1 August 2004 Mendocino County, California, USA [1] Alliance for Rural Community Health [2]...

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www.ruralcommunityhealth.org

August 2004 Mendocino County, California, USA

[1] Alliance for Rural Community Health

[2] Mendocino SHARE

[3] National Health Information Infrastructure

[4] OpenHRE.org

[a]

Open Health Records Exchange

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"On the National Health Information Infrastructure, nobody knows you're a dog."

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Alliance for Rural Community Health

[1]

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Mendocino County, California

Northwest coast of California

Two hours north of San Francisco

Population 87,000

3,500 square miles

Low population density (24 / sq. mi.)

Long distances between rural communities over mountain roads

Economically depressed

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Alliance for Rural Community Health

A consortium called “ARCH”

Founded 1999 by six Community Health Centers in Mendocino County

Non-profit public benefit corporation

Governed by a twelve-member Board of Directors

MISSION: To assist and support Alliance members in providing quality health care to individuals, and in improving the health of our communities.

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ARCH Consortium Members

Clinic Type Encounters

Anderson Valley Health Center RHC 7,000

Potter Valley Community Health Center FQHC Look Alike 14,000

Long Valley Health Center FQHC 20,000

Redwood Coast Medical Services FQHC 22,000

Mendocino Coast Clinics FQHC 25,000

Mendocino Community Health Clinics FQHC 135,000

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ARCH Org ChartAVHC LVHC MCC MCHC PVCHC RCMS

Board of Directors

Executive Director

Director of Health Policy

Office Manager

Director of Collaborative

Activities

Director of Mendocino

SHARE

Chief Technology

Officer

Fiscal Manager

Technical Project

Manager

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ARCH Website

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ARCH Funding Sources

The California Endowment

The California Wellness Foundation

HRSA’s Bureau of Primary Health Care

Tides Foundation

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Community Clinics Initiative

CCI Grant from the Tides Foundation in 1999 to build an enterprise ASP model Practice Management System

Phase One Anderson Valley Health Center (AVHC)Mendocino Coast Clinics (MCC)Mendocino Community Health Centers (MCHC)

Phase Two Long Valley Health Center (LVHC)Potter Valley Community Health Center (PVCHC)Redwood Coast Medical Services (RCMS)

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Enterprise ASP Plan

Phase One Installation Project, 1999 - 2000

Host enterprise servers at MCHC Data Center

Practice Management Software runs on Windows NT servers

56K fractional T1 circuits

Remote sites use thin clients via a Citrix sessions

Internet access from remote sites through Citrix desktop

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Enterprise ASP Result

Good News Phase One enterprise ASP live in 2000 Patient scheduling, registration and billing

Bad News T1 lines intermittent Disagreements on ASP priorities Consortium Executive Director and CIO quit

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Lessons Learned

Enterprise ASP failed for social not technical reasons

Remote sites uncomfortable with distant support

Governance model unable to avoid frustrating all participants

Collaboration across separate institutions is possible

Decentralised solutions are optimal

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New Decentralized Direction

Summer 2002

New Executive Director and new CTO select decentralized technology solution

Site level servers for each clinic

No ASP model

No enterprise WAN

Every site made whole, no dependence on another site

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Mendocino SHARE[2]

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Santa Barbara County Care Data Exchange

July 2003

SBCCDE Interim Report

Loosely coupled p2p decentralised solution to PHI data sharing

Functionally consistent with decentralised IT collaboration model in ARCH consortium

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A Modest Technology Proposal

August 2003

Innocent ProposalScaled down clone of SBCCDE as a technology component in a $2 million HCAP grant application

Is This Wise?

ARCH has no idea that this proposal is way larger than HCAP funds

Funded, October 2003

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Mendocino SHARE Project

Securing Health Access and Records Exchange

Modeled after Santa Barbara County Care Data Exchange

Target Population 32,000 +

Under 200% of poverty level

48% uninsured

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SHARE Collaborative

All six ARCH Community Health Centers

Consolidated Tribal Health Project, an IHS clinic

All three local hospitals

Ukiah Valley Medical Center

Howard Memorial Hospital

Mendocino Coast District Hospital

Mendocino County Department of Public Health

Mendocino County Department of Social Services

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SHARE Objectives

Health Records Exchange

Coordinated chronic disease case management

Patient enrollment

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SHARE Staff

John Walton, Project Director

30 years clinical and administrative experience in community and hospital settings

Will Ross, Chief Technology Officer

12 years in production agriculture and horticulture

15 years in technology project management

Greg Wenneson, Technical Project Manager

25 years in software development and software project management at NASA Ames, Autodesk and other commercial settings

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SHARE Technology Vendor

RFP Published February 2004

12 vendors submitted bids

Extensive negotiations

Viewed 5 full demos

Browsersoft Selected, April 2004

Overland Park, Kansas

An IBM Development Partner

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SHARE Prototype

Built by Browsersoft

Dave Forslund’s OpenEMed used for first prototype

Load PIDS files totaling over 50,000 patients from multiple domains, including multiple files from a single domain

