Beacons share strategies, successes

The Beacon community program was designed to drive investment in health IT infrastructure, and as the three-year grant-funded projects come to an end this fall, a wide range of achievements have been recognized.

Janhavi Kirtane Fritz, acting director of the program for the Office of the National Coordinator for Health IT, led a webinar detailing some of the impressive results, including new exchange capabilities, performance improvement, technology deployment and regional learning.

Fitz said the program will be releasing public briefs about each community’s lessons learned in the coming weeks. Learning guides will be practical implementation guides that “take the promise of IT-enabled intervention and try to codify the major lessons,” she said.

The San Diego Beacon Community works with a very dynamic population, said Executive Director Dan Chavez, due to tourism, military, education and border issues. They have piloted and continue to pilot a wireless cardiac device system allowing pacemakers to wirelessly communicate to the internet to provide updates to physicians. Another focus has been Project 25 in which the city and county aligned with hospitals to focus on the 25 most frequent users of the healthcare system. The project has grown to over 50 frequent users. Efforts have resulted in a substantial reduction in utilization of the healthcare system. Visits were reduced by almost half in the six-month study period and payments and lost charges were reduced by almost $800,000. “That’s a tremendous return on investment by focusing and utilizing the health information exchange to target this population.”

Chavez said he learned from his experience the importance of defining your project and what you’re trying to achieve in your implementations of technology. “Target your population very clearly. Start with a limited user base and only focus on key functionality.” He said the rollout plan also is critical. “Start out with small wins. First achieve adoption, then utilization. Focus on high-volume, high-value transactions. You cannot underestimate vendor dependencies as we get closer to interoperability. Never take your eye off the ball of interoperability. This methodology has worked very well for us.”

The Crescent City Beacon in New Orleans focused on its network of safety net providers who were early EHR adopters but were still experiencing gaps in care coordination, said Chatrian Kanger. “We were also interested in advancing and enhancing capabilities for better managing chronic care patients.” Two areas of focus were building and strengthening the health IT infrastructure to support care coordination through the establishment of a health information exchange (HIE) and improving clinical transformation activities by implementing registries.

“We learned early on that having high quality data was really at the foundation for supporting both of these activities. If practices didn’t trust the data in the EMRs, they certainly weren’t going to trust the data flowing into the HIE. We decided to focus on improving the data quality coming out of clinics’ EMRs. We have some practical steps that any community can take to improve data quality,” said Kanger.

The group established a six-step approach with aims of improving measure harmonization to get community health centers to adopt a set of community-wide measures, establish measure alignment reporting consistently, assist practices in using that data to drive quality improvement efforts and build trust in EMR data. They identified a set of e-measures so that “practices don’t get caught up in the pitfall of trying to select measures.”

They assessed practice proficiencies with reporting models and limitations and then tailored the approach for technical assistance based upon those findings. That included standardized reporting templates, written guidance in measure reference sheets, reporting manuals, data managers and quality improvement analysts at participating centers. Quarterly data workshops often were held in conjunction with EHR vendors. “Whenever challenges or needs were identified, we had support through a group of super users to make template enhancements or design enhancements to standardize workflows around data entry."

Quality checks were conducted after the first three steps and when a certain degree of reliability established. “We wanted to ensure that the proper data were included and the proper data excluded. After examining the validity of quality reports, providers received rapid feedback and monitored reporting over time. They could compare against their peers and national measure benchmarks and thresholds.

"Lastly, after successfully improving data quality coming out of EMRs, we wanted to make sure sustainable gains were made and weren’t lost. In the safety net setting, there is a lot of staff turnover. We incorporated data entry protocols into other protocols as a sort of sustainability plan."

Crescent City learned several lessons, Kanger said. For sustainable data quality, “it’s important to identify data champions at each practice to sustain efforts.” They worked through the Louisiana Public Health Institute as a data intermediary organization. Kanger also said that vendor engagement is very important. “A vendor that’s engaged understands your vision and your community’s needs. The relationship we established was a great way for them to learn how to operationalize their quality measures.”

Lastly and probably most importantly, according to Kanger, were standardized report templates. These “contributed to a reduction in data quality errors.” Rapid performance feedback helped the health centers make the most out of data for decision making.

Nontechnical components are just as important to success, she said. “Having community-wide buy-in and trust will go a long way in terms of allowing practices to feel comfortable with sharing data. Having a learning collaborative approach was proven successful in our community because it brings users together to share tips and questions and everyone receives the same message.”

At this point, the Beacon community has experienced such success that their efforts are spreading throughout Louisiana. They have networked to an additional 16 health centers, begun integrating public health and are developing an accountable care organization supported by quality reporting services.

"The Beacon project has been tremendously positive for our community," said Patrick Gordon of the Colorado Beacon Community. “Well before Beacon, we recognized that in getting to a higher performing system and getting to value-oriented payment and care models, there were three functions we must perform.”

1. Create a population focus in all care processes. Most care processes are encounter-based and patient-specific and not necessarily patient-centered. “Making the shift is fundamental and technology plays a big role in the change.”
2. Establish accountability for outcomes, value, making changes when things aren’t working, and for creating more meaningful and productive relationships with patients, he said.
3. Resource allocation. A mindset of making investments that align with processes producing value is important, Gordon said. “You can’t get to that analysis without taking a meaningful look at your population and the business intelligence of all players’ operations.”

They started with a framework for their HIE services. “We had a commitment to optimizing our resources for matching and managing individual patient identities because none of the other functions can work unless those systems are in place.” The Beacon built out an infrastructure to accommodate many more data-sharing sources and much more robust data matching, he said.

They also normalized discrete data—both clinical and administrative—in a usable way. The community creates a repository that can be used to support multiple apps and uses. It serves as a community asset within a trusted, secure framework.

“We knew we needed advanced tools for our risk strategy, population health management and quality improvement. Those manifest themselves in patient registries, predictive modeling tools and patient activation tools.” To deploy all of that in a flexible, cost-effective way, they created a web services layer to allow multiple participants to receive the app support they most value. “One size fits all cannot accommodate that model,” he added. Development of a web services communication architecture that can support that type of app deployment model was critical to tying back to clinical operations, he said.

“If our resources can’t be integrated in real clinical workflow, they’re not going to be used.”

The Colorado Beacon also put significant emphasis on a region-wide learning structure which engaged more than half of the primary care base in the development of basic data use and e-measure competencies. An evolving system has grown and local leaders now share their experience, collaborate to solve problems and organize their work in a rational way, Gordon said.

Pooling resources and establishing good relationships helped the Beacon get to a successful deployment cycle, he said. “Throughout the process, when people were willing to give their time, communicate issues through a structured process and create and commit to process changes, the payoff is better tools, better measures and overall better performance. That has to be demonstrated and redemonstrated but when you can get this cycle moving it can be very powerful.”