QUALITY HEALTH NETWORK
744 Horizon Ct No 210, Grand Junction, CO 81506

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Organizations Filed Purposes: Clinical Data Acquisition,Aggregation and Delivery: Quality Health Network (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 mission 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 2019, more than 4,600 providers, care team members and other healthcare staff were connected to the QHN network and they made over 1.1 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 2019, QHN continued its expansion with the addition of new providers and healthcare services, which currently total more than 430 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 in 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 Colorado Regional Health Information Organization (CORHIO), the HIE that serves the eastern part of Colorado and has been expanded to include the HIEs in Utah(UHIN) and Arizona(Health Current). In 2019, QHN continues 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. 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 clincal 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.

Clinical ImprovementPopulation 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 systems 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 are 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 and registry applications embedded in the provider's electronic health record (EHR) systems. These registry applications provide for the longitudinal monitoring capabilities needed to proactively manage disease and aggregate outcomes 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 4,300 QHN users with their data needs for the utilization of registry tools embedded in their EHRs. Prescription drug and Opiod 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 300 QHN users. 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 & 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 the QHN's secure electronic network, processes which transferred patient medical information between providers were paper-based manual processes, utilizing photocopying, 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 1,400,000 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, medical errors and loss of crucial time, due to missing or incomplete medical information, are reduced using the QHN system. The Grand Junction Veterans Affairs Medical Center(VAMC) recognizes the value of this data repository resource which connects their providers and care team members to QHN. VAMC providers have recognized the value of the QHN system for improved care coordination and have continued to expand the number of VAMC users to nearly 150 utilizing QHN. Access to the extensive QHN clinical data repository by VAMC providers, continues to support quality of care improvements for the approximately 40,000 VA patients across Western Colorado and Eastern Utah. The large rural expanse and geographically challenging terrain Western Colorado encompasses can make access to VAMC facilities difficult for veterans. Consequently, veterans must seek care from their community's local hospitals, physicians, and other healthcare providers. This makes it difficult for VAMC providers to coordinate veterans' care, something critical to improving quality and reducing costs and the burden on government. Most providers in Western Colorado are connected to QHN, allowing them to exchange critical health information when it's needed for care, regardless of where the patient is treated. Historically, when veterans are seen outside VAMC facilities, this information has not been accessible, so VAMC providers were often unaware of the services their patients received outside of the VA 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 providers EHR system in a document called a Continuity of Care Document (CCD) or progress note. 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 two major grant opportunities during 2019. The Medicaid 90-10 Health Information Technology (HITECH) 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. The State Innovation Model Grant focusing on obtaining and reporting Electronic Clinical Control Measures from practices to the state. The goal of this grant contract work is to enrich and create a more complete patient longitudinal health record in the QHN System, improve transitions of care and to support ambulatory and long-term/post-acute care providers via the exchange of clinical data. Currently more than 180 providers are exchanging ambulatory encounter data with QHN, which may include, CCDs, care summaries(transcription), progress notes, alert notifications, and lab/radiology reports. This grant ended in 2019 but the work was continued under another source of funding through the Department of Health Care Policy and Finance (HCPF). 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 FQHCs in QHN's service area to support this quality improvement and cost containment work and help reduce the burden on these government programs.

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 & short-term workers in the farming, service, and recreational industries. These underserved patients often "float" in and out of eligibility for insurance/financial assistance & 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 90-10 grant contract with 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. The models QHN is currently supporting include Colorado's Accountable Care Collaborative Program and the Comprehensive Primary Care initiative (CPCi).

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