The Tipping Point: Moving DIRECT(ly) from

Availability to Adoption

September 17, 2013

Presentation Overview:

• Tennessee’s Direct secure messaging

implementation program (Health eShare)

• Pilot community initiatives and lessons learned

using Rogers’ Diffusion of Innovation Theory

• The Tipping Point: Using the three rules of

epidemics as an approach to statewide roll-out

Tennessee’s Health eShare Effort

• Utilize these best practices and lessons learned from the pilot communities for statewide rollout

Phase 1:

Work with at least two pilot communities and

HISP vendors to define use cases, best practices and test implementation

strategies

• 4,000 participants by January 2014

Phase 2:

Generate widespread adoption and USE of

Direct technology across the entire spectrum of health professionals

Health eShare’s Incentive Program

Tennessee offers $500 per participant with an assigned, unique Direct email address.

Participants applying for the incentive must:

• Be licensed professionals that are in good standing with the State

• Be listed in the provider directory on the Health eShare website

• Establish at least one Direct account with a DTAAP accredited HISP Vendor

• Send at least one non-test Direct message for each user account

• Comply with HIPAA and/or other applicable regulations within each participant’s professional role and responsibility

Health eShare Direct Pilot Informants

HIT Specialists & HISP Vendor (ICA)

University of Memphis FedEx Institute for Technology

Center for Supply Chain Management

Community Participants

Provider interviews & Focus Group

Inputs

U of M FedEx Institute: - Trailed HIT Specialists & identified

implementation “glitches”

- Source for independent assessment of

implementation and process flow

- Offered workflow solutions

ICA: - CareAlign® web portal was used as Direct

interface within pilot communities

- Worked with Qsource to align Direct incentive,

registration & authentication processes

- Provided ongoing data for populating the web-based

provider directory and map

- Produced ONC provider metrics

- Partnered on idntifying use-cases and integrating

with other HISPs & HealthVault®

Memphis

Community Pre-pilot

Focus Group

Pre-pilot Inventory

of Provider Inputs

Into:

• Direct Knowledge

• Barriers

• Needs

• Opportunities

• Potential Use

Cases

Sample Feedback:

“Currently we are spending a huge amount of time

faxing. It is a drain on our resources as well as a hold up

with patient care. We are hoping this process will

resolve a significant component of that”.

“We need to be better at sharing information with

specialists and need the information back from them.

They spend the same amount of time because we didn’t

get the chest X-Ray, for example”.

“We are trying to take the burden off the patient

because now we have to ask them what the specialist

told them since we don’t get reports. We don’t want the

patient to have to be the messenger”.

“For those who have gone through Stage 1, we are

looking at Stage 2 practice management capabilities

that are less expensive and/or less cumbersome”.

Tennessee Pilots

• Three Communities: Urban, Semi-Urban and Rural

• Use Cases were developed by each community

• Commitment was established via community charter

• Rapid Cycle Implementation: 6 months

Community Demographics Use Case

Hickman County Rural

(pop. 25,000)

Community Health

Campaign:

Patient Portal

Chattanooga Semi-urban

(pop. 340,000)

Care Transitions:

Hospital to

Community (home,

physician, home

health, nursing home)

Memphis Urban

(pop. 930,000)

ACO Implementation

Surprising Pilot Results

The financial incentives for participating were not as effective a motivator as anticipated.

Participant adoption and use case varied depending on community use case, but in general, participation and sustainability were low:

• Used regularly for case manager referral

• Tried but not used regularly for hospital to physician referral

• Patient portal rarely, if ever used

Best Practices & Lessons Learned - Rogers’ Innovation Adoption Curve

Motivation and incentives are changing in potential impact as Direct achieves

greater adoption.

Source: Rogers, E.M. (2003) Diffusion of Innovations (5th edition), New York, NY,

Free Press

Desire to be a leader/champion

Ease of use/simplicity

Incentives/Costs

Value/Usefulness

Requirement

The Tipping Point

A Statewide Effort

• Expanding participating HISP Vendors

• Statewide Marketing campaign

• Assessing use cases and incentives that work

After working with

3 pilot communities,

Health eShare is now

expanding adoption efforts

statewide.

• Physicians

• Hospitals

• Home Health & Long-term Care Facilities

• Laboratories

• Department of Health

We hope to reach this goal by achieving a

widespread adoption of Direct technology across

the entire spectrum of health professionals, with an emphasis on:

Lessons Learned

• The Law of the Few

• The Stickiness Factor

• The Power of Context

The Three Rules of Epidemics*

*Source: Malcolm Gladwell (2000), The Tipping Point, New York, NY, Little Brown

The Law of the Few

• The 80/20 Principle

• Connectors, Mavens and Salesmen

• Knowledgeable, influential peers create spread

• Find appropriate champions

Participant Recruitment

The Stickiness Factor

• Messages need to make an impact

• Make your message memorable

• Keep it simple; but effective

Marketing the Product

The Power of Context

• Community/provider characteristics

• Support requirements

• The value of incentives

• Organizational buy-in

• Use cases that “sell”

Know the Customer

The Tipping Point: The Law of the Few

The Tipping Point: The Stickiness Factor

The Tipping Point: The Power of Context

• “Dear Colleague“ letter

• At the elbow support

• Technology sensitivity/obsolescence

Next Steps

• Rapidly Expanding HISP Marketplace

• “Organically” Growing Pilot Markets

• Compendium of Use Cases and Linking to

Appropriate Technology

• Increasing Awareness

• Adapting to Change

• Documenting Lessons Learned “The real journey of discovery is not in seeking new lands, but

seeing what has already been there with new eyes.” - Marcel Proust

The Tipping Point….

Discussion

What questions

do you have?