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Scotland samaritan putnam rural health network information technology presentation
- 1. Implementing Health Information Technology as a Network Ken McMinn
- 2. Samaritan Scotland Putnam Rural Health Network (SSPRHN)
- 34. INFORMATION TECHNOLOGIES Federated vs. Centralized pros & cons
- 40. QUESTIONS ???
Hinweis der Redaktion
- Welcome Everyone! My name is Kenneth McMinn. I am the IT Manager at Scotland County Memorial Hospital located in Memphis, Mo and I am the Chairperson of a CAH network IT Committee. I have been asked to share details about our Network and the road IT has taken in the network. First I will give a brief background information re: network.
- The network name is Samaritan Scotland Putnam Rural Health Network or SSPRHN for short. <I know it is a mouth full, but I will try to get the name straight. It probably took me 2-3 months to finally get the name down>
- Funding for the SSPRHN was provided through the U.S. Department of Health and Human Services, Health Resources and Services Administration also known as HRSA.
- In September 2005, SSPRHN applied for the HRSA planning grant. The initial grant review came back as being recommended for funding at a level less than requested but was not funded due the lack of funding – confusing? – was for us also but some nine months later – and to our surprise we received another notification that our grant was being funded for the total amount requested beginning September 1, 2006. What happened was that HRSA had initially awarded all of it’s allocation for this particular grant period however as they were completing the fiscal year not all of the allocated money was used by the grantees and thus we were funded.
- The purpose of the Network Planning grant was to further collaboration of our three initial critical access hospitals. Samaritan located in Macon, Mo; Putnam located in Unionville, Mo; and Scotland located in Memphis, Mo.
- Basically during the planning phase, we spent our time collecting ideas concerning how the organizations might collaborate. We then recorded those ideas on paper, decided to move further with the collaboration and to write an application requesting funds to further develop the network.
- With all the information gathered during the planning process, the group submitted an application to HRSA requesting Network Development funding in October 2007. Our application scored very high and SSPRHN was awarded the grant in May 2008.
- With the receipt of the HRSA Network Development Grant, our focus shifted towards formalizing the collaboration of the SSPRHN.
- Briefly lets discuss, the SSPRHN project and what formalizing means.
- SSPRHN created a series of goals, objectives, and activities to be performed during the duration of the development grant. Briefly I’ll review the goals and outcomes, Goal 1 included but was not limited to establishing Articles of Incorporation, receiving 501 (C) 3 status, expanding the network and hiring a network coordinator. All of the objectives of Goal 1 were met and exceeded in year 1 of the grant. How objectives of Goal 1 was exceeded in year 1 was that expansion of the network originally planned for grant year 2 and 3 was condensed into year 1 – NEXT SLIDE
- We added Sullivan County Memorial Hospital located in Milan, Missouri, and Hermann Area District Hospital located in Herman, Missouri early on to help build network capacity and to strengthen the network.
- In response to Goal 2, we identified 5 areas of focus and formed a committee for each focus area. The focus areas are Workforce, Operations, Performance Improvement, Information Technologies, and Community. Each committee meets regularly and discusses ways to help improve the network.
- Some examples of committee outcomes of Goal 2 thus far include…… the RHC networking grant was received in November, 2008 and was for approximately $74,000
- In Goal 3 we further expanded the Community committee to include Community health needs assessment and partnerships with local organizations.
- In response to Goal 3, a study of community health data was performed by MHA students, chagned from our original idea of a community project centered on obesity to the promotion of health careers, and in December, 2009 we secured $208,000 in grant funding to partner with 11 local schools and the community to promote health careers.
- In Goal 4 we are looking at possible methods of revenue generation, creating a new business model, and reassessing the SSPRHN strategic plan.
- In response to creating a plan to sustain the network, we will be performing an assessment of network revenue generation opportunities, an assessment of membership savings, identification of SSPRHN business partnering opportunities with other organizations and grant funding opportunities and strategic plan that covers the period of 2012- 2015.
