Case Study "The Tipping Point: Moving DIRECTly from Availability to Adoption" Featuring: Dawn FitzGerald, Chief Executive Officer, Qsource As part of the American Recovery and Reinvestment Act (ARRA), awards were made to states to create the necessary infrastructure for widespread adoption of Direct technology. In partnership with the State of Tennessee, Department of Finance and Administration, and Office of eHealth Initiatives, Qsource was contracted to provide technical assistance to healthcare professionals in selecting, implementing and using certified Direct technology to improve the quality and value of healthcare. A key component of the project was the selection of pilot communities in which to identify, develop and implement use cases that were sufficient to create a social and behavioral threshold for universal community-based adoption of Direct technology. Together with ICA as our Direct technology vendor, Qsource implemented the pilot over 5 months, culminating in a report of lessons learned from these pilots. These lessons learned are being used to inform Tennessee’s statewide roll out of Direct with the goal of achieving 4,000 users by February, 2014. This presentation will highlight best practices and lessons learned with regard to Direct implementation, along with up to date information on the status of Tennessee’s statewide rollout of Direct technology. Learning Objectives: ∙ Attendees will be able to describe three general principals of expanding provider adoption ∙ Attendees will receive a brief review of Rogers’ Innovation Adoption Curve and the various incentives that are effective promoting early IT adoption along that curve ∙ Attendees will hear valuable lessons learned in IT adoption from three distinct healthcare communities

1. The Tipping Point:
Moving DIRECT(ly) from
Availability to Adoption
September 17, 2013

2. 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

3. 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

4. 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

5. 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

6. U of M FedEx Institute:
- Trailed HIT Specialists & identified
implementation “glitches”
- Source for independent assessment of
implementation and process flow
- Offered workflow solutions

7. 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®

8. 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”.

9. 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

10. 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

11. 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

12. The Tipping Point

13. 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:

14. 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

15. The Law of the Few
• The 80/20 Principle
• Connectors, Mavens and Salesmen
• Knowledgeable, influential peers create spread
• Find appropriate champions
Participant Recruitment

16. The Stickiness Factor
• Messages need to make an impact
• Make your message memorable
• Keep it simple; but effective
Marketing the Product

17. The Power of Context
• Community/provider characteristics
• Support requirements
• The value of incentives
• Organizational buy-in
• Use cases that “sell”
Know the Customer

18. The Tipping Point: The Law of the Few

19. The Tipping Point: The Stickiness Factor

20. The Tipping Point: The Power of Context
• “Dear Colleague“ letter
• At the elbow support
• Technology
sensitivity/obsolescence

21. 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

22. The Tipping Point….

23. Discussion
What questions
do you have?