Arizona Health Care Cost Containment Health System Medicaid Transformation Grant Program Health Information Exchange (HIE) & Electronic Health Record (EHR) Utility Project The HIeHR Project Provider Focus Groups Fall 2007 - PowerPoint PPT Presentation

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Arizona Health Care Cost Containment Health System Medicaid Transformation Grant Program Health Information Exchange (HIE) & Electronic Health Record (EHR) Utility Project The HIeHR Project Provider Focus Groups Fall 2007

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Title: Arizona Health Care Cost Containment Health System Medicaid Transformation Grant Program Health Information Exchange (HIE) & Electronic Health Record (EHR) Utility Project The HIeHR Project Provider Focus Groups Fall 2007


1
Arizona Health Care Cost Containment Health
System Medicaid Transformation Grant
ProgramHealth Information Exchange (HIE)
Electronic Health Record (EHR)Utility Project
The HIeHR Project Provider Focus GroupsFall
2007
2
Agenda
  • Slide Presentation
  • Overview of Key Concepts
  • Written Survey
  • Focus Group Discussion

3
OVERVIEW OFTHE HIeHR PROJECT
4
Medicaid Transformation Grant Program
  • Competitive grants program established by Deficit
    Reduction Act (DRA) of 2005
  • Administered by CMS (Centers for Medicare and
    Medicaid Services)
  • Designed to slow Medicaid spending growth while
    increasing access to healthcare

5
AHCCCS Medicaid Transformation Grant
  • February 2007 to November 2009
  • Awarded 11.7 Million
  • Strategy is to develop and deploy statewide
  • Health Information Exchange (HIE) and Viewer
  • Web-based portal and electronic health record
    (EHR)
  • Database and analytics for clinical decision
    support and population health management
  • Together, called the HIeHR Utility Project

6
HIeHR is
  • A web-based electronic health record (EHR) and
    health information exchange (HIE) to give all
    providers access to AHCCCS patients health
    information via Internet connection at the point
    of service

7
HIeHR UtilityProject Vision
  • Improving healthcare delivery at point of care
    (quality and safety)
  • Single view of patient information
  • Integrated clinical decision support tools
  • Reducing costs and achieving efficiencies
  • Eliminate duplicate tests and imaging
  • Reduce administrative burdens on medical
    practices
  • Eliminate duplicate communication channels (labs,
    x-rays, etc.)
  • Analytical tools for effective care management

8
HIeHR UtilityProject Vision (cont.)
  • Enhancing self-management by AHCCCS members
  • Enable access to health information and online
    wellness materials
  • Increase public health and bio-surveillance
  • Automated disease reporting
  • Automated syndrome reporting

9
HIeHR will start with
  • AHCCCS Providers throughout the state
  • Primary Care Providers
  • Physician Specialists
  • Long-term Care
  • Behavioral Health
  • Emergency Departments
  • Dentists
  • Consulting Pharmacists

10
Key HIeHR Partners
  • Clinician Providers
  • Hospitals (Emergency, Inpatient, Outpatient, and
    Diagnostic Imaging)
  • Services providers (lab, imaging, pharmacy)
  • Managed care organizations and health plans
  • State Agencies (immunization, birth records,
    chronic illness registries and laboratory data)
  • Academic medical centers
  • Community Health Centers (CHCs)
  • Professional societies
  • Quality and patient safety organizations
  • Health and chronic illness advocacy organizations
  • Other Arizona HIEs
  • Arizona Health-e Connection
  • State Medicaid Programs Collaboration (14 states)

11
UNDERSTANDING THE TERMINOLOGY
12
Health Information Exchange (HIE)
  • Mobilizes healthcare information electronically
    across organizations within a region or community
  • Capable of electronically moving clinical
    information between disparate healthcare
    information systems while maintaining the meaning
    of the data exchanged

13
Goal of HIE
  • Facilitate access to and retrieval of clinical
    data to provide safer, more timely, efficient,
    effective, equitable, patient-centered care

14
RHIOs
  • Regional Health Information Organizations (RHIOs)
    are electronic networks intended to help multiple
    healthcare organizations such as hospitals, labs,
    radiology centers, etc. in a given area exchange
    health and patient data through an HIE.

