We begin by describing the environment from which OCHIN emerged and key aspects of OCHIN’s early history, including the impetus behind the development of the collaborative. We focus also on the organizations that helped establish initial goals, direction, and a longer term vision for the consortium.
Early leadership. Key stakeholders in the creation of OCHIN included the OPCA, CareOregon and consolidated health centers in the State of Oregon, notably the health center run through the Multnomah County Department of Health. These organizations headed the development of a steering committee composed of themselves as well as leadership from relevant offices within State government. Several members of this steering committee were interviewed as part of our site visit. Under the organizational umbrella of CareOregon, the steering committee applied for and secured a Community Access Program (CAP) grant that allowed them to hire staff and begin the process of developing the consortium in late 2000. In addition to citing the need for improvements in safety net health center administrative systems, the original CAP application emphasized OCHIN’s potential to collect and distribute high quality information on the health status and health care experience of vulnerable populations through a coordinated central data warehouse.
Organizational goals and focus. OCHIN’s original steering committee believed that it was important to maintain the consortium’s non-profit status and to focus on reaching out to different primary care safety net providers across the State and region. OCHIN sought to collaborate with consolidated health centers rather than other providers such as hospitals or private group physician practices. After securing CAP funding, the OCHIN steering committee brought on Mike Leahy (then a consultant with the Tillamook County Health Department’s consolidated health center) as Executive Director. The steering committee also prioritized the procurement and implementation of a sophisticated practice management system that could improve administrative efficiency and facilitate HIPAA compliant data exchange for the State’s 30-plus consolidated health centers and other safety net providers. The decision to prioritize practice management coincided with Multnomah County’s ongoing independent effort to select a practice management system vendor for their own consolidated health center. Over time, Multnomah County merged these activities with those of the health centers represented in the original OCHIN steering committee.
Vendor selection and initial implementations. After gathering the initial IPM partners and deciding to prioritize the procurement of a practice management vendor, the new OCHIN staff developed a request for proposals and evaluated the 25 responses they received. The first tier of evaluation focused primarily on functionality and workability of proposed solutions. The question of affordability was reserved for subsequent phases of the selection. Following an initial review of proposals, three vendors were selected as finalists including Epic (the ultimate winner) and NextGen.
The final selection process involved a live product demonstration by the three finalists, after which each consolidated health center in Oregon was given the chance to hear presentations from the finalists and fill out score cards. This process resulted in Epic’s selection as OCHIN’s software vendor. Several respondents mentioned that Epic was selected primarily for its extensive experience with marquee private group practices such as Kaiser Permanente and the Cleveland Clinic and because it would be able to provide an electronic medical records (EMR) system, which remained one of OCHIN’s goals. It should be noted that some of the OCHIN leadership was familiar with Epic from previous experiences and actively sought out Epic’s bid and was instrumental in capturing the software company’s attention. To date, seven IPM partners have “gone live” with the new integrated practice management platform in over 50 clinic sites and the partnership continues to expand within and beyond Oregon. Multnomah County Health Department plays a central role in hosting and supporting the main OCHIN server.
Plans for expansion. While the group of initial IPM partners allowed OCHIN to begin operations and secure additional funding, OCHIN’s leadership and current IPM partners acknowledge the need for further expansion to ensure an independently sustainable model capable of financing access to software and associated services. The current scope of the practice management initiative (involving seven IPM partners and more than 500,000 encounters per year) is substantially subsidized through temporary grant funding from HHS. At the time of vendor selection the OCHIN Board understood that — given the cost of the Epic product — longer term viability of the network would require establishing partnerships with safety net health centers outside of Oregon. At the time of the site visit OCHIN had one out of state IPM partner (Pike Market Health Center in Seattle, WA) and another implementation was planned for late 2003 (in Santa Cruz, CA).
Future direction and funding. The consortium is continuing to expand service and product offerings to individual health centers. In addition to two years of initial funding through the CAP program, OCHIN recently secured three additional grants, each focused on an important component of the consortium’s practice management and anticipated EMR offerings. In particular, immediate plans include at least doubling the annual volume of practice management visits managed by the Epic software by 2006 and developing an EMR product to be rolled out to alpha and beta sites in FY 2005. Early indications suggest that it will be possible to work with OCHIN to incorporate the existing BPHC software used in monitoring care delivered as part of the Health Disparities Collaborative project into a comprehensive EMR.
OCHIN continues to work towards implementing a safety net data warehouse for Oregon, but the consortium does not currently have adequate funding or resources to develop or manage the systems necessary for collecting patient data from the non-partner health centers that do not use the Epic software and integrating these data with that of the IPM partner health centers to form the basis of a patient- or encounter-level data warehouse. Currently, administrative data on patient encounters from IPM partner health centers is captured in a master patient index (MPI), which OCHIN leadership describes as a precursor to the data warehouse and a potentially rich source of utilization and administrative data related to safety net care in Oregon. The MPI currently includes data on the approximately 400,000 patients who obtained care via IPM partner consolidated health centers over the last two years.
Organizational affiliation and governance. CareOregon served as the administrative home for OCHIN in its initial two years of existence. In particular, CareOregon served as the grantee organization for the original CAP grant that supported OCHIN. At the time of its creation and subsequently, both CareOregon and OCHIN agreed that the formal legal relationship between the two organizations was a temporary arrangement that would last only long enough for OCHIN to become a viable, independent entity. At the time of our site visit, OCHIN was going through a legal separation with CareOregon that has subsequently been finalized.
Separation from CareOregon was possible at this time because of additional grants secured for the consortium through other IPM partner consolidated health centers and organizations. In conversations following separation, OCHIN leadership indicated that their new independent status will result in greater freedom for OCHIN as it seeks to establish its own viability as a financially independent safety net provider network. As before, OCHIN is governed by a board of directors including leadership from State officials, consolidated health centers, the OPCA and CareOregon. In addition to being one of OCHIN’s IPM partners with representation on the Board of Directors, the Multnomah County Health Department houses OCHIN’s centrally located servers and support staff. Many of OCHIN technical staff are former employees of either CareOregon or Multnomah County.