Quality Health Network

Clinical Data Acquisition,Aggregation and Delivery: QHN utilizes a secure HIE network as the foundation for the services provided to health organizations and providers to support the Quadruple Aim in Healthcare - improving patient outcomes, improving the physician experience, improving patient experience, and reducing the cost of healthcare for all. Since its inception, QHN has continued a steady focus on its founding purpose of expanding the opportunity, resources, and infrastructure necessary to increase the widespread provision of high-quality coordinated healthcare. The provision of services by the QHN network has placed Western Colorado in a strong position to achieve innovative, meaningful healthcare reforms. As of the end of calendar year 2022, more than 5,200 providers, care team members and other healthcare staff were connected to the QHN network and they made over 1.6 million data repository query requests to the Patient Summary record (patient longitudinal record). QHN facilitates the ability of area healthcare providers to collaborate and coordinate care through the secure exchange of information and securely communicate, in a manner fully compliant with HIPAA and all other patient privacy laws and regulations. During 2022, QHN continued its expansion with the addition of new providers and healthcare services, which currently total more than 520 associated health and human service provider organizations, long-term care facilities, home healthcare agencies, behavior health and Hospice programs. These operations and expansions are in the Western Colorado medical neighborhoods QHN serves: Mesa, Delta, Montrose, Garfield, Pitkin, Hinsdale, Eagle, Ouray, Rio Blanco, San Miguel, Gunnison, Moffat, Routt, and Summit counties. More than 90-percent of the providers in QHN's service area are now connected to the robust QHN network. QHN continues to expand cross-state and cross-regional HIE-to-HIE connectivity. This is an effort to improve the coordination and continuity of care statewide, and as people travel across state borders. This HIE-to-HIE information exchange work was established statewide with Contexture, the HIE that serves the eastern part of Colorado, and has been expanded to include the HIEs in Utah (UHIN) and Arizona (Contexture). In 2022, QHN continued to work on expanding HIE-to HIE-exchange to other HIE's throughout the western United States and other parts of the country. This type of exchange, based on the Patient-Centered Data Home (PCDH) concept, is a cost-effective, scalable method of exchanging patient data among health information exchanges. QHN is also a participant with the eHealth Exchange that enables exchange with many other eHealth Exchange partners such as the VA. HIE-to-HIE exchange is a critical step toward establishing a robust national interoperability infrastructure between regional and state HIEs. Considering the significant percent of the Colorado population that are "snowbirds and travel for recreation, the secure electronic transmission of information between healthcare providers across regional and state lines has translated into a significant exchange of clinical information. This robust exchange of patient information between and among HIEs translates into improvements in coordinated care, patient safety, and reduced healthcare costs. QHN is also a participant in the federal Health and Human Services program to develop secure infrastructure for the nationwide exchange of health Information called eHealth Exchange. QHN delivers real-time, critical patient information and provides a robust repository of patient clinical data (Patient Summary Record) to treating providers serving patients in life-threatening as well as non-emergent care situations. The ability for treating providers to securely access patient records and send directed, encrypted patient clinical information via QHN's high-speed network improves transitions of care and health outcomes. This immediate access to patient data reduces the burden on Government by decreasing medical errors, duplicative testing, and the expense associated with the manual delivery, storage and processing of paper records.

Indigent Care Support In QHN's medical trade area, the estimated underserved (uninsured or underinsured) population approaches 30 percent. This population tends to be transitory in nature, as the area attracts many seasonal and short-term workers in the farming, service, and recreational industries. These underserved patients often "float" in and out of eligibility for insurance/financial assistance and other government supported subsidies - and present for care in multiple care settings. To effectively treat this population, access to current patient eligibility and clinical information from previous care episodes is critical. The QHN HIE supports equitable treatment for all patients - wherever they may present for care by providing accurate patient demographics to authorized providers to assist with ascertaining eligibility and clinical information to support care coordination and continuity. The cohorts of underserved patients positively impacted by this QHN functionality are most frequently Medicaid and/or Medicare eligible. The resulting effect of this system functionality is more efficient, cost effective care for this underserved population, which helps reduce the burden on government. As a recipient of the grant contracts from HCPF, QHN has focused on increasing the number, and enhancing the services offered, to QHN participants who serve the Medicaid population and Federally Qualified Health Centers (FQHCs) focused on treating the underserved. QHN not only supports individual care providers and organizations that accept and provide care for the indigent population, but also supports the data needs of several programs focused on improving the care delivery models for the Medicaid population. These new models will replace the nation's reliance on fragmented, fee-for-service care.

