|OCHIN|2009 Annual Report

BOARD OF DIRECTORS Dr. John SaultzBoard Chair Professor and Chair Family Medicine Oregon Health & Science University

Bob Marsalli Secretary Chief Executive Officer Klamath Health Partnership, Inc.

Glenn Kulm Treasurer Director of AdministrationSanta Cruz County Health Services Agency

Vanetta Abdellatif Director of Integrated Clinical ServicesMultnomah County Health Department

Dr. Homer Chin Medical DirectorClinical Information Systems Kaiser Permanente NW Region

Tom Fronk Finance DirectorBenton Community Health Center

Ruby Haughton-Pitts President R. Haughton-Pitts Communications

Craig Hostetler Executive DirectorOregon Primary Care Association

Gil Muñoz Executive DirectorVirginia Garcia Memorial Health Center

Dr. Joseph E. Scherger Clinical Professor Dept. of Family Prevention MedicineUniversity CSDMedical DirectorAmeriChoice San Diego

Herrmann Spetzler CEO/Executive OfficerOpen Door Community Health Centers

Joel Young Oregon Health Division

Abby SearsChief Executive Officer OCHIN

OCHIN updates vision and mission in 2009 The OCHIN board of directors and staff participated in a series of strategic visioning processes that produced our strategic plan and revised vision and mission statements.

In 2010 you will see a new vision and mission that reflects our commitment to the future and builds on 10 years of hard work in the health information technology community. As we celebrate our first 10 years of success, we remain committed to meeting the ever-changing needs of the medically underserved.

V I S I O N :

OCHIN IS A CATALYST

IN THE TRANSFORMATION

OF THE DELIVERY OF HEALTHCARE

M I S S I O N :

WE PIONEER THE BEST AND MOST

INNOVATIVE USE OF INFORMATION

AND INFORMATION TECHNOLOGY

FOR THE MEDICALLY UNDERSERVED

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V I S I O N :

OCHIN IS A CATALYST

IN THE TRANSFORMATION

OF THE DELIVERY OF HEALTHCARE

M I S S I O N :

WE PIONEER THE BEST AND MOST

INNOVATIVE USE OF INFORMATION

AND INFORMATION TECHNOLOGY

FOR THE MEDICALLY UNDERSERVED

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Dear OCHIN Collaborative – In our 10 year history, this is the year we have been waiting for. The federal administration has made a commitment to support electronic health records for the safety net at the highest levels we have ever seen. With electronic health records becoming a household word, we look forward to the day when everyone will have a personal health record and be able to manage their own health care information.

Legislation providing health care for most Americans passed the U.S. House and Senate and will be hotly debated in 2010 with hopes of passage. These are truly exciting times for the OCHIN Collaborative.

At OCHIN this has been the time for action. We have stepped up to the challenge of increased technical and support needs of our collaborative, the demands of new business opportunities and developments that allow us to be an innovator in meeting the federally mandated meaningful-use requirements.

Our staff has been moving at the speed of light to make sure that every OCHIN member clinic is well positioned for the future and can meet the federal meaningful-use requirements. At a time of economic recession, we are adding staff to support you, and we have made adjustments in the way that we do business to meet the demands of the new HIT world.

As OCHIN’s CEO, I can assure you that we are on course for meeting the federal meaningful-use requirements for 2010 and beyond. This year our annual report is dedicated to you and to meaningful use.

Sincerely,

Abigail Sears CEO

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The federal economic

stimulus law regarding

“meaningful use”

is an acknowledgement

that improved health care

requires both technology

and the efficient use of

health information to

help clinicians make better

decisions at the point of care.

Meeting Human Needs Through Meaningful Use

The federal HIT work group’s earlier recommendations offered objectives for qualified EHRs that helped us gauge our

progress along the continuum of readiness. As the work group prepares to issue its final

recommendations at the end of 2009, we are confident our collaborative will meet all of its 2010 objectives and measures, thus improving

patient care in the areas of:

Quality Safety Efficiency Reducing health

disparities

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Moving Towards Meaningful Use

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At OCHIN we believe that so much more is possible with our practice management (PM),

electronic health records (EHR) and supporting tools. Our members can anticipate greater improvements

in quality, patient safety and smoother delivery of individual patient and population-based care due

to innovation and greater data collaboration.

At our 2009 user group meeting called “Moving Towards Meaningful Use,” we addressed

what members could expect and how those expectations will be supported in EpiCare.

From case management, disease management and benchmarking to billing, we offered over 40 sessions designed to help our collaborative

members prepare for meaningful use.

