Memphis, TN

1
Memphis, TN Thomas Duarte, Executive Director,
MSeHA
2
MSeHA Background

• 501(c)3 organization serving the Memphis area of
  1.1 million citizens
• 25 of Shelby County citizens are at or below the
  poverty line
• Began as a TN funded planning project in August
  2004
• Awarded an AHRQ Regional Demonstration contract,
  Sept 2004
• Received additional funding from the State of
  Tennessee

3
AHRQ Grant

• 5 year grant
• MSeHA to accomplish in years 1-3
• Data sharing
• Interoperability
• Documentation of lessons learned
• MSeHA to accomplish in years 4-5
• Evaluate the impact on patient treatment and care

4
MSeHA Participants

• Board was formed in 2005
• Baptist Memorial Health Care Corporation (5
  facilities including MS)
• Methodist Healthcare including Le Bonheur
  Childrens (7 facilities)
• The Regional Medical Center (The MED)
• St. Francis Hospital (2 facilities)
• St. Jude Childrens Research Hospital
• Christ Community Health Clinics (4 facilities)
• Shelby County/Health Loop Clinics (11 facilities)
• UT Medical Group (400 clinicians)

5
Early Planning

• Participants identified data elements and agreed
  to provide clinical and demographic information
  from inpatient, outpatient and ER encounters
• Began in the ER and expanded to include
  hospitalists and ambulatory sites
• No minimum data sets
• Participants encouraged to send what they could

6
Why the Emergency Department?

• Access to data
• Ability to impact patient treatment and care
• Reduce duplication of tests
• Potential to show ROI
• Use data to gain sustainability model

7
Data Obtained

• Data feeds include IP, OP, ER and Claims
  information
• Data includes
• Patient identification and demographics
• Lab results
• Encounter data
• Medication history (claims)
• Dictated reports
• Discharge, imaging, cardio, HP, Diagnostic
  codes, etc.
• Allergies

8
Data Summary Since May 2006

• Patient medical record numbers 1.14 million
• Patient records with clinical data 874,000
• Total records with ICD-9 codes clinical data
  915,000
• Number of text reports
• Imaging 2.41 million
• HP 3.35 million
• Discharge Summaries 87,483
• Anatomic Pathology 314,365
• Patient encounters/month 151,910
• Clinical lab results/month 2.97 million

9
How It Happened

• Participant costs 25-35K/year/site (less for
  subsequent sites)\
• Participant resources
• IT staff
• Internal QA
• Commitment to NOT let the MSeHA interfere with
  participant initiatives
• CEO commitment and champion for RHIO/HIE
• Implementation support (Vanderbilt Center for
  Better Health)
• Signing up users
• Training/support/site management
• Privacy security
• Establishment of Work Groups

10
Lessons Learned

• Make the data easily accessible and secure
• Provide ease of search for patients

11
Lessons Learned - Usability

• Provided standardized mapping of lab results
  (LOINC) to aggregate clinical data from multiple
  participants

12
Focus

• Get the participants to the table
• Begin with a narrow focus
• Identify data where there is agreement on
• Focus on policies and procedures for a single use
  of information
• Diagnosis and treatment
• Create a flexible system that can be used in
  different workflows
• Take as much data as you can you may need it
  later
• Early wins are possible
• Site visits for feedback, issue resolution and
  system usage

13
MSeHA Today

• 14 hospital ERs
• Hospitalists in 3 health systems
• 4 primary care Safety Net clinics
• 11 primary care Safety Net/Public Health clinics

14
Sustainability

• Obtain funding
• Identify population segments that will benefit
  from implementation
• Demonstrate the benefits
• Identify the potential customers
• Benefits to payors, employers
• Disease management
• Specific populations
• Pain management
• Workmans comp.

15
MSeHA Goals Focus

• Improve outcomes
• Reduce hospitalizations
• Eliminate unnecessary diagnostic tests
• Reduce ER visits
• Control costs
• Have greater PCP involvement

16
MSeHA Evaluation Goals

• Improve the quality of care by improving access
  to data at point of care
• Demonstrate the impact of the MSeHA in the ED
• Demonstrate how the MSeHA improves community
  healthcare delivery

17
Stakeholder Drivers

• Incomplete information increases admission rates
  and length of stay
• Lack of data impacts ED efficiency and ambulatory
  care
• Incomplete data at point of care impacts test
  ordering
• Incomplete data at point of care impacts clinical
  outcomes