Clinical Improvement, Population Health Management and Chronic Disease Management: While the chronically ill comprise a relatively small percentage of the total population, they historically account for a large percentage of the healthcare delivery system resources and associated expenses. Medicare and Medicaid eligible populations suffer disproportionately from chronic illnesses. A key component of QHN's quality improvement activities is the provision and implementation of high-value technical applications to support providers' ability to identify and manage the care of chronically ill patients. These applications support population health management, risk stratification, predictive modeling tools, and proactive care coordination to reduce the burden on these government supported programs. These tools help in the early identification and treatment of patients with chronic disease to improve patient outcomes and reduce healthcare costs. As the electronic network connectivity work in the QHN medical trade area continues to mature, the process to improve evidence-based, coordinated care for chronic disease is progressing by implementing these sophisticated applications. This helps providers move from the current system of episodic care to a coordinated system of care that creates and maintains healthy populations. QHN's network and advanced architecture supports the data needs of these applications to help providers integrate coordinated chronic disease management and preventive care into their workflow and make them more successful as they transition to new value-based payment models. Improvements in care require that these chronic disease states be not only managed and controlled during the patient visit, but that proactive management and patient engagement occur. This level of coordinated care is only practical with the support of these applications.QHN actively works to support providers as they implement and use population health management, registry, and quality measurement applications. These applications provide for the longitudinal monitoring capabilities needed to proactively manage disease and aggregate outcomes, and support measurement, for groups of patients or the entire provider's patient panel. Registries and other care coordination tools also enable providers to involve care team members to efficiently support the patient care process and actively engage patients in their disease management. Managing diseases via a registry is the expected best practice as providers develop more efficient means to care for patients. QHN supports most of the nearly 5,200 QHN users with their data needs for the utilization of population health tools embedded in their EHRs, or via other supporting applications. Prescription drug and Opioid abuse is a major area of concern, not only in the state of Colorado but nationwide. QHN provides services under a pilot project to improve access and use of the Colorado Prescription Drug Monitoring Program (PDMP) by enabling access to PDMP via the QHN System for nearly 290 QHN users. QHN has enabled access to the Colorado Department of Health Care Policy & Financing's (Colorado Medicaid) Prescriber Tool Opioid Risk Module OpiSafe via the QHN platform. Improving Care Coordination and Care Transitions: The transition of a patient from one care setting to another is frequently the source of reduced system efficiency, duplicative diagnostic testing, and the impetus for increased medical errors. This transition may be from provider to provider or from care setting to care setting such as the hospital to rehabilitation facility, home health care or hospice facility. It is common for a patient to receive care and treatment from many disparate providers during a single episode of care. Having real-time, concise, and accurate patient medical information available to all providers involved in the care of the patient during these transitions is essential for improved quality, safety, and cost reduction. Prior to the availability of QHN's secure electronic network, processes which transferred patient medical information between providers were paper-based manual processes, utilizing photo-coping, fax and courier services, and many providers were unaware of the outcome of care patients received in other care settings. The QHN patient longitudinal health record (Patient Summary), established for each of nearly 2 million unique patients in the QHN system, is a comprehensive record of all care a patient receives from disparate sources. Referring physicians, consulting physicians, discharge planners, long-term care facilities, hospice organizations and care coordinators frequently access the data repository. Patients receive better, faster, and more appropriate treatment due to the QHN system which rapidly exchanges current patient information amongst the patient's care providers when and where it's needed. Duplicative testing, medicals errors and loss of crucial time, due to missing or incomplete medical information, are reduced using the QHN system. Care coordination and care transitions rely upon the successful and timely transfer of physician generated patient-centric progress notes and care plans between and among treating