# Presentation: 043350

## Population Health:  A Sustainability Strategy for a Disease Registry?

- AHRQ 2007 Annual Meeting
- September 27, 2007
- Eleanor Littman RN MSN
- Health Improvement Partnership of Santa Cruz County

## Outline

- The Santa Cruz Story
- Innovation & Collaboration
- Vision: Community-wide Diabetes Registry
- Lessons Learned
- Project History
- Population Health is Value Proposition
- Future
- Chronic Disease Registry and/or Health Information Exchange?

## Santa Cruz County, CA 

-  Central California Coast
-  75-miles S. San Francisco
-  265,000 residents
-  North – Silicon Valley Beach
-  South – Agricultural
-  Isolated
-  Progressive
-  Innovative
-  Collaborative

- Santa Cruz County, CA

## Fragmented Private Health Care System 

- Fragmented _Private_ Health Care System

- Three private hospitals
- CHW/Dominican – largest
- Sutter Maternity & Surgery
- Watsonville – for profit
-  Three
- Two competing medical groups
- Physicians Medical Group – IPA
- Sutter/Santa Cruz Medical Foundation
- Dominican Medical Foundation (July 2007)

## Innovation: Clinical Messaging

-  2000 web-based  expansion private physicians
-  2004 County clinics including mental health
-  2005 Community Health Centers

*A Health Information Exchange?  *

## Innovation:  EMR Adoption (40%)

- Private practices (2000)
- Dominican Hospital Cerner (2006)
- Santa Cruz Medical Foundation Epic (2007)
- County Clinics Epic (2006)
*“**Threw Public Health off IT bus”*

## Collaboration: HIP

- Health Improvement Partnership
- Founded in 2003 (CAP grant)
- Incorporated in 2005
- Public-private collaboration of health care leaders
- Common ground issues in competitive environment
- Accomplishments
- Healthy Kids (98% children Santa Cruz County)
- Project Connect (Frequent ED Users 54% ****)
- Diabetes  IOM Invitation (Jan 2004)

## Vision – January 2004

- Expand current IPA diabetes point of care registry to ALL providers
- Test point of care registry 1st step EMR
- Build community-wide database
- Outcomes:
- Higher standard of care consistent across the County
- Track diabetes population in the aggregate

- Build on strong history of collaboration and innovation!

- Dr Wells Shoemaker

*Name of handshake collaborative.*

- AHRQ Grant: Santa Cruz County, CA Diabetes Mellitus Registry (DMR), 2004-2007

## Reality - September 2007

## Project History 2004 - 2005

## Project History 2006 - 2007

## Lessons Learned

- Collaboration
- Build trust requires neutral entity
- Business proposition before governance
- Legal
- Point of Care Registry built on certifying “provider relationships”
- Not legal basis for building community-wide registry
- Adoption
-  EMRs =  Point of Care **X**  resources

## Lessons Learned: Technology

- Technology
- Complexity of:
- Obtaining multiple sources of data (CMS)
- Combining multiple sources of data
- Patient matching (MPI)
- Adapting internal tool for community use
*Positive Outcome:*
- Public Health back on bus -- 2006 InfoLinks Project (RWJF)
*Driver?....*

## Lessons Learned: Value

- Ranking*****
- Action Reports for individual providers (turf wars)
- _Community Database for Population Health_
- Community Patient Lookup
- Performance Reports with Benchmarks
- Performance Reports for Payers
- Point of Care Tool
- Care Management Tool
- *Results from October 2006 Business Case Survey (n=12)

## Population Health Moves Up

- Santa Cruz County Health Services Agency willing and accepted as neutral public entity
- Value in community with commitment to collaboration to improve health status
- County, HIP, Foundations $$
- Hospitals funded Community Assessment Survey x 10 years

## Benefits of Population Health Focus

- EMRs are friends not foes
- Demographics (language, residency)
- Identify Inequities
- Point of care (smoking, weight, BP)
- Identify pre-morbid conditions
- Example:  pre-diabetes
- Integration of Public Health and Clinical Care

## Next Steps

- Planning Community Disease Registry
- Requirements (Population health +)
- Integrating public health & clinical care
- Due Diligence on technology
- Refine Value Propositions
- Pilot Project – demonstrate & evaluate
- Wait for EMR adoption before community-wide implementation (60%?)
- Support EMRs in community health centers and small private practices

## Chicken or Egg?

- Is there a value proposition for a disease registry as a first step to health information exchange?
- OR
- Is the value proposition for health information exchange that includes a disease registry?

## www.chroniccarenetwork.org