Martin Ciccocioppo, MBA, MHA

1
Progress ReportJanuary 2007

• Martin Ciccocioppo, MBA, MHA
• Chairman of the PAeHI Board of Directors and
• Vice President, Research
• The Hospital Healthsystem Association of
  Pennsylvania

2
Technology Can Transform Care Delivery

• The Promise of Health Information Technology
• Interoperable
• Quality Care
• Decision Support
• Cost Effective Care
• Bench-to-Bedside
• Medically Underserved
• Consumer Involvement
• Accuracy and Privacy
• Public Health Monitoring

3
Activities Paving the Way to NHIN

• Executive Order 13335
• Coordinator of ONCHIT
• Strategic Framework
• ONCHIT published a RFI seeking public comment
• 21st Century Health Information Act
• RFI Response Summary
• HHS Awards Contracts to Advance Nationwide
  Interoperable HIT
• HIT Leadership Report
• HHS Awards 4 Contracts (18.6 million ) to
  Develop NHIN Prototypes
• American Health Information Community
• HHS Announces Regulations that support
  e-prescribing
• and EHR adoption

4
Activities Paving the Way to NHIN
2006
2005

• AHIC Workgroup recommendations.
• ONC RHIO Contract to develop model guidelines for
  State level RHIOs.
• CCHIT is launching commercial certification of
  ambulatory EHRs in April announcing results in
  late June.
• 2 key health IT bills have momentum H.R. 4157
  and S.1418.
• More recent health IT bill introduced by Rep.
  John Porter (R-NV) that required FEHBP insurance
  carriers to offer EHRs/PHRs.
• CMS issues PHR RFP
• CfH releases policies for Common Framework
  implementation.

2004

• ONC awards suite of contracts totaling 36M to
  support the develop of technology building blocks
  to drive industry transformation.
• HHS Secretary Michael Leavitt creates the
  American Health Information Community.
• Wired for Health Care Quality Act of 2005 passes
  the Senate.
• CMS says it will follow MedPAC suggestion to
  establish P4P reimbursement systems.
• CMS and OIG issued new proposed rules to create
  exceptions to Stark/AKB for eRX and EHRs.

• President Bush calls for widespread adoption of
  interoperable EHRs within 10 years.
• Dr. David Brailer appointed as nations first
  National Coordinator for Health IT and releases
  Framework for Strategic Action.
• Markle Foundation releases a report on a Common
  Framework for health information exchange.
• AHRQ awards 139 million in grants across 38
  states to support health IT adoption.

1999-2002

• Institute of Medicine (IOM) releases
  groundbreaking reports setting foundation for
  health IT movement
• To Err Is Human -- 11/99
• Crossing the Quality Chasm -- 03/01
• Fostering Rapid Advances -- 11/02

2002
Markle Foundation organizes Connecting for Health
(CfH), a public private collaboration to advance
health IT adoption.
Prepared by William S. Bernstein Manatt, Phelps
Phillips, LLP
5
National Strategic Framework

• Inform Clinical Practice - brings EHRs into
  clinical practice
• Provide incentives for EHR adoption
• Reduce risk of EHR investment
• Promote EHR diffusion in rural and underserved
  areas
• Interconnect Clinicians
• Regional collaborations
• Develop a national health information network
• Coordinate federal health information systems
• Personalize Care
• Encourage use of Personal Health Records
• Enhance informed consumer choice
• Promote use of telehealth systems
• Improve Population Health
• Unify public health surveillance architectures
• Streamline quality and health status monitoring
• Accelerate research and dissemination of evidence

6
RHIOs HIEs Today

• Trend is being validated
• Forming at a remarkably rapid rate
• Over 200 nationally
• Forming as legal entities
• Dont appear to be going away soon
• Doubt slowly eroding
• Federal government is trying to help identify
  commonalities
• Need to find the appropriate degree of criteria
  'looseness' for RHIO maturity stages
• 2007 Prediction - Private sector will continue
  to inch along w/RHIO experiments
• December 2006 - TOP 1 search on HIMSS Site
  RHIO

