Stan Shaffer, MD
Founder, Healthy Mothers,
Healthy Babies
Kendra Wyatt
Strategist, Community
Access, Cerner

Delivering Care in Haiti
Medical Pathology – Social Pathology
Community Focus – Community Engagement
Measuring Outcome – Measuring Impact
The Principles and Comparisons
Medical Home Theory
Kansas City, Missouri: Jackson Country Free Clinic
Lasso the Power of Community and Information Technology
Austin, Texas: Indigent Care Collaboration
JaxCare, Jacksonville, Florida
Health Banks- Privacy, Portability with Purpose
Live from the WHO Standards Meeting, Kenya

Lifetime risk of death from pregnancy
Sweden
United States of America
World average
Haiti
Afghanistan
1:30,000
1:4000
1:75
1:16
1:6

Percent of deliveries with skilled birth attendant

● = 5,000 child deaths / year

(< 5 years)

(< 28 days)

• Clean delivery, breast feeding, antibiotics
→ Sepsis deaths ↓94%
• Prenatal tetanus vaccine
→ Tetanus deaths ↓81%
• Malaria prevention
→ Low birth weight deaths ↓59%
• Neonatal resuscitation
→ asphyxia deaths ↓39%
Jones, Child Survival II, 2003; Lancet 362:65-71

Prenatal Care
(percent of total)
Births Attended by
Skilled Health Staff
(percent of total)
Neonatal Mortality
Rate
(deaths per 1,000 live births)
Haiti
Country wide
(WHO statistics)
79
24
34
Baseline
Community
Survey
51
13
40

Why didn’t you go to the hospital?
1. Too far
2. Too expensive
3. Untrustworthy
Underlying Medical pathology is Social pathology

Why didn’t you go to the hospital?
1. Too far → Community services
2. Too expensive → Free care
3. Untrustworthy → Quality
Consistency
Hospitality

Hospital
Comprehensive
Expensive
Remote
Birthing Home
Home
Limited care
Inexpensive
Convenient
Obstetricians
Nurse Midwives
Matrones

Continuity of Care




Pregnancy planning
Prenatal care and triage
Prevention of infections
Syphilis, HIV, Malaria
Safe birth




Clean delivery
Skilled birth attendants
Breast feeding support
Vaccinations
Nutrition and micro-nutrient supplementation
Child development

• Outcome monitoring
• Quality assurance
• Performance improvement
• Communication
• Resource sharing
• Health mapping
• Community health atlas

Community Health Atlas

Santé Communautaire
Education
HIV - DOT
Vit A

Santé
Communautaire
Elimination of
Intestinal Parasites

Maternal Transfers
Vaginal bleeding
Postdates
Hypertension/Pre-eclampsia
Preterm labor
Repeat C-Section
Prolonged labor
Abnormal fetal position
Prolonged ROM
Eclampsia
Large uterine size
Fetal death
2
2
2*
1
1
9
8
17
12
Number
21*
19

Prenatal Patients
668
Deliveries at MN
514
Live Births
514*
Neonatal survivors
511
Fetal Deaths
1
Deliveries at Home
60
Live Births
88*
Neonatal deaths
3
Neonatal survivors
85
Neonatal deaths
3
Hospital Referrals
94
Fetal Deaths
4
Maternal Deaths
0
Maternal deaths
3
2005-2006 delivery data

Prenatal Care
(percent of total)
Births Attended by
Skilled Health Staff
(percent of total)
Maternal Mortality
Ratio
(pregnancy related maternal deaths per 100,000 live births)
Neonatal Mortality
Rate
(deaths per 1,000 live births)
Maison de Naissance
Primary Outcome Measures
Haiti
Country wide
(WHO statistics)
79
24
Baseline
Community
Survey
51
13
680
34
----
40
MN
Community
2005-2006
99
91
498
9

 Employment
 Mothers clubs
 Community activism
 Vaccination campaigns
 Seeking water, housing, micro-loan programs

The value of a society is increased only as it cares for its most vulnerable.
John Rawls
Child survival…a measure of civilization… not just for the countries with high child mortality, but also for countries that could have changed the situation.
William Foege

This isn’t charity work, it’s social justice.
Paul Farmer

Childbirth in a Haitian Village

Partners In Health
Healthcare as a Right vs Commodity
“Anywhere you have extreme poverty and no national health insurance, no promise of health care regardless of social standing, that's where you see the sharp limitations of market-based health care.”
Paul Farmer

A medical home is defined as primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective.
A medical home addresses how a primary health care professional works in partnership with the family/patient to assure that all of the medical and non-medical needs of the patient are met.
The physician should be known to the person/family and should be able to develop a partnership of mutual responsibility and trust with them.

