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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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www.ruralcommunityhealth.org
"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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www.ruralcommunityhealth.org
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]