7
Many Private Sector Changes

• Different models emerging including those
  focused on personal health record
• Intel-Walmart Announcement
• This weeks AHIP- BCBSA personal health record
  announcement
• The goal of NEPSI is to increase patient safety
  by making eRx accessibleand desirableto all
  physicians by providing it free of charge.
• Enormous amount of activity related to value
  based purchasing employer toolkit through
  coalition of employers working with DHHS, work of
  AQA and NQF, etc.
• The Pennsylvania Health Care Quality Alliance
  (PHCQA) is a coalition of Pennsylvania health
  care providers and insurers designed to improve
  the quality of patient health by developing a
  consistent, uniform, statewide approach on
  hospital quality measures
• More funding emerging from states

8
RHIO Activity in Pennsylvania
West Central PA Collaborative 5 Hospitals
(Dubois, Clearfield, Elk Regional, Brookfield
Punxsutawney) DuBois Regional Medical Center
(DRMC) Received Arc Grant 1.5 Million
Central Penn Health Information Collaborative
(CPHIC) -James Walker, M.D. -39 counties -50
hospitals

• NE PA RHIO, INC
• -John Regula, Sabatini J. Monatesti
• 24 HC Institutions
• 6000 Providers

Aetna Foundation PA Grants -2004 PA Grant totals
200,000 -3 hospitals/health systems -8
organizations/foundations -3 universities
Danville
Pittsburgh
Harrisburg
Philadelphia
Philadelphia Health Information Exchange -Hx
Technologies, a Philadelphia-based health
information service provider -Supports 4
hospitals -Was awarded a 1.7 million grant by
the National Cancer Institute (NCI)
Pittsburgh Regional Health Care
Initiative -Hundreds of clinicians -42
hospitals -4 major insurers
Geisinger Clinic -1-Year AHRQ Planning Grant
200,000 -3-Year AHRQ Impl. Grant 1.5 million
Southern Alleg. Regional Hlthcare
Alliance -1-Year HRSA Grant -5 hospitals
Wellspan Health -Selects Allscripts as Ambulatory
EMR -2 Hospitals -X Locations
9
Central Pennsylvania Health Information
Collaborative

• CPHIC
• Region Description Forty central Pennsylvania
  counties
• Mission Health information exchange facilitator
• Participants Six hospitals/health systems and
  one physician group practice signed MOU
• Funding Undetermined, but leveraging benefits of
  AHRQ Grant
• AHRQ RHIO Implementation Grant Project
• Region Description Central Pennsylvania
• Mission Exchange health information for common
  patients across three hospitals
• Participants Geisinger Medical Center, Shamokin
  Hospital and Bloomsburg Hospital
• Funding AHRQ initial planning grant followed by
  3-year implementation grant

10
Philadelphia Health Information Exchange

• Region Description Philadelphia
• Mission Allow regions hospitals and clinics to
  exchange digital medical records
• Participants Hx Technologies, HUP, CHOP,
  Presbyterian and Pennsylvania Hospital
• Funding National Institutes of Health grant for
  Interoperability, Portability of EMRs

11

• Overview  The goal of the Highmark eHealth
  Collaborative is to encourage the adoption of
  health information technology used in patient
  care in order to improve patient safety and
  quality of care while increasing cost efficiency.
  To support this critical objective, Highmark
  Inc., made a major contribution to The Pittsburgh
  Foundation for the funding of the Highmark
  eHealth Collaborative, a supporting organization
  of the foundation.
• Grants up to 7,000 per physician for eRx/eHR
  solution from Registered Vendor.
• Practice Must pay at least 25 of cost.