15
Electronic Health Record(EHR)
  • Longitudinal record, including all patient
    medical information from multiple sources
  • Accessible from any location by any authorized
    provider caring for a patient in the system
  • Includes demographics, progress notes, problems,
    medications, medical history, immunizations, lab
    data, radiology reports

16
Not to Be Confused with EMR
  • The Electronic Medical Record (EMR) is the
    electronic replacement for paper charts in one
    particular physicians practice.
  • The EMR is the physicians own electronic record
    of his or her patients medical care.
  • An EHR for a patient could include records from
    multiple EMRs originating from each of the
    providers participating in the care of this
    patient.

17
Or Confused with PHR
  • The Personal Health Record (PHR) is medical
    information in the possession of an individual
    patient or the patients non-professional
    caregiver.
  • Format may be paper documents, electronic media,
    or a combination of both.

18
THE ARIZONA LANDSCAPE
19
Health-e Connection
  • Governors executive order for Arizona Health-e
    Connection Roadmap issued in 2005
  • Goals
  • All medical records into electronic format
  • Create statewide health data exchange
  • Achieve by 2010
  • Arizona Health-e Connection non-profit
    organization formed in 2007 to implement Health
    Information Exchange and the deployment of Health
    Information Technology in the state

20
Southern Arizona Health Information Exchange
(SAHIE)
  • Coalition of all southern AZ hospitals, major
    practices, most commercial plans, AHCCCS plans,
    Community Health Centers
  • Coordinating at technical and adoption levels
    with AHCCCS and Health-e Connection
  • 25-member steering committee (Funding
    institutions plus organizations representing
    regional and state-level interests)
  • Governance structure planning completed
  • Implementation will start in Dec. 2007
  • Currently selecting vendor for HIE design and
    technology

21
Arizona Government Information Technology Agency
(AZ GITA)
  • 2007 Rural Health Information Technology Adoption
    Grants - 1.5 million
  • 7 Grants Awarded
  • 2008 Rural Health Information Technology Adoption
    Grant Process - 1.4 million
  • Focus on Regional Health Information
    Organization (RHIO) Facilitation

22
PRIVACY AND SECURITY
23
Arizona Health Privacy Project
  • Purpose
  • Build privacy and security infrastructure for
    health information exchange in Arizona
  • Technical standards
  • Policy standards
  • Legal requirements

24
Now Developing
  • Three Legal projects
  • Propose statutory and regulatory amendments to
    remove barriers to HIE
  • Design an enforcement framework for inappropriate
    access to HIE
  • Draft model policies/procedures and a model
    participation agreement for Arizonas HIEs/RHIOs

25
ELECTRONIC HEALTH RECORD
26
Interoperability Overview
  • Interfaces
  • Use of industry standard formats
  • Coding standards
  • Translation mapping
  • Version control
  • Registry Integration
  • Immunization, EPSDT, public health surveillance
    measures
  • Scanning
  • Secure Communications
  • Email, Fax, Instant Messaging

27
Security Overview
  • Follows community and industry standards
  • Password compliance
  • Auditing
  • Appropriate controls for record access
  • Record locking
  • Patient Privacy
  • Secure Portal for Patient Access
  • Methods for Data Recovery
  • Archiving

28
We Need Your Input!Potential EHR Features
29
e-Prescribing
  • Medication Orders
  • Medication search, favorites, and order sets
  • Medication History
  • Eligibility/Formulary Checking
  • Drug Interaction Management
  • Drug-drug, drug-food, drug-allergy, etc.
  • Refill Management
  • Electronic Submission
  • Warnings/Alerts
  • Contraindications, substitution not allowed, etc.
  • Patient Education Materials

