
Eleanor Littman RN MSNHealth Improvement Partnership of Santa Cruz
County
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Outline
The Santa Cruz Story Innovation & Collaboration Vision: Community-wide Diabetes Registry
Lessons Learned Project History Population Health is Value Proposition
Future Chronic Disease Registry and/or Health
Information Exchange?
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• Central California Coast• 75-miles S. San Francisco• 265,000 residents • North – Silicon Valley Beach• South – Agricultural
• Isolated • Progressive • Innovative• Collaborative
Santa Cruz County, CA
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Fragmented Private Health Care System
Three private hospitals CHW/Dominican – largest Sutter Maternity & Surgery Watsonville – for profit
ThreeTwo competing medical groups
Physicians Medical Group – IPA Sutter/Santa Cruz Medical
Foundation Dominican Medical Foundation (July
2007)
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1995 IPA partnered with Axolotl Clinical Messaging 2000 web-based expansion private physicians 2004 County clinics including mental health 2005 Community Health Centers
Innovation: Clinical Messaging
A Health Information Exchange?
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Innovation: EMR Adoption (40%)
Private practices (2000) Dominican Hospital Cerner (2006) Santa Cruz Medical Foundation Epic
(2007) County Clinics Epic (2006) “Threw Public Health off IT bus”
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Collaboration: HIP
Health Improvement Partnership Founded in 2003 (CAP grant) Incorporated in 2005 Public-private collaboration of health care
leaders Common ground issues in competitive
environment
Accomplishments Healthy Kids (98% children Santa Cruz County) Project Connect (Frequent ED Users 54% ) Diabetes IOM Invitation (Jan 2004)
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Vision – January 2004
• Expand current IPA diabetes point of care registry to ALL providers
• Test point of care registry 1st step EMR
• Build community-wide database
Outcomes:• Higher standard of care consistent
across the County• Track diabetes population in the
aggregate
Build on strong history of collaboration and innovation!
Dr Wells Shoemaker
Name of handshake collaborative.
AHRQ Grant: Santa Cruz County, CA Diabetes Mellitus Registry (DMR), 2004-2007
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Reality - September 2007
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Project History 2004 - 2005
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Project History 2006 - 2007
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Lessons Learned
Collaboration Build trust requires neutral entity Business proposition before governance
Legal Point of Care Registry built on certifying
“provider relationships” Not legal basis for building community-
wide registry Adoption
EMRs = Point of Care X resources
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Lessons Learned: Technology Technology
Complexity of: Obtaining multiple sources of data (CMS) Combining multiple sources of data Patient matching (MPI) Adapting internal tool for community use
Positive Outcome: Public Health back on bus -- 2006
InfoLinks Project (RWJF) Driver?….
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Lessons Learned: Value
Ranking*
1. Action Reports for individual providers (turf wars)
2. Community Database for Population Health3. Community Patient Lookup4. Performance Reports with Benchmarks5. Performance Reports for Payers 6. Point of Care Tool7. Care Management Tool
*Results from October 2006 Business Case Survey (n=12)
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Population Health Moves Up
Santa Cruz County Health Services Agency willing and accepted as neutral public entity
Value in community with commitment to collaboration to improve health status County, HIP, Foundations $$ Hospitals funded Community
Assessment Survey x 10 years
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Benefits of Population Health Focus
EMRs are friends not foes Demographics (language, residency)
Identify Inequities Point of care (smoking, weight, BP)
Identify pre-morbid conditions Example: pre-diabetes
Integration of Public Health and Clinical Care
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Next Steps
Planning Community Disease Registry Requirements (Population health +) Integrating public health & clinical care Due Diligence on technology Refine Value Propositions
Pilot Project – demonstrate & evaluate Wait for EMR adoption before
community-wide implementation (60%?)
Support EMRs in community health centers and small private practices
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Chicken or Egg?
Is there a value proposition for a disease registry as a first step to health information exchange?
OR Is the value proposition for
health information exchange that includes a disease registry?
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