12
Benefits of Statewide Coordination

• Body for Cooperative HIT Diversity
• An important driver to NHIN
• Key driver moving regions and communities toward
  health information
• Technology attracts young Physicians to
  Pennsylvania
• Statewide community provider HIT coordination
• Interconnection for substitute care HER needs
• Immunization Screening through HIE
• Reduce Medication Errors
• Protect Public (Pandemic, Bioterrorism/Chronic
  diseases)
• Monitor Disease Outbreaks
• Newborn/Children screening
• Increase Physician Efficiencies
• Decrease inefficiencies with rising healthcare
  costs

13
What is the PAeHI ?
The Pennsylvania eHealth Initiative (PAeHI) is a
broad statewide coalition (non-profit) of health
care stakeholders (public/private partnership)
dedicated to fostering the adoption and
implementation of standards-based electronic
medical records across the state and to enable
the timely and efficient sharing of patient
information by means of health information
exchange for the benefit of all Pennsylvanians.
14
PAeHI Mission

• Enable the use of information technology to
  improve healthcare quality and efficiency and
  ensure patient safety for all Pennsylvanians.
• Ensure secure, confidential access to health
  information to enable individuals and communities
  to make the best possible health decisions.

15
PAeHI 2005 Highlights

• Conceptualized in March 2005 40 stakeholders
  met
• Explored the need for a statewide organization
• Series of organizational meetings occurred
• Statewide HC IT Symposium - July 2005
• PAeHI adopted by-laws - September 2005
• PAeHI Incorporated as PA Non-profit Corp. -
  September 2005
• 1st election of Board October 2005
• First Board of Directors in place - November
  2005

16
PAeHI 2006 Highlights

• Raising awareness among providers and other
  health care stakeholders of the role health
  information technology can, and must, play in
  improving the lives of Pennsylvanians
• Expansion of PAeHI's membership from 40 founding
  entities to 160 organizations and more than 230
  individuals participating in or supporting the
  activities of PAeHI
• Establishment of four standing committees
  (Business Analysis and Technology, Communications
  and Education, Membership, and Finance)

17
PAeHI 2006 Highlights (cont.)

• Continuous face-to-face and virtual meetings of
  the full PAeHI board and its subcommittees
  throughout 2006 with much of the focus on
  increasing awareness of the membership
• Increased government commitment to and
  participation in this truly public-private
  partnership
• Improved understanding of both the regional and
  national health information technology and health
  information exchange landscape
• Laying the groundwork for the development in
  early 2007 of a multi-year strategic plan

18
PA eHealth Initiative Goals

• Increase the adoption of EMR and other health
  information technologies by encouraging pay for
  achievable, fair quality measures and other
  incentives to boost their adoption.
• Encourage the planning of locally sponsored
  initiatives with the long-term goal of statewide
  and national connectivity and develop consortium
  sponsored clinical data exchange initiatives.
• Develop communication mechanisms to disseminate
  information to consumers, as well as collect
  information from consumers regarding the goals,
  objectives, and activities of the consortium.
• Improve Population/Public Health

19
PA eHealth Initiative By-laws

• PAeHI consists of nine classes of membership.
• Hospitals
• Insurance
• Quality Improvement Organizations
• Supporting Member Organizations
• Government
• Business/Purchaser
• Physicians/Physician Organization
• Professional Health Care Organizations
• Consumers/Public Interest Organizations
• The business and affairs of the PAeHI shall be
  managed and governed by its Board of Trustees.
• Business and financial condition of the PAeHI to
  be
• disclosed annually.