providers. This data can be summarized within the provider's EHR system in a document called a Continuity of Care Document (CCD) or progress note and shared with QHN. Everyday thousands of healthcare providers across Western Colorado utilize QHN to view inpatient and outpatient data, lab and radiology results. The data contained in the QHN System is of great value to providers and helps create a clinical picture of the patient. QHN continued to participate in grant service contracts with the Colorado Department of Health Care Policy and Finance (Colorado Medicaid) during 2022. The Medicaid Management Information System (MMIS) administrative contract funding supports QHN's work with qualified Medicaid and referring organizations to assist providers with new and enhanced HIE utilization, which includes but is not limited to: the exchange of ambulatory encounter information, alert notifications, lab and radiology reports, single sign on, and image exchange. QHN's secure network and uniquely connected technology also allows authorized providers to receive hospital (emergency department, etc.), Admission, Discharge, and Transfer (ADT) alerts for real-time notifications of care occurrences that occur on their patients. QHN continues to focus on the expansion of the delivery of ADT alerts to providers, care coordinators, and organizations.Managing a patient's care across all care settings is the cornerstone of the new Medicaid and Medicare payment models. QHN is providing alerts to multiple Federally Qualified Health Centers in QHN's service area to support this quality improvement and cost containment work and help reduce the burden on these government programs. While QHN's historical focus has predominately been on the medical side of a person's health, this does not include the many social factors that affect a person's health. To address this concern, QHN provides a social information exchange called the Community Resource Network (CRN). This social information exchange combines social, behavioral, and medical information to get more comprehensive view of a person. CRN allows those involved in coordinated care to view pertinent information to guide the person more efficiently to better health. This collaboration is critical to improve the health and safety of those QHN serves, reducing unnecessary duplication, reducing the burden on government supported healthcare programs and ultimately driving down the cost of health care. CRN system went live in mid-2020. At the end of 2022, CRN had over 420 users and 150 network partners participating.Funding Sources: Grant contracts help support the work required to build the technology infrastructure, data interoperability exchange capabilities, and robust data warehousing essential for the advanced analytics and data needs of new care and payment models. QHN continues to support the efforts of the State HIT Roadmap and various HCPF contracts that procure services to make improvements to the Health Information Exchange capabilities and infrastructure in Colorado. These contracts focus on those providers and organizations who serve the Medicaid population. These investments have allowed QHN to increase and enhance connectivity with Medicaid and Medicare providers, expand acquisition of ambulatory data, including data from behavioral health and long-term care providers, to enrich the data repository. This supports the common vision of improving outcomes for Medicaid, Medicare and all patients in western Colorado. The collective impact of these acquisitions, and the practice transformation work they support, has been instrumental in the evolution of the healthcare delivery system of Western Colorado.

Support for Public Health Programs: QHN continues to work with public health and community providers to improve patient care and public health through the timely exchange of, and access to, health information. The Mesa County Health Department (MCHD) has a unidirectional interface with QHN for direct delivery of transcription and laboratory and radiology results, ADT's and has been actively involved in the community care coordination pilot. QHN continues to work with other public health agencies throughout Western Colorado to share information and improve the connectivity with the QHN Network. To better serve the indigent in Mesa County, MCHD partnered with Marillac Clinic, the Federally Qualified Health Center (FQHC) in the Grand Junction area, co-locating a Marillac Clinic within the health department. This has allowed patients who seek care at MCHD to have quick and easy access to a full range of medical services, including vision and dental care. QHN is supporting these public health programs, MCHD and Marillac Clinic, through its existing secure high-speed electronic data collection/delivery infrastructure in addition to QHN's work supporting other FQHCs across QHN's service area. This infrastructure creates a mechanism to electronically deliver and query critical health information and to alert providers when an important health event occurs. In addition, public health programs throughout the QHN service area are being supported by QHN's Community Resource Network social information exchange system.