TheVanderbiltHIEExperiencein

The Vanderbilt HIE Experience in

Memphis

MarkFrisse,MD,MS,MBA
VanderbiltUniversityMedicalCenterDepartmentofBiomedical
Informatics
Informatics
PortionsofthisworkwerefundedthroughAHRQContract290040006,the
StateofTennessee,andVanderbiltUniversity.Thispresentationhasnotbeen
approvedbytheAgencyforHealthcareResearchandQuality.
 Memphis:EarlyHITexperience
SmartTechnology,StuntedPolicy:DevelopingHealthInformationNetworks
PaulStarr.HealthAffairs(May/June1997)
Paul Starr Health Affairs (May / June 1997)
FailureinVermontandMemphis
Thedifficultiesofsecuringcooperationareillustratedbytwoprojectsthatendedincomplete
failure.
InMemphis,theoriginalgrantee,theMemphisBusinessGrouponHealth,soughttobuilda
CHMISaroundthecitystwoprincipalhospitalsystems,BaptistandMethodist,whichtogether
controlmorethanhalfofthemarket.TheBusinessGrouphadalongstandingbusiness
relationshipwithBaptistbutnotwithMethodist,nordiditincludemanyotherelementsofthe
p p , y
community,suchaspublicofficials.AMethodistrepresentativewaslateradded,andthegrant
wasmovedtoanewnonprofitentity,buttheeffortlackedabroadcommunitybase.It
collapsedwhenBaptistunilaterallydecidedtocontractfornetworkserviceswithIMS
Medacom,oneoftwofinalistsintheselectionprocessforavendortobuildtheCHMIS.
p
Localphysiciansreportedlywerenervousaboutthecollectionofdataontheirpractices.One
participantsummedupthereactionoflocalhealthcareproviders:Ifsomebodyisgoingto
havemybusinesssensitivedata,Istandtolose.(HaroldPetersen,assistantdirector,
Computing and Telecommunications, University of Tennessee, interview, 12 July 1995.)
ComputingandTelecommunications,UniversityofTennessee,interview,12July1995.)

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 WhatistheMemphisExchange?
DevelopedbyVanderbiltUniversityRegionalInformatics
ManagedbyaMemphisBoard;movedtocommercialvendor(ICA)
15 h it l 15 b l t
15hospitals;15ambulatorysites
it
Total#ofrecords:>5million
Total#ofpatients:1,250,000
MonthlyEncounterData:110,000
MonthlyICD9admissioncodes(Chiefcomplaints):34,000
Monthly labs: 2,400,000
Monthlylabs:2,400,000
Monthlymicrobiologyreports:25,709
Monthlychestxrayreports:34,996
C
Comprehensiveprivacyagreements
h i i t
Coststoparticipantslessthat$50,000perhospital
Overallannualoperatingcost under$2.5million

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 CommunityLeadership:MidSouth
eHealthAlliance
H lth Alli
15 hospitals; 14 clinics

BaptistMemorialHealthCareCorp.(4
facilities)
ChristCommunityHealth(4primarycare
clinics))
MethodistHealthcare(7facilities
includingLeBonheurChildrensMedical
Center)
g (
TheRegionalMedicalCenter(TheMED) )
SaintFrancisHospital&St.Francis
Bartlett(TenetHealthcare)
St.JudeChildrensResearchHospital
Shelby County/Health Loop Clinics (11
ShelbyCounty/HealthLoopClinics(11
primarycareclinics)
UTMedicalGroup(300+clinicians)
MemphisManagedCare/TLC(MCO)

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Whatdoestheinterfacelooklike?

