Latest News

Community Care Collaborative – CMO Message

Posted on 9 June, 2015

Mark Hernandez

May 2015 CCC Newsletter – As I talk with individuals in the area about the need for better integration of healthcare services for the uninsured and underinsured in Travis County, one foundational element identified as necessary to integration is access to data. Timely access to data is critical for two important reasons: support of point-of-service care and population health management.

We are fortunate that we have a solid history of collaboration in the sharing of data by safety net providers in Central Texas through the Integrated Care Collaboration (ICC). As you will read below, the ICC already operates a health information exchange, known as ICare, which will serve as the initial backbone of our data efforts in the CCC. The CCC, and our target population, are benefitting from this community’s early recognition of the importance of data to healthcare delivery and its commitment to making this a reality.

Mark Hernandez, MD

ICC Formation and Goals

In the spring of 1997, a group of Travis County safety net health care organizations formed the Indigent Care Collaboration (ICC) to address shared issues around the provision of care to low-income, uninsured residents of Central Texas. Original goals for the ICC included the development of collaborative programs and projects to help increase access, improve quality, and lower the costs of providing health care services to low income clients across Central Texas. A main focus of this work was the development of an internet-based, longitudinal patient health record database to identify and track care of the target population. To create the database, the organizations signed business associate agreements that allowed them to share a limited set of patient demographic and encounter data that could be aggregated for population analysis. To make data available to be shared and viewed for patient care, individuals agreed to have their data shared through an opt-in process at the point of care. The ability to collect data around shared patients assisted ICC members in –
• sizing the target population,
• identifying health care needs, and
• facilitating the adoption of more coordinated care practices.
The participating entities changed the name of the organization to the Integrated Care Collaboration in 2008 to better reflect the goals and mission of the organization.

ICC – – ICare

Through the efforts of these visionary providers, the foundation of a community health record was initiated and the first exchange of data among safety net providers began in 2002.This was the start of the ICare system, which now contains data on approximately 1 million patients and 7 million encounters.

As the ICare system grew in both the type and volume of data collected, the ICC was able to generate reports on a variety of subjects such as hospital emergency department (ED) and inpatient utilization versus primary care utilization. In addition, data collected was made available to diabetes, asthma and other disease-specific coalition groups to inform program/project development and allow for the ability to stratify care interventions based on patient’s severity of need.

Between 2010 and 2014, the ICC and its members made major design changes to the ICare system to expand and enhance its health information exchange (HIE) performance, including:
• Enhancing the HIE platform to support technology-enabled, patient-centric delivery and the ability to measure defined care outcomes;
• Supporting both query-based (i.e., allows for a provider portal to view data) and Direct-protocol (i.e., allows providers to send secured messages) based HIE solutions; and
• Pairing a Data Warehousing and Analytics solution with the data to facilitate performance-based outcome analysis, validate patient information, and assist with community health research.


The enhanced ICare system ensures that the ICC and its members are able to achieve federal Meaningful Use standards, expand and enhance existing care coordination programs, research and evaluation capabilities, and meet the goals of both the Texas Health and Human Services Commission (HHSC) and the Texas Health Services Authority (THSA) under the State Strategic Plan.

The ICC has achieved full accreditation with the Texas Health Information Exchange Accreditation Program (TX-HIEAP) and from the Electronic Healthcare Network Accreditation Commission (EHNAC) which means that the ICC’s processes for data collection, storage, and exchange comply with established laws and public policy. Additionally, it allows the ICC to exchange data with state and federal programs.

ICare is not the only HIE in the State of Texas, but it is the oldest. As the ICC approaches its 20th anniversary, it is poised to move into the next phase of its evolution by building upon the significant foundational work already accomplished to transform ICare into a more robust and fully functional regional Health Information Exchange (HIE).

ICC – Relationship with CCC

Over the past year, the ICC has been restructured to focus exclusively on the continued enhancement of ICare. Since August 2014, the ICC has been co-located with the Central Health Joint Technology Team to more easily support the CCC with its technology projects. Initial CCC-focused projects for the ICC have included –
• Creating daily electronic reports of emergency department and inpatient utilization data for CommUnityCare to support the CCC patient navigation project;
• Participating with CCC and Seton staff on the “One Button” project that will make hospital discharge data directly accessible via clinic electronic medical record (EMR) systems; and
• Loading patient care plans created by paramedics into ICare to allow for community access in support of the CCC’s Community Health Paramedic (CHP) program.
The ICare system is the foundation for much of the technology structure and exchange capabilities needed to create the “integrated” aspect of the CCC’s planned integrated delivery system (IDS) to transform care delivery.

The ICC remains a 501(c)(3) organization that is governed by a board of health care providers that serve a multi-county region and desire to collaboratively address shared issues in the care of the safety net population. These organizations include Austin Travis County Integral Care (ATCIC), Central Health, St. David’s, and Seton Healthcare Family. The ICC has 27 participating provider organizations that currently submit data through the Health Information Exchange. As the ICC heads into its 20th year and beyond, it plans to expand its base membership and data services beyond the safety net to include insurance companies, regional provider groups, and the new UT Dell Medical School. The core ICare system can assist all providers in helping the CCC and Central Health in achieving its goal for a model healthy community by leveraging the data to create new models of care as well as to create a possible academic center for excellence in analytics and population health.

ICC Team

Leader Spotlight Team

The ICC staff pictured above from left to right:
• Tony Nelson — Director, HIE Operations and Security
• Patricia Davis — Interface & Production Analyst
• Cheryl Coleman — Executive Assistant & Office Manager
• Edie Morris — Executive Director & CFO
• Carole Tamayo — Director of Technology Projects
• Jeff Strickland — Senior Linux & Network Engineer
ICC not pictured:
• Jarrod Knox — Senior Developer Architect
• Stephanie Dozier — Senior Business Data Analyst