PROJECT BRIEF:
DIRECT PILOT IMPLEMENTATION: MPS (CONNECTICUT)
Last Updated: 10/20/2010

Sponsor(s):
  • Medical Professional Services, Inc.(MPS)
  • Quest/MedPlus
  • DocSite/Covisint
  • Middlesex Hospital
  • The Kibbe Group, LLC
  • American Academy of Family Physicians (AAFP)
  • eClinicalWorks
  • Microsoft HealthVault (MHV)
  • Community Health Center, Inc. (CHC)

Contact(s):
  • Doug Arnold (MPS) Lead Contact
  • Jessica Settelmayer (Quest/MedPlus)
  • Kim Long (Quest/MedPlus)
  • Vidit Saxena (eClinicalWorks)
  • Donna Callaghan (DocSite/Covisint)
  • Lud Johnson (Middlesex Hospital)
  • David Kibbe, MD (The Kibbe Group)
  • Steven Waldren, MD (AAFP)
  • Umesh Madan (MHV)
  • Shanti Carter (CHC)

Objective:
  • To demonstrate the feasibility of using Direct protocols to connect and securely share clinical information among a diverse group of physicians in small practices in Connecticut who have a heterogeneous set of HIT tools (from web access with email, modular EHR components to fully functional EHRs), a hospital, a Federally Qualified Health Center (FQHC) and a large laboratory provider in support of Meaningful Use and the continuity of care through the use of five critical Direct User Stories listed below:
  • Direct User Stories:
1. Primary care provider refers patient to specialist including summary care record
2. Primary care provider refers patient to hospital including summary care record
3. Specialist sends summary care information back to referring provider
4. Hospital sends discharge information to referring provider
5. Laboratory sends lab results to ordering provider
Description:
  • MPS will work with a diverse group of MPS physicians (primary care physicians and specialists) in small practices in Connecticut to implement User Stories 1-5 above
    • Many MPS primary care physicians already refer patients to MPS specialists
    • Middlesex Hospital is the primary hospital for hundreds of MPS physicians.
    • Many MPS physicians use both Middlesex Hospital and Quest Diagnostics for laboratory services
  • MPS physicians currently employ a heterogeneous set of HIT tools:
    • Physicians only have web access with email
    • Physicians have web access and use modular EHR components, e.g. DocSite
    • Physicians have web access and use a fully-functional EHR, e.g.eClinicalWorks
  • Many MPS Physicians have a web portal (Care360 from Quest/MedPlus) for laboratory tests
    • Use Care 360 for CPOE of laboratory tests and to view and share lab results
    • Quest/MedPlus has an established interface with DocSite
    • Quest/MedPlus has an established interface with eClinicalWorks
  • Many MPS Physicians also use the laboratory at Middlesex Hospital (MH) and can view results on the MH lab portal
    • MH uses the Cerner laboratory system which is already interfaced with eClinicalWorks
    • MPS staff enter lab results from MH lab into DocSite
    • Quest/MedPlus is already interfaced with eClinicalWorks and many other EHRs
    • MH uses Quest Diagnostics for reference laboratory services
  • MPS physicians will use their currently deployed HIT resources mentioned above, as well as an ever-expanding set of HIT tools and EHRs, to connect and securely share clinical information in support of Meaningful Use.
  • ~50 MPS physician members are also members of the CAFP and AAFP
Participants:
  • Medical Professional Services, Inc. (MPS)A clinically-integrated, multi-specialty IPA in Connecticut with ~400 physician members who have offices in 34 Connecticut cities and towns. MPS is adding new members monthly and currently includes physicians in the following specialties:
    • 160 primary care physicians (Pediatrics, Internal Medicine, Family Practice)
    • 18 Obstetrics/Gynecology
    • 80 medical specialists (Allergy, Cardiology, Dermatology, Endocrinology, Gastroenterology, Hematology/Oncology, Infectious Disease, Neonatology, Nephrology, Neurology, Physical Medicine, Pulmonology, Rheumatology)
    • 67 surgical specialists (General Surgery, Ophthalmology, Oral & Maxillofacial Surgery, Orthopedics, Otolaryngology, Urology)
    • 58 hospital-based specialists (Emergency, Hospitalists, Radiology, Behavioral Health).
    Douglas S. Arnold is the Executive Director MPS and the lead contact on this Pilot. Mr. Arnold is also the President of the MPS Foundation, Inc. Mr. Arnold received a B.A. from the University of Illinois and an M.B.A. from the Wharton School of the University of Pennsylvania, where he concentrated in Health Care Systems Management. Mr. Arnold has over 25 years experience in healthcare management and consulting. His career has been focused on the management and clinical integration of large networks of physicians.
  • Quest/MedPlus: Quest is a major national provider of clinical laboratory services and its MedPlus subsidiary is a major innovator in healthcare IT interoperability. Quest/MedPlus has interfaces with hundreds of EHRs.
  • DocSite/Covisint: An award-winning clinical decision support, quality performance management and health information exchange company focused on making better patient care easier for physicians across all specialties.
