The Learnings of a
National Health IT
Collaborative
Presented to the
Institute of Medicine (IOM)
By:
Abby Sears
CEO of OCHIN
April 8, 2014
Who is OCHIN?
Who is OCHIN?
• As a nonprofit organization, healthcare innovation
organization designed to promote access to quality,
affordable healthcare for all.
•
One of the nation’s
largest and most
successful Health
Information Networks
 In 18 states, coast-to-coast
 Touching over 4,500
physicians
Who We Serve
• Any member of the healthcare continuum requires equal access to
the next generation of integrated healthcare delivery
• We have a history in underserved populations, Federally Qualified
Health Centers, Mental/Behavioral Health, Public Health Agencies,
Rural Health Clinics, and Critical Access Hospitals
What We Do: Breadth and Depth
What Makes Us Different?
The Community as a Learning System
State Public Health
Community Organizations
Community
Practice
Federal
Agencies
Community
Members
COMMUNITY FOCUSED:
Governance
Engagement
Standards & Trust
Analysis
Dissemination
Integrated
Delivery
System
Health Information Organization
8
Academic,
Foundation,
and Data
Partners
The Community as a Learning System; The National Committee on Vital and Health Statistics, 2011
Member Engagement Along the Adoption Curve
Barriers and Opportunities to New Technologies:
Clinical Practice changes via technology
The obstacles are numerous and are challenging to
resolve
• Data and Privacy policies need updating
• Healthcare is highly regulated environment
• Varied business requirements of different clinical
domains and requires time and commitment to
capturing the data
• Payors and Federal agencies have different data needs
and requests
• Challenges of small practices with little to no IT support
• Economic issues of running small practices
• Change Fatigue – so many environmental demands at
one time
Changes Are Necessary: Policy and More
• Rules at the federal and state level: New rules for
technologically sharing data for integration of behavioral and
mental health and more
–
–
–
–
Alcohol and drug data is protected from other clinicians
Family Planning data
Sharing of immunization data across state lines
Different narcotic prescription rules by state
• Increased support in the field
– Especially for small practices, clinics with 1-10 providers
• Lack of sophistication, staff, funds, interest
– They want the help, but have neither the infrastructure, nor the
financial support, to get it
– “what is useful” functionality continues to be unclear
– Larger practices do this in-house
Off the Shelf Products: What can you do with them?
• Adding Technology to “Canned” Solutions
– Focus is on meeting regulatory requirements: PQRS,
HEDIS, Meaningful Use and privacy concerns
– Social determinants of health
– HIE
– Provider Directory issues
– Major pieces of the software products still are working
out the basics
– Is it standard programming or customer…how does this
impact future upgrades
Change requires a three pronged approach
Technology Change
Training/Documentation
Data and reporting on utilization
Needs to be in the workflow and lots of reinforcement and
training
– Alternative Payment methodologies – technology has
been deployed but the workflows haven’t changed
– Building more functionality than the physicians can
accommodate
– It takes time to reinforce new behaviors
– Constant reinforcement by the environment with
continuous education and support
– Teach at every level in the clinic
Follow the money: Payors and Price
• Payors are differentiating themselves on quality and cost
– Need to pay for quality in a slow and incremental way that doesn’t
hurt the providers but continues to encourage slow, gradual change
– Pilot small projects that will look at new ways to pay for quality across
the spectrum of providers – ask them to fund projects that bridge
organizations
– Look for reward programs
• Be willing to consider taking on some risk especially in small
amounts
– Look at PACE program of high risk Medicaid and Medicare patients for
good opportunities
• Encourage the payors to agree on definitions of quality at the
community or better yet at the state level
– Ask to show improvement not an outcome or a target
– How to use data to impact positive change needs to be part of all
education requirements at Medical Schools
Sharing and Celebrating the Achievers
• Peer to Peer knowledge sharing creates high leverage
learning opportunities especially on a shared system Sharing knowledge between practices and clinicians
– Most clinicians want to have provide excellent quality
– More focus at the medical associations
– Send comparison data in non-threatening and learning
environments to discuss why and what can change
• Look at the continuing education system for
opportunities advanced knowledge
Sharing technology knowledge: Why can’t I email or
copy it?
• Flexible vs non-flexible systems:
– Flexible typically means the product is highly configurable
which has a direct correlation to cost; manual staff
resources to build and maintain
– Lower cost systems tend to allow less customizability
– Are we on different versions?
– Did we buy the same hardware?
– Are we in the same state? Are the regulations the same?
– IP confidentiality and non-disclosure issues
Breaking Barriers: Innovation and Partnership
• There is no one answer, but there is an approach – build
change packages
• Innovation at the clinic level – starts with physicians
• You need to invest, but you can’t do it alone
• Partnering with groups to build
• Look for shared learning opportunities help each other – Peer
groups
• Capitalize on continuing education process
• Use Associations to support new legislation
• You get what you pay for in Health IT because of regulation
requirements
• Requires a high touch approach
Success Stories
• IPAs, safety net clinics, Regional Extension Center and
Hospital Deployments to perform group purchasing and
support
• Advocacy to improve legislation and policy to build;
potential new legislation around CFR-42
• More education programs to support more workforce
• Build an ongoing support mechanism for
• HIT investments by Foundations for social venture
capital in products to help embedded change
Thank You
OCHIN Inc.
@OCHINinc
Abby Sears
CEO of OCHIN
searsa@ochin.org