Maison de Naissance
Providing a Physical Birth Home
Virtual Consults
Virtual Consults
Data Center
Outreach
Via Football
Clubs Drinking Water
Waste
Management
Faith Partnerships
Agriculture
Productivity
Community
Health
Workers
Home
Cement
Floor
Tile Roof
Cell Phone
Connectivity
Power
MN Health Bank
MN Baby,Mama,
Family
Midwives
Les Cayes
Hospital
Education
(BTI)Business
Technology
Institute
Haitian School of Midwifery
Government
Entrepreneurism

The Mother of them all….
Indigent Care Collaboration, Austin Texas
AUSTIN/TRAVIS COUNTY HEALTH AND HUMAN
SERVICES DEPARTMENT
AUSTIN TRAVIS COUNTY MENTAL HEALTH
MENTAL RETARDATION CENTER
(ATCMHMR)
AUSTIN WOMEN'S HOSPITAL
CENTRAL TEXAS MEDICAL CENTER
CITY OF AUSTIN COMMUNITY CARE SERVICES
DEPARTMENT
JOHNS COMMUNITY HOSPITAL
LONE STAR CIRCLE OF CARE
PEOPLE'S COMMUNITY CLINIC
PLANNED PARENTHOOD OF THE TEXAS CAPITAL
REGION
ROUND ROCK HEALTH CLINIC
ST. DAVID'S HEALTH CARE
SETON FAMILY OF HOSPITALS
TRAVIS COUNTY HEALTHCARE DISTRICT
TRAVIS COUNTY MEDICAL SOCIETY
UT SCHOOL OF NURSING
VOLUNTEER HEALTHCARE CLINIC
WILLIAMSON COUNTY AND CITIES HEALTH
DISTRICT
All Members of the Safety Net
Community Participate
Community Health Record
Community Health Workers

Virtual Medical Home Framework
Community
Foundation
Philanthropy
Health Plan
Employer
Faith
Health Ministry
Government
Public Health
Birth Center
Education
Hospice
Environment
Nutrition
Person
Family
Affordable
Housing
Appropriate
Clothing
Pharmacy
Grandmothers
Community Center
Sports Clubs
Mobile
Clinic
Medical Home
FQHC, Safety Net
Community
Health Worker
Specialist
Hospital
Health System

Jacksonville Health Information Network
Community Health Record
A Virtual Medical Home
Duval County
Health Department Med
Claims
Shands
Jacksonville
Baptist Health System
McKesson
SMS
Cerner
JaxCare
Claims
Mayo Clinic Hospital Cerner
.csv Files
Jacksonville Health Information Network
Accessible via a secure internet site (SSL 128-bit encryption)
HL7 Interfaces,
Data Extracts
St. Vincent’s
Medical Center
Memorial
Hospital
University of
Florida
.M. Sulzbacher
(FQHC)
IDX
Cerner
MediTech
IDX
AllScripts
Med Mgr
Brooks Rehabilitation
Hospital
MediTech
HMS
Duval County
Health Department

Person Controlled Health Record Bank
The Virtual Medical Home

H.R.2991
Independent Health Record Trust Act of 2007
Dennis Moore
U.S. Rep, D-Kan
Paul Ryan
U.S. Rep, R-Wis
Saving money and lives using non-centric, consumer-driven independent health record banks
Charter for not-for-profit, cooperative institutions with member-owned accounts
IHRBs could save money and lives
Sale of data with revenue considered tax-free income
Gives providers access to data in emergencies
Vision for a “New Transaction”
• "By offering member-owned accounts, independent health record banks have one focus —the patient.”
•- U.S. Sen. Sam Brownback, R-Kan.

Speaker will update attendees on results of the WHO
Health Information Standards Conference Held December
4-7, 2007

Stan Shaffer, MD
Maison de Nassaince www.maisondenaissance.com
shaffers@umkc.edu
Kendra Wyatt
Cerner Corporation www.cerner.com
kwyatt@cerner.com
Partners In Health
PIH.org
Bridget McCandless, Medical
Director, Jackson County Free
Clinic bmmcca@comcast.net
Ann Kitchen, Executive Director,
Indigent Care Collaboration akitchen@icc-centex.org
Rhonda Poirier, Executive
Director, JAXCARE rpoirier@jaxcare.org