- First Meeting: The first meeting of the SSPRHN IT Committee took place on September 17, 2008. Prior to the first committee meeting the focus area of IT had been established by the governing board, the committee membership was appointed, and the meeting structure was set but there was no agenda/purpose proposed beyond bringing the group together to identify interest on which to collaborate. I remember at that time wondering “What are we here for? I was not alone – I found out later that none of the technical people present had a clue to why we were there or what we were suppose to be doing. Over the course of the next four meetings the group worked towards gathering information about each organization so that we would be better able to assess the IT status of each of the member organizations, yet we continued to struggle with the question of “What is our ultimate goal? RHIO, HIE, ????? We were clueless. It is OK to be clueless.
- In retrospect, as a committee, our initial meetings provided a period for personal discovery, getting to know each other as professionals, understanding the value proposition that comes from networking, building trust, learning about each of the other organization’s IT status, and defining our purpose as a committee. At this stage of our evolution, and being the skeptic I am, I remember thinking that it was “Great to know the other IT people”, but how are they going to help me? As the meetings continued, the answer to my question would become evident….
- First Project: We gathered information regarding current setup of hardware and software. EMR progress (if any). During subsequent meetings our discussions and efforts cumulated into creating a simple survey to gather information about the individual institutions IT status. This information was compiled, shared, and served as a stepping stone to help develop our thinking toward defining a common goal. Results of the initial survey revealed that none of our organizations had administered surveys to our staff to measure our readiness to adopt IT, nor measured the IT knowledge of our staff or ask staff about our IT needs (this had been done in an informal manner and with selected staff but not including all hospital staff), none had written Organizational IT Plans, and we identified that everyone was using a different prime software vendor.
- We were attending the SSPRHN committee meetings in the name of “networking” without a defined agenda or purpose. At this stage we came to the conclusion that it was logical that we visit with other organizational networks to discover if they had established IT committees and if so what was the purpose, the activities of, and what was being accomplished through the efforts of the IT committees. Along this journey we also expanded our knowledge in several related areas such as informatics, total facility EMR implementation, etc. I would like to share, with you, some of the places we visited along our journey and what we learned. We visited the hospital in Thayer County, NE, which had been awarded a HRSA grant for $1.6 million to implement EMR. The system was a beta site for HMS and their partnering sites. We learned of the Thayer success in fully integrating HMS within their organization, the challenges they had faced with the vendors, internal staff, and external. Thayer representatives reported their HMS account representative played a huge part in their seamless transition and their HMS Users group.
- In the area of IT, Western Healthcare Alliance hospital membership is greater than 18 hospitals and has developed a centralized server for email and backup by utilizing a secured VPN. Their NOC Datacenter is located in Grand Junction, CO. WHA also has list serves for their member Dept mgrs, they bring in vendors at their regular IT meetings, and are currently researching an offsite pharmacy. Another opportunity that WHA-IT committees are considering, is looking to bring Cisco certification onsite for members instead as a cost saving measure when compared to the cost of sending personnel to CA for training. As a result of the WHA visit, our members thought a backup server was an interesting idea and we began researching the idea.
- The group conferred with a member of the Department of Health Management and Informatics faculty at the University of Missouri. The faculty member led a discussion regarding the difference between Informatics and Information Technology. As a result of the meeting we learned that Informatics is more concerned with how the knowledge fits in and supports the IT, and that it is more centered around data and research. Various IT opportunities and tools were discussed. Specifically, during the discussion, it was suggested that sharing of information, hosted and delivered through a Regional Health Information Organization (RHIO), might be of future consideration by the SSPRHN.
- The IT committee participated in a webinar entitled “How to Get Funding and Support for Your Healthcare IT Projects”. This 90 minute webinar was administered by Beacon Partners, HIT HRSA, and Healthcare IT Transition Group. Topics discussed included getting internal support for projects, importance of vendor selection, how to approach private funding, and the value of partnerships. We visited the ICAHN - They have approximately 55 members thus far and have put together an IT committee for the purposes of networking, education, have a centralized server for their members for back up email and Performance Improvement reporting.
