The Center for Primary Care Informatics (CPCI), a data warehouse at the heart of quality improvement efforts by the Community Health Care Association of New York (CHCANYS), has become a priority for the organization in less than two years.
Originally conceived as a fundamental part of a statewide Health IT program, the CPCI has proven its mettle with high-priority initiatives like a cancer registry for federally qualified health centers (FQHCs) that recently won a multimillion-dollar grant from the Centers for Disease Control & Prevention.
Lisa Perry, Vice President for Health IT at CHCANYS, was there from the beginning. We asked her to take us back to when the idea for a shared data warehouse sparked support from 11 health centers and a vendor willing to begin work while CHCANYS raised funds to support the project.
Every state could use a CPCI! Can you tell us when and how it came about?
It started in 2010 when we launched the first statewide health IT program for New York State’s FQHCs .FQHCs serve populations with low screening rates for breast, cervical, and colorectal cancers—people with low income, who are uninsured or underinsured, and who have limited access to healthcare.
Before then, we didn’t have a statewide program for Health IT technical assistance and training. There were local programs in New York City, and a small network upstate. We needed a statewide program. As we were planning, a data warehouse emerged as a high priority, and was named as one of five goals in a three-year strategic plan approved by our Board of Directors.
Lots of FQHCs were interested for different reasons: to improve data quality through validation processes; to work with CHCANYS and with their peers on specific initiatives to improve quality of patient care; to enable benchmarking of data with peers; to allow modeling of alternative payment and delivery systems emerging through health care reform.
With so many data warehouses out there, we asked how CHCANYS and its data warehouse would differentiate. The answer was in quality improvement. There’s a lot of excitement around really using the data for the enhancement of the lives of the patients we treat.
The analytic tools that are part of our warehouse are only the beginning. CHCANYS staff specialists in Health IT and Clinical Quality Improvement are building a wraparound program of technical assistance to support our health centers in use of the data to monitor and improve care quality. Our health centers will benefit from sharing of best practices; for instance, the “secret sauce” a peer uses to improve compliance with diabetes testing protocols.
How did you take the data warehouse from concept to reality?
In 2011, we became aware of the data warehouse product and its reporting software, known as DRVS (Data Reporting and Visualization System) at a few meetings with colleagues around the country. I kept hearing about it from people I really respect. We began talking with the vendor at one of these meetings, and had a series of conversations that developed into an unusual partnership because we didn’t have any money. They took a chance on us, and we appreciated that. And we weren’t going to be the guinea pig, which was a huge selling point.
We then began to develop a strategy and a plan for rolling this out in New York State. We held a couple of online webinars for our health centers and talked it up. My boss, Elizabeth Swain, CHCANYS’ CEO, is a huge supporter of this. Without her support, it wouldn’t have happened. She was willing to take the risk of doing the project and was so enthusiastic, it was infectious.
During a webinar in the Fall of 2011, we recruited volunteers from our membership. To our enormous gratification, 11 health centers stepped up. They became our pilot; three of them went live in April, less than a year from the contract signing.
It was an efficient process, due to the vendor’s experience interfacing with multiple EHRs. New York State has over 60 FQHCs that are very independent, and many were live with EHRs long before this project started.
We needed a vendor-neutral product that could be customized if necessary. We even had one health center that had built its own EHR that’s now ONC-certified and they’re going for Meaningful Use. The vendor was willing to work with them–about as customized as you can get.
What were the challenges along the way?
This is complicated, totally new territory for us. We developed a combined business associate and data use agreement with the health centers to define CHCANYS’ access to protected health information in order to construct “limited” data sets, which are stripped of all patient identifiers except limited geographic information. This access will allow us to match our clinical data with external data—for example, payer data and census data—and to create data sets that comply with HIPAA privacy regulations.
Other members of CHCANYS’ Health IT team, James Welsh, Director of Data Systems, and Bill Leo, Assistant Director, Technology Solutions, were instrumental in developing the data use agreement and in addressing members’ concerns regarding privacy, security and the interface process to connect health center EHRs to the CPCI.
Are you talking about de-identified patient data?
Yes, a “limited” data set is basically de-identified data with the exception of some limited geographic information. Also, at this time, CHCANYS does not have regular access to patient-level data through the DRVS standard reports, just aggregated health center data. Health centers can access their data at the health center, location, provider and patient level through these reports.
It seems like there’s a trend toward writing grant applications around data-driven projects. Do you see that?
Yes, but we are selective about which projects we do, based on benefits to members. Right now we’re beginning to talk about ways to fund a health center’s cost for the data warehouse. CHCANYS has raised grant funding to cover each health center’s interface, and would like to find a funding source to help cover the health centers’ software subscription costs.
Well, good luck with that and the cancer registry, and thanks for speaking with the Azara Community!
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