20
PAeHI Board of Directors
Board Members Martin J. Ciccocioppo
(Chairman), Vice President, Research, HAP Mark
J. Jacobs (Vice Chairman), Director, IT, WellSpan
Health Dan Jones (Secretary), Chief Operations
Officer, Quality Insights of PA Tom Tabor
(Treasurer), Senior Vice President and CIO,
Highmark Inc Kenneth D. Coburn, M.D.,
President, CEO CMO, Health Quality Partners
F. Wilson Jackson III, M.D., Owner, Jackson
Gastroenterology Darlene M. Kauffman, Associate
Dir., Payor Relations, PA Medical Society Don
Levick, M.D., MBA, Lehigh Valley Hospital
Teresa Shuchart, Chief Information Officer, PA
Dept. of Public Welfare Jay Srini, VP, Emerging
Technology, HIMSS, UPMC Anthony Wilson, Special
Assistant to the Secretary of Health, PA DOH Ex
Officio Members Roger F. Mecum, Executive
Director, Pennsylvania Medical Society Donald
F. Wilson, MD, Medical Director, Quality Insights
of PA James M. Walker, MD, Chief Medical
Informatics Officer, Geisinger Health System
21
Members as of Dec 2006
22
Barriers being addressed ?

• PAeHI role still evolving-few in advanced stage
  
• Federal IRS Status still pending
• Sustainable value proposition
• Financing operations still questionable
• Achievable technical architecture
• Still in process of defining value
• Diversity and size of PA
• Progress never fast enough
• Architectural debate
• 42 of efforts focus on governance policy
• Increase involvement at local provider levels

23
Opportunities for PAeHI

• Positioned for statewide HIT collaboration
• Education Standards/Certification/Funding
  Sources
• Catalyst for informing providers citizens on
  HIT
• Collaboration will increase need for local
  efforts and providers
• A Private-Public sector opportunity less
  government
• A single neutral convener
• Organizationally positioned for a HIT utility
• Serve as institute for HIT
• Bridge between public health personal care
  sectors
• HIT Facilitator - patient care mostly paper
• Leader for Collective Medical trading area
  analysis
• Can fill the Gaps that currently exist in PA for
  NHIN
• Can build a HIE

24
PAeHI - Next Steps

• Strategic Planning Retreat, January 31, 2007
• Identify specific operational HIT priorities
• Release a multi-year strategic plan
• Seek Operating and Project-specific Funding
• Create an Operating entity
• Quarterly Newsletter
• PAeHI HIT Summit, September 2007
• Maintain a pulse on PAs HIT landscape
• Serve as conduit eHI/Connecting Communities
• Expand involvement of members
• Support w/governmental, provider interest
  groups
• Promote support efforts NHIN

25
Impact on Community Health

• Improve care through greater access
• Speed clinical information and communication
  among providers without geographic boundaries
• Ultimately reduce care costs affecting care
  premiums
• Community benefits from patients participating in
  their health w/ shared HIT
• Goal and performance will show value to HC
• Statewide connectivity can reduce rate of
  infections
• Reduce health disparities
• Can help Pennsylvania Manage chronic disease
• Leverage HIT education
• Improve data reporting
• Faster alerts of disease
• Still Too Early to identify best practices to
  see value

26
Impact on Provider Community

• Statewide effort can make Technology an Enabler
  not an Eliminator
• Neutral convener for Independent Providers
• Boarder reach to for collaboration
• Better position to relate to governmental and
  provider stakeholders across the state
• As EHRs migrate care to Ambulatory Settings
  care relationships will change between provider
  patient
• P4P Quality Incentives will ultimately change
  the balance of adoption information sharing
• Plugging the HIT holes at the local provider
  level will create new demand opportunities for
  technology

27
Tax Relief and Health Care Act

• Tax Relief and Health Care Act of 2006 (H.R.
  6408) approved by Congress last week as 109th
  Congress came to a close.
• Year-end package of tax, trade and healthcare
  legislation
• Contains provisions relating to new incentive
  payments for covered providers who report on
  quality measures
• Enables the CMS development of quality reporting
  for Medicare hospital outpatient and ambulatory
  surgical center (ASC) services
• Prevents Medicare physician payment reductions in
  2007
• Establishes a three-year demonstration on the
  concept of a medical home model to provide
  targeted and coordinated care to patients
  suffering from one or more chronic conditions.
• Legislative changes prescribed within the context
  of the Medicare program