The federal government’s 2010 expectations:

Allow patients to access clinical information

Comply with state and federal privacy, security and data sharing regulations

Document patient progress and provide clinical summaries

Exchange critical information with other health care providers

Implement drug interaction safeguards

Send patient reminders about follow-up and preventive care

Submit immunization and laboratory data to relevant public health registries

Collaborative Member Puts Meaningful Use to Work

In 2008, OCHIN announced the availability of a free compatible software tool called Solutions to help clinics move toward greater quality improvements in patient care. Over the past year, many of our collaborative members put Solutions to work using various aspects of the metrics offered by this product.

Dr. Michele Violich, medical director at the Watsonville Health Center of the Santa Cruz County Health Department, realized the value of Solutions when treating patients with diabetes. Frequently such patients fail to have their lab work done to monitor their condition. Using her skills as a medical provider and her understanding of research protocols, Dr. Violich and her staff began assessing the short and long-term value of using the Solutions tool.

Together they worked with OCHIN’s quality improvement staff to design a 12-week project called Solutions Pilot for Recalling Diabetic Patients with an Overdue A1c. Everyone agreed that the overarching goal was to help patients improve their diabetes control.

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The Protocol Focusing on patients without an A1c test in the last six (6) months

Updating the patient’s primary care provider and medical data in the file

Creating an algorithm to determine workflow, patient contact and documentation

Designing a way to chart results and continue follow-up after the pilot

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Promising Results

At the start of the pilot in July, 66.9% of Dr. Violich’s diabetic patients had completed an A1c test in the previous six months. Using the interventions of the pilot, patients showed improvements each month thereafter.

They also made patients aware of free, generic and low-cost prescription drugs and inexpensive lab tests. Patient response was positive. One diabetic patient told Dr. Violich,

There are hundreds of useful metrics in Solutions to improve patient health and track outcomes. Dr. Violich is using the developed workflow from the pilot to do quarterly follow-up interventions and help patients achieve tighter diabetes control.

“I came back to the clinic after your call because I was touched to see that you were concerned enough to contact me.”

Updating the patient’s primary care provider and medical data in the file

Aug. Sept. Oct. Nov.

68.0

%76

.3%

76.2

%76

.7%

In addition to the quantitative data that showed an 11% increase in A1c tests completed, Dr. Violich and her staff were able to help patients restart medications, reaffirm diet and exercise recommendations, and they provided information and other services to assist patients with their overall health.

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In 2007, the Federal Centers for Medicare and Medicaid Services (CMS) approved a $5.5 million grant for the state of Oregon to develop and implement the Health Record Bank of Oregon (HRBO). In 2009, OCHIN agreed to partner with the state and its technology design vendor, WebMD, by implementing a community engagement and information campaign that informs both clinicians and Oregon Health Plan (Medicaid) patients about the value of personal health records (PHR). The overall goal of the HRBO is to increase the availability of patient-centered health-related information with the expectation of improving health care quality, outcomes and patient and provider satisfaction while also reducing health care costs. Following the completion of a two-year pilot project, state officials anticipate extending this campaign from 50,000 OHP patients to all Oregonians.

Currently, the OCHIN Collaborative is comprised of approximately 70% of all safety-net clinics in Oregon and serves over 700,000 patients. The use of the OCHIN/Epic practice management, electronic health record and other supporting software products allows our clinicians to assist patients in understanding their health record and begin transferring information to patients in an electronic format.

OCHIN’s role is to introduce personal health records (PHR) to Oregon Health Plan patients and help them to start using a (PHR) to manage their health care. PHR usage is growing and changing and OCHIN is looking forward to participating in future developments. By connecting with state health record banks, we are building on our commitment to improve continuity of care for underserved populations. We believe in giving patients ownership and empowering them to participate in the delivery of their care.

Health Record Bank of Oregon

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Health Record Bank

Da

ta T

ran

sfe

r La

yer

HEALTH RECORD BANK

Sec

ure

Pa

tien

t D

ata

HEALTH SYSTEMS

•prescriptions

•lab results

•office visits

•hospitalizations

•other data

Patie

nt

Priv

ac

y a

nd

Co

ntr

ol L

aye

r

OREGON HEALTH PLAN PATIENTS

Stored Secure Data Bank

•view

•print

•choose

•approve sharing

•enter information

•transport record

Secure Personal Health Record

Health and medical history information is transferred into a secure data storage bank where the individual can view, choose to approve, print, enter information and share their information with others. PHRs are portable and secure. They provide individuals with greater access, mobility and control over their private health information, regardless of where they choose to receive care.

M I S S I O N

The mission of OCHIN’s Practice Based Research

Network (PBRN) is to improve the health of underserved populations, enhance their

quality of care, and inform health policy through research.

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Practice-Based Research Network

OCHIN’s PBRN is registered with the Agency for Healthcare Research and Quality (AHRQ) and focused on improving health care delivery and health outcomes of the medically underserved.

