WE...a hui for health is a coalition dedicated to building and enhancing community to address health care access in a timely and culturally competent way. WE is a traveling caravan bringing health education and screening to areas where disparities are high. WE would like to communicate and provide participants with their medical information through the CDMP software, supported by UH. We seek support to adapt the software to meet our program and patients’ needs and provide training to WE staff.

Please describe your innovation?

CDMP will provide clinical data repository to improve care through patient engagement, integration of care, advanced decision support and population reporting. CDMP can increase access and education through the web or smart phone. It will allow a screening participant to access results and recommendations, then share it with their PCP. It will assist a patient to ID providers, then educate them in a culturally appropriate manner. CDMP will elevate the screening event to a longitudinal experience. The CDMP will benefit WE, our partners and the patients we serve. For WE it will aid in communicating with our patients and partners and will maintain longitudinal data of our services. For patients it will provide a portal to access screening results, receive follow up from WE and to receive current health education. For partners, CDMP will be a data warehouse, allowing aggregation and analysis of collective data. Increased patient communication will increase the likelihood of follow up.

What is the problem or situation that your innovation seeks to address?

WE focuses on populations with health access issues. The HI Health Data Warehouse defines this as accessibility (those with transportation issues or in rural areas), affordability (lack insurance or means for care) and appropriateness (language and cultural barriers). Community based screening has limited impact as participant with and without disease are not consistently linked back to providers. The Hawaiian population has particularly poor metrics in measuring health outcomes both related to longevity and the burden of disease. There is also a problem with the integration of disease specific screening efforts and the aggregation of data from the screening activities. Bottom line, WE…a hui for health aims to improve the CDMP platform so that it is tailored to the unique needs of the populations WE serves. We would like to utilize this tool to provide culturally and individually tailored follow up for the participants to facilitate their access to healthcare services.

What effort have you made to test out your new idea?

WE...a hui for health’s collaboration is strong, (See attached WE info). CDMP is an advanced information platform licensed as open source software through the University of Hawaii and is used in over 100 sites in the United States and Australia. The unique features of CDMP make it particularly attractive for WE’s screening program with strong local support from the University of Hawaii. One of WE’s members, Project Vision Hawai‘i has acquired CDMP through a community grant and has invited other WE member agencies to join in using this open source platform. WE partners have agreed to collaborate and we have developed MOAs to create unified data collection forms and are working together on how the program can be tailored for wide application among members. We have a formal committee devoted to implementation and are collectively poised to pioneer CDMP in our preventive health caravan and move screening from an “episodic”, one-time event, to an entry point into the healthcare system.

What is particularly noteworthy or novel about your innovation?

WE partners (OHA, the Native Hawaiian Health Systems, and the Department of Hawaiian Homelands) independently collect valuable data through our respective programs about Native Hawaiians, who have some of the worse health outcomes in their own homeland. WE will provide the platform and technology to aggregate our preventative health outreach services data and make that data accessible to inform patients as well as provider agencies on where to focus resources and measure long term outcomes, to promote self-efficacy. Many health care providers, insurance companies and physicians, alike utilize electronic medical records. However, CDMP is new technology providing a clinical data repository and is focused on improving care through patient engagement, integration of care, decision support and population reporting. This can be done via the web or over the smart phone. The program will also assist a patient for their follow-up care, then educate them culturally appropriate manner.

What impact do you expect your innovation will have on the problem or situation described in the previous question?

This data repository will serve as the historical record of the people we see and serve. It benefits our provider partners by being able to track patients who utilize our services over time. It will benefit patients by providing easy access to their screening data that they can share with their PCP or keep in their personal health files. Basically, use of the CDMP program will allow longitudinal and interactive component to our wellness events. We can send follow up reminders via email and encourage access to screening results and interactive education after our events via the patient portal. We will also benefit the research sector with aggregated data from independent public health initiatives consolidated into our data storage site. This technology will serve as the cohesion between our initiatives building community capacity within the WE and within the communities we serve.

What other community partners will you need if your innovation is to scale beyond your organization?

Our primary partners include: UH TeleHealth Institute, OHA, and the Native Hawaiian Health Systems under Papa Ola Lokahi Our secondary partners include: Department of Health, Health Plans, Community Health Centers, Religious organizations, Dept of Hawaiian Homelands Hospitals, and provider groups. With demonstrated application of this program among WE partners, we will look to the broader networks that our partners have to promote how CDMP can facilitate improving access and long term follow up of patients who enter healthcare through our services. Secondary partners: Department of Health, Health Plans, Community Health Centers, Religious organizations, Dept of Hawaiian Homelands Hospitals, and provider groups.

Why are your organization, partners, and key personnel suited to take on this project?

WE...a hui for health has a strong record of bringing diverse organizations together to provide screening and health education to communities with limited resources and limited access. In addition, WE's has successfully partnered with key health care providers such as the Native Hawaiian Healthcare Systems to screen and educate people in rural or isolated communities. WE has been successful in raising funds to make our services available at no charge and partner agencies provide qualified staff, pro bono, which enable us to provide over 4500 screenings, demonstrating our collective commitment to addressing health disparities in our rural communities. WE has also taken major steps in establishing MOAs to collectively approach data collection and stewardship for the purpose of facilitating access to preventative healthcare.