Can’t scale efficiently past 10,000 records

HIPAA compliant testing using simulated data with false name pairs and false birthdates

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SHARE Prototype

Patient Lookup

Three value limit during prototyping phase

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SHARE Prototype

Correlating Multiple Patient Listings

“Show Grouped”

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SHARE Prototype

Viewing a Patient

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SHARE Prototype

Graphing a Result

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SHARE Discovery Process

Lessons Learned

SHARE technology vision exceeds current funding

Current code not scalable

Current code not ready for production use

Needs formal architecture

Productizing needed

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SHARE System Level Architecture Meeting (SLAM)

July 14 – 15, 2004

Two day brainstorming session

Review lessons learned in iterative Year One discovery process

Include Open Source experts from outside Mendocino SHARE

Imagine an optimal technology road map for Year Two

Meeting funded by BPHC

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SHARE SLAM #1 Participants

Invitees

David Forslund, LANL

Jie Wang, Stanford University

Guy Fisher, Primary Care Coalition of Montgomery County

David Uhlman, Pennington Firm

Tom Passim, Mitretek Systems

ARCH

Will Ross

John Walton

Greg Wenneson

Browsersoft

Don Grodecki

Paul Misner

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Clinic A(export only,

non-integrating simple systems)

HealthPro

PECS

export PIDS

BrowserPortal

SHARE

export PIDS and Clinical

Clinic B (bigger)(non-integrating

simple systems)

HealthPro

PECS

export PIDS

expo

rt P

IDS

an

d C

linic

al

Pharmacy

Clinics A and B – export data from systems only (not bi-directional). Access to SHARE is by Browser not integrated into clinic systems . If datacomm link goes down , no access to SHARE .Clinic/Hospital C – access to/through SHARE via hospital local MPI (bi-directional). DataComm goes down, still have local MPI .

expo

rt PI

DS

and

Clin

i cal

BrowserPortal

Hospital C, Enterprise

System (eg. Cerner)hopefully SHARE integrated

Enterprise System

export (or exchange?)

PIDS and Clinical

local MPI

export PIDS /

Clinical

export/importPIDS and clinical

non-integratedsystem

?? how does other data

get back to “C” system/

user??

SHARE SLAM #1

IllustrationGreg Wenneson

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SHARE SLAM #1 Outcomes

Technology to Test in Next Iterations (August - November)

Run PIDS index as OpenLDAP

Run PIDS with POJO (can do WS when needed)

Use MySQL to manage PIDS updates

UCLA DataServer for population data de-identification

Test lexicon transformer based on Mayo Clinic LQS

Launch portal for virtual SLAM

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National Health Information Infrastructure

[3]

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NHII

July 2004

Mendocino SHARE solution matches major national proposals

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NHII Strategic Framework

Inform Clinical PracticeIncentivize EHR adoption

Reduce risk of EHR investment

Promote EHR diffusion

Interconnect CliniciansFoster regional collaborations

Develop a national health information network (Mendocino SHARE in here)

Coordinate federal health information systems

Personalize CareEncourage use of Personal Health Records

Enhance informed consumer choice

Promote telehealth systems

Improve Population HealthUnify public health surveillance architectures

Streamline health status monitoring

Accelerate dissemination of evidence

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NHII Strategic Framework

Before Conference Mendocino SHARE is an LHII

Mendocino SHARE is developing free LHII software

After ConferenceMendocino SHARE is less than a full LHII

Free/Public Domain LHII software projects can collaborate

Mendocino SHARE

Massachusetts SHARE

Indiana Patient Care Network

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OpenHRE.org[4]

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OpenHRE.org Portal

Launched August 2004

Development content placed on portal

OpenHRE.org available to any free or open source (FOSS) software components contributing to LHII solutions

OpenHRE.org uses NHII technology framework to identify FOSS projects

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OpenHRE.org Goals

Protect patient privacy

Provide patient access to records

Increase availability of records

Maintain local control of records

Create affordable solutions for small & rural sites

Interoperate with enterprise HIT systems

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OpenHRE.org Challenges

Funding < Vision

Local buy-in not yet accomplished

Develop solutions while HIT standards evolve

Identity correlation without new records bureaucracy

Collaborate nationally

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OpenHRE.org Vision

Feature complete suite of LHII components

No “Health ID”

No “rip and replace”

Scalable and evolvable

Open Standards

Decentralized

Auditable

Free

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"It's very important that you try very, very hard to remember where you electronically transferred Mommy and Daddy's Personal Health Records."

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Open Health Records Exchange

Mendocino SHARE Home Pagewww.ruralcommunityhealth.org/projects/msp.html

Open HRE Project Portalwww.openhre.org

Questions or CommentsWill Ross, Chief Technology OfficerAlliance for Rural Community [email protected]

1 August 2004 Mendocino County, California, USA [1] Alliance for Rural Community Health [2]...

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