28
Tax Relief and Health Care ActTITLE IMedicare
Improved Quality and Provider Payments

• 2007
• Creates quality reporting system for the
  voluntary reporting by eligible professionals of
  data on quality measures specified by the HHS
  Secretary beginning in July 2007.
• Quality measures used for data reporting from
  July 1, 2007 - December 31, 2007 are those
  identified as the 2007 physician quality measures
  under the Physician Voluntary Reporting Program.
  The HHS Secretary can change these measures
  through consensus-based process in January 2007,
  if changes are published on the CMS website by no
  later than April 1, 2007.

29
Tax Relief and Health Care ActTITLE IMedicare
Improved Quality and Provider Payments

• 2008
• Quality measures used for data reporting in 2008
  will be measures adopted or endorsed by a
  consensus organization (such as the National
  Quality Forum or AQA).
• Measures will include those submitted by a
  physician specialty, and those that the HHS
  Secretary identifies as having used a
  consensus-based process for measure development.
  
• Measures will include structural measures such as
  the use of electronic health records and
  electronic prescribing technology.

30
Tax Relief and Health Care ActTITLE IMedicare
Improved Quality and Provider Payments

• 2008 (cont.)
• Not later than August 15, 2007, a proposed set of
  quality measures that the HHS Secretary
  determines appropriate for eligible professionals
  to use to submit data in 2008 and that meet the
  conditions above, will be published in the
  Federal Register for public comment.
• Not later than November 15, 2007, a final set of
  quality measures that the HHS Secretary
  determines appropriate for eligible professionals
  to use to submit data in 2008 will be published
  in the Federal Register.

31
Tax Relief and Health Care ActQuality Reporting
Payment in 2007

• Quality Reporting Payment in 2007 - Transitional
  Bonus Incentive Payment Structure
• If any quality measures are established under the
  physician reporting system in the bill applicable
  to eligible professionals furnishing covered
  services and the eligible professional
  satisfactorily submits data on such quality
  measures to the HHS Secretary, eligible
  professionals will be paid from the Federal
  Supplementary Medical Insurance Trust Fund an
  amount equal to 1.5 percent of the HHS
  Secretarys estimate of the allowed charges for
  all such covered professional services furnished
  during the reporting period. This amount is in
  addition to the amount otherwise paid under part
  8 B of title XVIII of the Social Security Act.

32
Tax Relief and Health Care ActQuality Reporting
Payment in 2008- 2009 and Beyond

• Quality Reporting Payment in 2008- 2009 and
  Beyond - Physician Assistance and Quality
  Initiative Fund
• Establishes a Physician Assistance and Quality
  Initiative Fund for physician payment and quality
  improvement initiatives with respect to payment
  of covered physicians services furnished during
  2008.
• Monies totaling 1,350,000,000 shall be made
  available for Fund expenditures from the Federal
  Supplementary Medical Insurance Trust Fund

33
Privacy and ConfidentialityImportant Area of
Focus

• Increasingly, this is becoming an issue
• It is imperative, that state and regional
  initiatives tackle these issues responsibly on
  the front end, with great care, to build and
  maintain public trust
• PAeHI will work with eHI and Connecting
  Communities to take on this issue in 2007 and
  support responsible practices and policies in the
  field, to build and maintain public trust

34
What Does All of this Mean?

• Continued interest in state and regional health
  information exchange initiatives
• Likely a combination of national, regional and
  local approaches
• Seeing more alignment now coming from
  Administration on how national standards and
  policies work syncs up with efforts at the state
  and regional effort
• Alignment of quality and health information
  exchange is a sweet spot
• Privacy and confidentiality a key, key issue!

35
For more information

• Visit www.paehi.org
• or
• Contact
• Martin Ciccocioppo
• Vice President, Research, HAP and
• PAeHI Board Chair
• [phone]
• Email martinc_at_haponline.org