- We visited the Lakelands Rural Health Network in Greenwood, SC to view their live Health Information Exchange (HIE) which was funded by the federal government. We were very impressed with the way they set up their exchange, as they used adapters (servers) for each hospital. That adapter queried the hospitals own Electronic Medical Record (EMR) into a webpage where all info could be looked at and information pulled for Quality Improvement. The South Carolina Office of Rural Health is a state repository of Medicaid information and has been used as a registry to identify where patients have been seen. Once it is determined where a patient has been seen, you can query the hospital they have been in. Your hospital’s information is yours and can be seen elsewhere for a short time, if necessary. CareEvolution is the company that created the interfaces between each hospitals EMR that was included in the demonstration project. You can think of this like the Expedia site you put in a name and it finds matches. We also learned during the visit that developing an RHIO is more than just being able to electronically transfer information - that governance, policies, and procedures are critical issues and must be in place – Lakeland found this out the hard way – the lack thereof actually caused them to have to stop their project in mid stream and address these issues of governance, policies, procedures, etc. As a result of this visit our IT committee discussed the importance of governance and determined that the Lakeland model, i.e. a federated type model, dissevered much consideration.
- Besides the numerous site visits we previously talked about other external organizational networking that has occurred during our journey thus for also include
- By April, 2009 it was obvious to our membership that we had committed to a PURPOSE! We wanted to share information not only between our hospitals but to other bigger hospitals where we send patients. As a member of the IT committee, it was at this point, that I now believed our committee not only had a purpose that was worth the time spent but we also had a common vision for the future – external transfer of information.
- How do we share information among ourselves? We thought of Google Groups, Email, Listserves. Ultimately we wanted to get something secure and reliable, and came to conclusion that Microsoft Sharepoint and VPN (Virtual Private Network) would be the solution. The VPN would also allow us to share health information securely.
- Our initial ideas of information we can share between our entities include……
- So we looked at becoming an HIE, to share health information. Some of the benefits are listed here. (READ THESE)
- The values of a health information exchange are that it will improve the delivery of health care and ultimately provide a single health record to view. Efficiency through HIE will help increase continuity of care and sharing of health information will become a common practice with the help of American Reinvestment and Recovery Act.
- Explain.
- Pros & Cons: We agreed that a Federated model would be our preference because it would have the most up-to-date data, and our information would not be stored at a distant location. As IT managers, it was important to us to have control over where our information is stored. We didn’t like the idea of having someone else being responsible for keeping the system going.
- Along our journey we have also monitored the numerous state and national IT efforts. In the MO-HITECH draft operational plan, it indicates that it will support HIE efforts. If MO-HITECH supports HIE efforts, then we will be looking to connect to MO-HITECH for health information exchange. Need to mention the NHIN, regarding the national effort to link together. Need to mention ARRA. Meaningful Use – requires electronic sharing information as quickly as 2011.
- At this time the elements we are considering in regard to electronic exchanging information include -
- There are several things to consider when choosing to join an HIE. These include: Goals and philosophy of the HIE Services that the HIE offers Participant technology requirements Economics and sustainability Anticipated non-economic benefits (quality, safety) Applicable state and federal regulations are addressed Any risks, liability, project failure or security breach Date use agreements HIE’s current developmental maturity Legal structure of the HIE
- During the last 18 months we have experienced a journey that has transformed us from working in our own silos to participating in a collaborative manner. As a group we have determined where each member organization is currently at with regard to level of IT Implementation. We have also been able to leverage resources such as policy and procedure sharing, list serves, etc. Our individual knowledge and experience has been enriched as a result of networking. We have expanded our original membership from three hospitals to five and have increased committee participation accordingly. We now share common goals in the areas of problem solving and external health information exchange and are looking to the future in order to better anticipate our community opportunities and challenges on a regional basis. An added bonus of collaboration is that we feel that we will make better and more informed decisions in regard to Information Technologies, armed with additional information.
- The present members of the SSPRHN IT Committee are -
- Here is our contact information. If you have any questions that come to mind later on, send me an email or call.