With our PBRN partners we are building the infrastructure to collaborate with research experts on studies that are consistent with evidence-based practices. In 2009, the OCHIN Collaborative served over 700,000 individual patients. The ability to aggregate this patient data to inform and improve health care provides us with many opportunities to participate in local and national research projects. As OCHIN’s PBRN develops we welcome partners who can participate with the collaborative as we strive to improve the health of underserved populations.

The OCHIN Collaborative is one of only a few organizations in the nation currently capturing aggregate health care data and statistics of low income and uninsured populations. There are no other organizations in the country whose sole focus is research to improve the health of underserved populations, and this is why OCHIN agreed to be the PBRN’s administrative home.

PATIENTS SERVED 707,852VISITS 6,018,137

SEX

Female 57%Male 43%

ETHNICITY

Hispanic 30%Non-Hispanic 61%Not Collected/Unknown 9%

RACE

American Indian 1%Asian 3%Black 5%Not Collected/Unknown 20%White 70%

FEDERAL POVERTY LEVEL

100% and below 58%101% - 150% 10%151% - 200% 4%Over 200% 10%Unknown 18%

PATIENTS SERVED BY PAYOR MIX

Commercial 10%Medicaid 37%Medicare 5%Self-pay 43%Unknown 4%

VISITS BY PAYOR

Commercial 8%Medicaid 46%Medicare 11%Self-pay 33%Unknown 2%

Unique Patient Demographics

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Practice Management

Sites Organizations

2002

47

2003

838

2004

1260

2005

1469

-10

10

30

50

70

90

110

130

2006

1777

2007

1885

2008

2297

2009

27115

3,416 123,09065,031 166,143 185,737 206,935 258,777 325,572

20,306 90,10463,725 146,483

Patients

2002 2003 2004 2005 2006 2007 2008 2009

From 2002 through 2009 OCHIN Practice Management (PM) sites and clinics have grown from 4/7 to 27/115 with patient volume growing from 3,416 to 325,572 over the same period. Between FY’08 and ’09 PM volume has grown by 23%.

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Electronic Health Record

2006

39

2007

425

2008

1141

2009

1662

-10

10

30

50

70

90

110

130

3,416 123,09065,031 166,143 185,737 206,935 258,777 325,572

20,306 90,10463,725 146,483

Patients

2006 2007 2008 2009

Sites Organizations

From 2006 through 2009 electronic health record (EHR) site and clinic growth grew from 3/9 to 16/62 with individual patient volume growing from 20,306 to 146,483 in the same period. Between FY ’08 and ‘09 EHR growth was an estimated 31%.

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REVENUE: FY2008

User fees$3,249,788

Gifts in kind $314,646

EXPENSES

Salaries and benefits $4,662,573

Maintenance & support $ 1,191,4 87

Administrative $ 2,061,725

Total $ 7,915,785

CHANGE IN NET ASSETS $ 1,086,176

EBITDA $ 1,752,376

Total $9,001,961

Grant revenue $2,001,050

Implementation fees $2,659,556

Other revenue and consulting

$776,921

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REVENUE: FY2009

EXPENSES

User fees $4,102,024

Grant revenue $2,281,493

Implementation fees $2,963,633

Other revenue and consulting

$1,378,470

Gifts in kind $16,466

Salaries and benefits $ 5,867,829

Maintenance & support $ 1,609,297

Administrative $ 1,909,603

Total $ 9,386,729

CHANGE IN NET ASSETS $ 1,355,357

EBITDA $ 1,794,558

Total $10,742,086

The OCHIN Collaborative

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CALIFORNIA Adventist Health Feather River Hospital

Community Health Alliance of Pasadena

Monterey County Health Dept.

Open Door Community Health Centers

Pasadena Public Health Dept.

Placer County Health Dept.

Open Door Community Health Centers

Santa Cruz County Health Services Agency

Santa Cruz Womens Health Center

OREGON

Adventist Health

Asher Community Health Center

Benton Health Services

Clackamas County Health Dept.

Coastal Family Health Center

Community Health Center

Community Health Centers of Lane County

Community Health Center of Medford

Deshcutes County Health Dept.

Klamath County Public Health Dept.

Klamath Open Door Family Practice

La Clinica del Valle Family Care Centers

Lincoln Community Health Center

Mosaic Medical

Multnomah County Health Dept.

Oregon Health & Sciences University

The Reinhart Clinic

Tillamook County Health Dept.

Virginia Garcia Memorial Health Center

Waterfall Community Health Center

WASHINGTON

Cowlitz Family Health Center

18

707 SW Washington St. Suite 1200

Portland OR 97205-3529

Phone: 503.943.2500

Fax: 503.943.2501

www.ochin.org