30
Clinical Encounter
  • Clinical Documentation (SOAP)
  • Problem Lists
  • Status
  • Link to Encounter, Meds, Labs, etc.
  • Code search
  • Favorites (frequently used codes meds)
  • Allergies
  • Assessment Templates
  • Treatment Plan
  • Variances from standard and ability to create
    site-specific templates
  • Comprehensive, Historical View

31
Lab Orders/Results
  • Lab Orders
  • Test search, favorites, andorder sets
  • Status Inquiry
  • Electronic Submission
  • Warnings/Alerts
  • Instructions to Patient/Facility
  • Result Management
  • Normal/abnormal
  • Trending/graphing
  • Routing
  • Annotation

32
Radiology Orders/Results
  • Imaging Order
  • Test search, favorites, andorder sets
  • Status Inquiry
  • Electronic Submission
  • Warnings/Alerts
  • Instructions to Patient/Facility
  • Result Management
  • Normal/abnormal
  • Routing
  • Image linking

33
Case Management
  • Collaboration with case managers through HIE
  • Case Creation
  • Case List
  • Assignment rules
  • Care Planning
  • Notes
  • By case manager
  • By provider
  • Alerts
  • Workflow Support

34
Eligibility Inquiry/Verification
  • Link to Payer Web Sites
  • Electronic Verification
  • Online Display of Detail
  • Health and Prescription Benefits
  • Support Manual/Electronic Capture

35
Auth/Referral Management
  • Referral Generation/Communication
  • Internal/external
  • Clinical Guideline/Admin Support
  • Link Relevant Clinical Records w/ Referral
  • Referral Status/History
  • Consult Report Management
  • Authorization Management
  • Business Rules re Auth requirements
  • Auth Status/History
  • Electronic Submission of Referrals
    Authorizations

36
Analytics and Reporting
  • Reports by Individual and Groups of Patients
  • e.g., print out EPSDT reports
  • Outcomes Reporting
  • Standard Reports Able to Be Modified
  • Define Report Formats for Display, Print, and
    Export
  • Ad Hoc, on demand, and scheduled
  • Identified and de-identified data
  • Sort By, Group By, and Statistics
  • Save Report Parameters for Later Re-Generation
  • Support for Internal/External Reporting Tools
  • Registry Integration
  • Immunization, EPSDT, public health surveillance
    measures

37
Claims Submission Support
  • Claims Creation
  • Attachments
  • Coding support
  • History
  • Clean Claim Edits
  • Claim Status
  • Eligibility Verification
  • Electronic Submission/Routing/Receipt

38
  • Thank you for helping us to achieve our Mission
  • Shaping tomorrows managed care from todays
    experience, quality and innovation
  • www.ahcccs.state.az.us

39
For more information
  • Medicaid Transformation Grant Program
    http//www.cms.hhs.gov/MedicaidTransGrants/02_0125
    07awards.asp
  • Arizona Health Care Cost Containment System
    (AHCCCS), Arizonas Single Medicaid Agency
    http//www.azahcccs.gov/site/
  • AHCCCS Health Information Exchange Electronic
    Health Record Utility Project (HIeHR)
    http//www.azahcccs.gov/eHealth/

40
How to Become an AHCCCS Provider
  • Provider will need to access the following link
    to download and fill out required forms to become
    an AHCCCS Provider.http//www.azahcccs.gov/PlansP
    roviders/ProviderRegistration.asp
  • The registration forms must be completed, signed
    and mailed to AHCCCS Provider Registration, P.O.
    Box 25520 Mail Drop 8100 Phoenix, AZ 85002.
  • Existing providers may fax address updates to
    (602) 256-1474.
  • For further questions regarding registration,
    please call the AHCCCS Provider Registration Unit
    at (602) 417-7670, option 5. The in-state toll
    free number is 1-800-794-6862. The out-of-state
    toll free number is 1-800-523-0231.
  • Please note Effective March 1, 2007, the
    National Provider Identifier will be required
    prior to registration. This applies to all
    applicable providers.
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