AHCCCS - 2007 Medicaid Transformation Grant Final Report

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4.1 Project Mission
The mission of this project is to create and implement the requisite organizational and healthcare partnership elements, as well as the technological components needed to facilitate an integration of healthcare information in a state-wide clinical data repository.

The AHCCCS Clinical Data Repository (CDR) Project will offer integrated and normalized clinical data stored in a standards-based repository available to clinicians at the point of care for search and viewing. It will include valuable information in patient identification, demographics, diagnosis list, medication history, lab results, image reports, discharge summary, and public health information that will be collected from AHCCCS business partners. It has the capability of integrating financial encounter information (from the claims) with clinical encounter information (from the providers) to provide a more complete set of information for each patient.

The comprehensive repositories of the AHCCCS CDR Project will provide a source of information which will enhance the ability of AHCCCS for clinical and financial analysis by leveraging the existing data warehouse information.

The database will be used to populate various data marts as needed for analytical and public health reporting. The specific reports and queries will be defined by the project as it progresses with the input of the applicable stakeholders.

General Scope / Assumptions

All efforts should leverage existing standards to the extent that they exist, are applicable, and are implementable;
Where possible, leveraging existing solutions is preferable to de novo development;
Where possible, open source solutions will be considered;
All technical efforts will be conducted in coordination with relevant IT departments;
All efforts will identify and work with business champions and other stakeholders;
All efforts will have defined sustainability plans;
All efforts will have defined success criteria and endpoints.

4.2 Project Value Proposition
Foundational work for integrating a broad clinical repository as part of a state-wide integrated health information architecture.

Extend and Expand the community of collaborators and contributors (time, effort, data, $) to advance the implementation of HIT in Arizona.

Create value at a social level and at an individual provider level to produce benefit to the entire health industry.

4.3 Project Goals

Short Term: Implement value proposition based functional components of HIT-HIE and integrate other potential and on-going state efforts such as ePrescribing, eLabs, AMIE, etc
Mid Term: Create and maintain repositories of clinical Information
Long Term: Incrementally add services that enhance value proposition to/for participants, and sustainability of the overall infrastructure

4.4 Activities/Deliverables Funded
Extensive research and analysis was performed which resulted in the AHCCCS Clinical Data Repositories Project Requirements Document as the sole deliverable for this project, which has been included in this report.

The requirements document addressed the following subject areas:

Business Model
System Architecture
Use Cases: Ambulatory Medication Management; Laboratory Results Reporting; Consultations (Transfer of Care); Public Health Case and Adverse Event Reporting from Physician Portal; Hospital-based Care Quality Information Collection and Reporting
Requirements: Master Person Index (MPI) Services; Model and Terminology Services (MTS); Clinical Decision Support (CDS); Clinical Data Warehouse {OLAP}; Clinical Data Repository (CDR) {OLTP}; Physician Portal (including CCD viewer)

4.5 Goals Achieved/Not Achieved
The requirements document provides detailed requirements for the core repository functionality and the necessary supporting components. It also provides requirements for related components that can provide additional value once the foundation is in place.

The budget requirements for the different phases of the Medicaid Transformation Grant limited this phase to the completion of the requirements and analysis for the development and implementation of the clinical data repository.

4.6 Lessons Learned
The research and analysis identified a number of areas that present a challenge in building, implementing and operating a repository containing patient clinical data. Included among the challenges are the following:

Business model

Breadth of data and resource participation

Integration with other on-going efforts (e.g. AMIE, EHR, etc)

Availability in electronic format

Build or buy

Protecting privacy

Trust relationships & contracts

Governance, accountability & data custodianship

Controlling access

Managing & applying consent directives

Timeliness

Harmonization

Data structures (format)

Vocabularies (encoding, normalization)

Semantics

Heterogeneous technology environments

Number of organizations, connection points & systems

Controlling feeds and queries to the data

4.7 National Implications
At this point in time, the analysis indicates there is significant benefit derived from this type of a system, which could be leveraged by a number of types of organizations anywhere in the country. Until a prototype, pilot, or full implementation can validate the conclusions of this analysis, the implications nationally are limited to reuse of the research and analysis completed by this project.

4.8 Policy Findings
From the lessons learned, the policy issues that are important to the success of this type of system involve data ownership and custodianship, governance and accountability, patient consent and the ability to develop trusting relationships among natural competitors.

4.9 Impact to Medicaid
Impact to Medicaid covers avoidance in costs through a number of efficiencies including:

Reduction of lab costs due to duplicate laboratory tests

Reduction in Hospital, laboratory, and pharmacy claims

Reduction of drug costs due to duplicate scripts

Reduction in claim processing time due to availability of claim attachments

Reduction in Adverse Drug Reactions in ED rooms and Hospitals.

Reduction of administrative costs for generating and delivering reports

Increased quality of care

4.10 Cost Efficiencies and Savings
In addition to the benefits to Medicaid, the analysis identified the additional stakeholders and the potential benefits to each that a clinical data repository could potentially deliver:

Laboratories: Reduced costs for paper distribution for lab results; Reduced administrative costs due to lab results request.; Reduction of administrative costs for generating and delivering reports; Increased quality of care
Provider Organizations: Near real-time data access to complete patient history across providers and payers; Reduced administrative costs due to clinical document requests.; Reduction of administrative costs for generating and delivering reports; Increased quality of care

4.11 Sustainability
The work done in this phase only started the development of potential use cases, value propositions and ultimate business models through which this type of system could be sustained.

As future funding opportunities become available the continuation of this work, and ultimate conclusion in a repository that will realize the benefits iterated in the previous section can be performed.

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