  • Middlesex Hospital: Middlesex Hospital is home to world-class medical technology, Magnet nurses and some of Connecticut’s highest quality and patient satisfaction ratings, and has been named one of the 100 Top Hospitals in the United States by Thomson Reuters — the only hospital in Connecticut to receive the distinction two years in a row.
  • American Academy of Family Physicians (AAFP): The AAFP supports the ASTM Continuity of Care Record (CCR) was developed in response to the need to organize and make transportable a set of basic information about a patient's health care that is accessible to clinicians and patients. The CCR is intended to foster and improve continuity of care, reduce medical errors, and ensure a minimum standard of secure health information transportability. Adoption of the CCR by the medical community and IT vendors will be a great step toward achieving interoperability of medical records.
  • eClinicalWorks: eClinicalWorks, LLC, a medical software company, provides ambulatory clinical systems. It offers an electronic medical record system, which enables customers to manage patient flow, access patient records in-house or remotely, electronically communicate with the referring physicians, and securely send consult notes and clinical data; an enterprise practice management system that streamlines medical billing management; and a Web-based patient portal, which enables patients to view prescription information, laboratory and diagnostic results, and appointment information. The company also provides Electronic Health eXchange, a community portal that facilitates a holistic view of a patient's ambulatory record with hospital system integration and customers; on-demand application service provider solutions; on-premise client/server solutions; and eCliniWiki, a guide for customers to obtain and update online information, as well as interact with individuals. In addition, it provides wireless technology, hand held devices, and reporting solutions.
  • Microsoft HealthVault: HealthVault lets people consolidate their health information into one easily accessible account to help them become more informed and active in managing their health. HealthVault provides an ability for patients to receive Direct messages from providers, supporting Meaningful Use requirements with an ability for clinical solutions to send a copy of health information electronically to patients using Direct Project protocols. For more information about sending Direct messages to patients in HealthVault, see materials in Documentation Library.
  • Community Health Center, Inc. (CHC): CHC is the largest Federally Qualified Health Center in Connecticut with 12 locations. CHC is building a world class primary health care system, that is committed to caring for special populations, and that is focused on improving health outcomes for our patients as well as building healthy communities. Since 1972, CHC has been one of the leading health-care providers in the state of Connecticut, providing comprehensive primary care services in medicine, dentistry, and behavioral health. CHC is available to all, but has a special commitment to the uninsured, underinsured, and special populations such as patients with HIV/AIDS. CHC is a statewide, independent, private non-profit organization. In 2009 CHC provided high-quality medical, dental and behavioral health services to patients living in nearly every Connecticut city and town. With 100,000 active patients, CHC, Inc. is the health care home that works to keep our patients—and our communities—healthy. CHC incorporates prevention and health promotion, treatment of illness, and management of chronic disease—often all during the same visit. But CHC goes beyond the traditional health services to bring care wherever you are, using innovative service delivery models and state of the art technology.

Logical Diagram:

Direct_Pilot_-_MPS_Pilot.jpg
Resources Anticipated Being Available for Pilot:
  • Health Internet Service Provider (HISP): Quest/MedPlus has committed to build and operate a HISP for this Direct Geographic Implementation Pilot.
    • Quest/MedPlus is committed to serving as HISP for many other Direct implementations upon successful completion of this pilot
  • Direct Reference code to be incorporated into modular EHR components and EHRs for sending and receiving Direct messages with documentation
  • Stand alone software for manually sending and receiving Direct messages (i.e. external to EHR)
  • Substantial interoperability expertise, as Quest/MedPlus have built interfaces to hundreds of EHRs, hospital IS systems and practice management systems already
  • Substantial HIE expertise from DocSite and plans to apply lessons learned from the Montana HIE implementation project and the Vermont Blueprint for Health (ongoing) to the Connecticut project
    • eClinicalWorks is implementing nearly 3000 providers across 500 independent practices in New York City, including small physician practices, hospital networks and 23 Community Health Centers. eClinicalWorks will be a HISP for ECW users in the pilot.

