J.C.L.P.H.C.C

Chatham County Safety Net

Planning Council

Health Information Exchange

Pilot Project

History/Goals

• Formed in 2004 by the Chatham County Commission; became an independent 501(c)3 non-profit in 2007

• Lead by Chatham County Health Department as neutral convener

• Composed of representatives from both hospital systems, providers of health care to the uninsured, city and county government, local non-profit agencies and citizen groups

• Charged with working together to find efficient and effective methods to improve access to and quality of health care delivery to uninsured Chatham County citizens

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Methods

• Annual Evaluation to monitor trends in demand and successes in providing service

• Community Needs Assessments to gather information about specific health care needs

• Strategic Planning to meet emerging needs identified in evaluation and needs assessments

• Seeking of grants to implement projects on behalf of entire Council

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Information TechnologyHealth Information Technology was identified as the solution to gaps

in quality of care in 2005 Strategic Planning Session

Evaluation trends revealed that Patients• Seek care in multiple locations

• Have medical information scattered among various providers • Have medical records at individual providers that are likely to be incomplete • And are vulnerable to errors due to missing information

And that Chatham County Safety Net Planning Council • Had an unknown amount of duplication of data in evaluation reports• Was extremely limited in producing valid data by paper records and limited staff to

review them• Could follow trends in access but could not follow health outcomes

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GA DCH Grant AwardCCSNPC was named one of three state HIE demonstration projects

by the Georgia DCH. Grant funding began in 2008.

Formation of the IT Consortium• Members from all CCSNPC providers

• Curtis V. Cooper Primary Healthcare• J. C. Lewis Primary Health Care Center• Community Health Mission• St. Mary’s Clinic• Good Samaritan Clinic• Chatham County Health Department• Memorial University Medical Center (one Emergency Department)• St. Joseph’s/Candler Health Systems (two Emergency Departments)

• Hosted by Savannah Business Group, Gary Rost• Open to Community

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IT Consortium

Steps taken:• Encourage and support the adoption of Electronic Medical Records by

Safety Net Providers• Work with consultants to design the Health Information Exchange

structure to meet the identified CCSNPC and community needs

• Release RFP to vendors • Vendor selection and contracting• Hardware acquisition• Hosting environment• Implementation

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IT Consortium- Accomplishments

• Encourage and support the adoption of Electronic Medical Records by Safety Net Providers• J.C. Lewis Primary Health Care and Memorial Emergency Department first to adopt EMR’s• St. Mary’s Clinic and Community Health Mission next• Curtis V. Cooper Primary Healthcare received Federal Stimulus Funds to purchase EMR

system , currently in vendor selection process

• Work with consultants to design the Health Information Exchange structure to meet the identified CCSNPC and community needs• Primary challenge was to link 8 – 10 unrelated providers • Safety Net providers have limited funds and staff• Providers want to retain option of selecting the EMR system right for them• Providers want to have control over their own medical records• Elected to structure HIE based on CDR and EMPI

• Release RFP to vendors- March 2009

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IT Consortium - Accomplishments

• Vendor selection and contracting• Initial bids received were in the $2 to $5 million range• Invited vendors to present to CCSNPC IT Consortium to familiarize them with community goals

and scale of project• Released a follow up RFP asking for smaller scale Pilot Project bids• Unanimous vote to contract with Orion Health• Contract negotiations lengthy; involved detailed development of SOW

• Hardware acquisition• Had initially considered software as a solution or using hospital-based servers• As project developed, identified importance of CCSNPC- managed database

• Hosting environment- Location identified• Implementation of Pilot Project

• Involves J. C. Lewis Primary Health Care Center, Memorial Emergency Department and CCSNPC as manager of database and holder of software licenses

• Began October 2009

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Clin

ical

Care

Inf

orm

ation

Integration Engine

Emergency Visit Sum

mary

Clinical Data Repository

J. C. Lewis Health CenterElectronic Medical Records

Memorial Univ Med Center

Emergency Department

Electronic Medical Records

View Portal

Master Patient Index

Consolidated Medical Record

Consolidated Medical Record

Patient PrivacyProtecting patient privacy is a critical component of Concerto Portal.

Custom access policies can be created for individual patients.

All access to patient records is fully audited.

Implementation Challenges• Hardware Set up• Establishment of HL7 messaging

• J. C. Lewis EMR Vendor had not previously established HL7’s• Delays and Glitches, but ultimately successful• Quest Laboratory HL7 development

• Establishment of VPN’s• Testing Environment

• Checking and rechecking data in system• User training• User testing

• Move to Production Environment• Elected not to backload patient data except for demographics• Initial database does not include record of every patient• Elected to extend User Acceptance training to allow database to grow

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Implementation Challenges• Contracting among Pilot Project participants

• Developed Business Associate Agreement and MOU

• Privacy and Policy• Developing fields• Consulted with a number of existing HIE’s to review their documents• Began with a Privacy and Policy Document, to be developed into a Privacy and Policy Manual by

a Steering Committee during the Pilot Project period• Each provider responsible for adding information about HIE to their respective patient consent

forms• Opt in/Opt out availability

• User Engagement• User training• User testing

• Community / Patient Engagement• Simple, non-technical Power Point developed to explain function and advantages of HIE• Focus groups and development of printed patient information planned

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Lessons Learned• Stay focused on the community issue

• Will help in decision making• Keeps a collaborative group on the same page• Provides meaningful use

• Stay focused on patients, not technology• Technology is the tool, not the end point• Community members, users and patients themselves understand the meaning

for them, not the technical jargon

• Everything is more complicated than you anticipate• And takes longer and costs more!• Keep your mind and options open

• Allow time to develop processes• If you wait to start until everything is “perfect,” you will never start• Keep looking for errors; don’t assume something is working

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Community BenefitsThe Health Information Exchange will

Provide Patients• With a longitudinal summary medical record in the CCSNPC database• Reduction of the same paperwork multiple times• Reduction of repeat testing- labs, radiology, etc.• Avoid delays in appropriate care and medical errors

Provide Healthcare Providers • Complete, secure, easily accessible electronic records• Communication among providers through secure, safe protected electronic portals

with information updates in real time• Ability to see complete information and avoid duplication and errors

Provide Chatham County Safety Net Planning Council • With unduplicated records and accurate counts of patients served• Ability to follow trends in access AND health outcomes• Secure repository of patient records in case of emergency evacuation

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EncountersAllergies/Alerts

MedicationsLaboratory Tests

Radiology Studies

CCSNPC

CCSNPC

CCSNPC

CCSNPC

CCSNPC

CCSNPC

EncountersAllergies/Alerts

MedicationsLaboratory Tests

Radiology Studies

CCSNPC

Hospitals

Public Health

Correctional Health

Private Providers

Behavioral Health

State HIE’s