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Webroughtanarchitecture:Vaults

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 Datasharing:peopleandtime
g p p
FromJunethroughAugust,2005,theworkgroupfocusedonkeypolicyissues.Thislaidafoundationfortrustand
opendialogue.WhenwebeganworkingontheRegionalDataExchangeagreement,ouroverallapproachwasto
doasmuchworkaswepossiblycouldwithoutincurringlegalfees

January -
September October - November March May
February
Att
Attorney
Received P&S work
engaged to All Participants
Model group Distributed the
Distributed a represent agreed on the
Contract identified a start of a MSeHA
redline MSeHA . language on
Draft leader and framework based
document for Reviewed all May 10 th and
version . interested upon the model
each the feedback . document was
Distributed members to larger group .
organization
g Created the fullyy executed
to P &S agreed to meet Met to review
to review and finaldraft by May 19th
work to walk through questions and
give feedback for for initial use
group the model concerns
organizations on May 23rd
contract
to review

Total of 8 people
participated in this Review was done Review was
work representing by 30+ people
facilitated by the
representing all the
6 organizations . work group and
Group met several organizations that
board members .
times for 2+ hours are considered to
Involved 10
each time be in the MSeHA attorneys
several sought
representing the 9
advice from their
own counsel organizations

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 Evaluationcomponents
p `
Usage:who,whooften,where,why
g , , , y
Financialvalue
Overall
Diseasespecific
Di ifi
Clinicalvalue
Backache
Headache
Chestpain
Usability
Usab ty
Impactonworkflow

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 UsageintheED
g
Overallusage6.9%
g

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PatternsofUse Demographics

1%

Aggregate(LOINC)LabView

0.9%

M di ti
MedicationslistreportedthroughSurescripts
li t t d th hS i t.

2.2%

96.9%
DischargeSummary
Datespecificreportdetails.
63%

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 Whydidwesucceedintheinitial
years?
Senseofurgency(TennCare&afailingpublichospital)
Guiding coalition: Governor Memphis Vanderbilt
Guidingcoalition:Governor,Memphis,Vanderbilt
Extensive,realisticplanning
Our emphasis was on trust, not technology
Ouremphasiswasontrust,nottechnology
Focusedonversion1.0
Initiallyemphasisonlyonemergencydepartmentcare
Lowbarriertoentry(tookdatainanyformat)
Low,lowcost($2morlessannuallyfor1millionpeople)
Quickwins literallysavedlives
Gradualevolution
Must read: Kotter
Kotter, JJ.P.,
P Whytransformationeffortsfail.
Why transformation efforts fail Harvard Business Review
Review, 1995.
1995 (March
(March-April):
April): 59-67
59 67.

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 Whathasitdone?
Savedlives(anecdotal)
Changed workflow
Changedworkflow
Changedtestorderingbehavior
Reduced radiographic tests
Reducedradiographictests
Reducedtestingforsomespecificconditions
Reducedadmissions
Technologymodelisbeingadoptedinotherregions
Foundambulatoryconnectivityagreatchallenge
OurlessonsareapplicabletoVanderbiltandotherinstitutions
notjusttoexchanges

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 Whatwehavelearned
Sustainedcommunityleadershipwithasimplewhy
Beinthetrustbusiness
Valueinalowbarriertoentry,lowcost,andsimplicity
SomedatawerenotpartoftheHIE(e.g.,eRx)
Architecturedecisionareisimportant
Consumerengagementwasnotcriticalforus
W did
Wedidnotoverengineer(usedtheVUtaggingmodel)
i ( d h VU i d l)
Standardswereallowedtoevolveandnotforced
We built version 1 0 before building version 6 0
Webuiltversion1.0beforebuildingversion6.0
Ourfocuswasonwhatwecoulduniquely do
Costconsiderationswereparamount
p

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Predictionssupportedbyourwork
pp y
Theindividualwillbetheprimaryfocusofpatientcare
Mostpatientcareinformationwillcomefromoutsideofany
Most patient care information will come from outside of any
singletraditionalcaredeliveryunit
Allindividualswillbecomepartofpopulationswhosehealth
canbetrackedrealtime
b k d l i
Exchangebothverbthannoun(butverbisdominant)
Multipleexchangeswillcoexistinacommunity(e.g.,
Multiple exchanges will co exist in a community (e g
transitionsincare,readmissions,quality)
TheNHINframeworkcantiethemtogether
Valueandsustainabilitymustbeconsideredinthecontextof
arapidlychangingsystem

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 ThankYou!
mark frisse@Vanderbilt Edu
mark.frisse@Vanderbilt.Edu