Other Notes:
  • Many MPS physicians are already connected with Quest/MedPlus.
  • Many MPS physician are already DocSite users.
  • Middlesex Hospital is the primary hospital for hundreds of MPS physicians.
  • Middlesex Health System and hundreds of MPS physicians are participating in one of the ten Medicare Physician Group Practice (PGP) demonstration projects focusing on care coordination and shared savings for Medicare enrollees with chronic illnesses.
  • Many MPS physicians who are employed by Middlesex Hospital currently use eClinicalWorks.
  • DocSite will be using NHIN Direct use cases as the core of its Montana State HIE implementation.
  • Doug Arnold of MPS and Art Schreier of Quest/MedPlus are Board members of eHealthConnecticut, which is the Connecticut Health Information Technology Regional Extension Center (HITREC).
  • Doug Arnold, John Haughton, MD, David Kibbe, MD, and Steven Waldren, MD, are members of the Clinical Groupware Collaborative (CGC) and are working to bring other CGC members into participation in this pilot.
  • David Kibbe, MD, is a member of the NHIN Direct Reference Implementation Workgroup and Steven Waldren, MD, is the Director, Center for Health Information Technology, American Academy of Family Physicians.
  • Margaret Flinter is Vice President and Clinical Director of the Community Health Center, Inc. and is a family nurse practitioner by profession. Margaret earned her Bachelors Degree in Nursing from the University of Connecticut, her Master’s Degree from Yale University, and is currently a candidate for the doctoral degree at the University of Connecticut. She was the recipient of a Robert Wood Johnson Executive Nurse Fellowship from 2002-2005. Following her graduate training at Yale University, Margaret joined the Community Health Center in 1980 as a National Health Service Corps Scholar and CHC’s first nurse practitioner. Since 1987 she has held both clinical and administrative leadership roles in the organization. She recently established the Weitzman Center for Innovation in Community Health and Primary Care as the “research and development” arm of CHC and serves as the Director of the Weitzman Center. Margaret is also the founder of America’s first Nurse practitioner residency program which operates out of the Community Health Center.

Success Metrics:

Geography & Patient Population

Medical Professional Services, Inc. (MPS) includes ~400 physicians who have offices in 34 Connecticut cities and towns. These 34 CT cities and towns have a population estimated at 889,617 in 2008, which is 25.4% of the entire population of Connecticut. These cities and town range from urban/suburban cities with over 100,000 population (Waterbury and Stamford) to rural communities with populations under 10,000 (East Haddam). MPS physicians are in three geographic networks. These are greater Middlesex, greater Waterbury and greater Fairfield. If we include the populations for all the towns in these three regions, the breakdown is as follows:
1. Fairfield 271,932
2. Middlesex 410,790
3. Waterbury 206,895

· Medicare
In 2008 the CT DPH estimated that 13.7% of the entire state population was age 65 or older. This would equate to 478,007 persons in the entire state. If we apply this percentage to the population of the towns with MPS physicians, we estimate that 121,433 persons in these 34 towns are age 65 or older.

· Urban Underserved
We estimate that there are 68,386 persons who are categorized as living in poverty in 2008 in these 34 CT towns and cities (7.5% of total population). Some communities, such as Waterbury, have a poverty percentage that is substantially higher (over 16%).

Physician Specialty and Practice Size Mix within MPS (July 2010)
    • 160 primary care physicians (Pediatrics, Internal Medicine, Family Practice)
    • 18 Obstetrics/Gynecology
    • 80 medical specialists (Cardiology, Gastroenterology, Nephrology, Allergy, Dermatology
    • 67 surgical specialists (General Surgery, Orthopedics, Urology, Cardio-Thoracic
    • 56 hospital-based specialists (Emergency, Hospitalists, Radiology, Behavioral Health).