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eHealth Information: Federal Activities and Implications for State Policy

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AHRQ's work focuses on the marriage of Health IT systems with the way ... Privacy common law, ethics, good business, protections beyond basic HIPAA compliance ... – PowerPoint PPT presentation

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Title: eHealth Information: Federal Activities and Implications for State Policy


1
eHealth Information Federal Activities and
Implications for State Policy
  • Susan M. Christensen
  • Senior Advisor
  • CSG Health Policy Forum
  • On Mental Health Care and Wellness
  • May 31, 2006

2
Overview
  • Terminology Getting on the Same Page
  • Federal Landscape
  • AHRQ
  • Privacy and Trust
  • Resources
  • Legal Issues
  • Appendix Case Study Legal Issues

3
Terminology HIE v. HIT
  • No longer just about putting electronic medical
    records in hospitals
  • Electric health information systems across all
    care settings, as well as payers
  • Linking them together interoperability for
    health information exchange (HIE)
  • For HIE, communities and states (and some
    regions) are developing networked systems
  • To do this, its not just about investing in the
    technology (HIT) we must research how to do so
    in a way that
  • Maximizes the value we hope to realize
    clinically, economically, and for population
    health
  • Assures that security and privacy protections are
    baked into HIE

4
HIE Policy Issues
  • In addition, a new market is being created, with
    all the technical and policy issues that entails,
    such as
  • Standards for data exchange
  • Assuring consumer participation and patient
    protections
  • Security concerns
  • New business arrangements, new relationships
  • Disconnect between payment systems and new
    relationships/care delivery models

5
Whats the situation?
6
Federal Leadership
  • Presidents Executive Order 13335 (April 2004)
    federal leadership for the development of a
    nationwide interoperable electronic health
    information system
  • Created Office of the National Coordinator for
    Health Information Technology in HHS (ONC)
  • ONC is required to develop a national strategic
    plan to support
  • Public-private collaboration to develop, adopt
    and implement standards
  • Evaluate benefits of HIT
  • Address privacy and security issues
  • ONC serves as principal advisor to Secretary on
    national HIT policy, coordinates federal
    activities, and coordinates public-private
    outreach and consultation

7
ONC Health IT Roadmap To-Date
NOW
2006 GOALS
Recommendations for Biosurveillance Consumer
Empowerment Chronic Care Electronic
Healthcare Records
WORKGROUPS
Make Recommendations to the Community
Workgroups Established
Recommendations Report to the Secretary of
HHS
COMMUNITY
Community Established
Review Workgroup Recommendations
Interoperable Electronic Healthcare Records
NHIN Architectures Standards Implementation
Guidance Ambulatory Care Certification
Criteria
INFRASTRUCTURE
Contracts Awarded
2006 Strategic Plan
ONC
NHIN RFI Summary
Health IT Strategic Framework
FHA Strategic Plan
Health IT Policy Council Established
MAR
SEP
OCT
JAN
MAR
. . .
DEC
JUL
FEB
2005
2004
2007
2014
8
Four Major HHS Contracts
  • HHS has entered into four significant contracts
    http//www.hhs.gov/healthit/contracts.html
  • Harmonize industry-wide health IT standards (ONC)
  • Develop a conformance certification process for
    health IT (ONC)
  • Assess and develop plans to address variations
    business policies and state laws related to
    privacy and security (AHRQ)
  • Four contracts to develop nationwide health
    information network (NHIN) prototypes that can be
    used to test specialized network functions,
    security protections and monitoring, and
    demonstrate feasibility of scalable models (ONC)

9
Agency for Healthcare Researchand Quality (AHRQ)
  • Mission
  • To improve the quality, safety, efficiency, and
    effectiveness of health care for all Americans

10
Research at HHSWhere Does AHRQ Fit In?
  • NIH -- basic biomedical bench research and
    efficacy clinical trials
  • AHRQ -- effectiveness of healthcare services
    and the healthcare delivery system
  • CDC -- the public health system and
    community-based interventions
  • Other federal partners CMS (Medicare and
    Medicaid), HRSA (capital and resources,
    workforce), and ONC (collaboration and
    coordination on health IT)

11
Intersection of Safety, Quality and Health IT
  • Support diffusion of HIT to
  • 41 states
  • 40 million Americans
  • Improve medication safety
  • CMS e-prescribing demos
  • Provide HIT technical support to safety net
  • Community health centers
  • Critical access hospitals
  • Public hospitals
  • Privacy and Security

AHRQ
12
Focus on Adoption of Health IT
  • AHRQs work focuses on the marriage of Health IT
    systems with the way work is done in health care
  • Need to prepare for the impact of new Health IT
    systems
  • Health IT is one part technical, and two parts
    culture and work process change.
  • Opportunity to design new and better workflows
    and review work patterns that may never really
    have been examined.

13
State and Regional HIT Demonstrations
  • Five-year state-based contracts
  • Help states develop secure statewide networks
  • Ensure privacy of health information
  • Make an individuals health information more
    available to health care providers
  • FY04 Five states awarded 1M/year
  • Colorado
  • Indiana
  • Rhode Island
  • Tennessee
  • Utah
  • Delaware added in FY05

14
AHRQ National Resource Center for Health
Information Technology
  • Provides technical and expert support to health
    IT grantees, contractors, and selected other
    federal grantees (HRSA, CMS, IHS)
  • Contract award to NORC (up to 18.5M over 5
    years), in partnership with
  • Vanderbilt University
  • Center for IT Leadership (Partners)
  • Indiana University
  • Foundation for the eHealth Initiative
  • CSC
  • Burness Communications
  • healthit.ahrq.gov

15
Approaching the Trust Issue
  • Why is this important to people? What are
    people thinking? What is the threat?
  • Can we break it down? Is HIPAA compliance
    enough? Why not?
  • How to react?
  • Who should be involved?
  • What message?
  • Guidance for leadership?

16
Trust v. Privacy v. HIPAA
  • Clarify the issues
  • HIPAA legal requirement
  • Additional legal privacy requirements
  • Federal
  • State
  • Contractual
  • Privacy common law, ethics, good business,
    protections beyond basic HIPAA compliance
  • Trust broader public concern about security and
    reliability

17
Privacy and Security Contract
  • In September 2005, AHRQ awarded Privacy and
    Security Solutions for Interoperable Health
    Information Exchange
  • Overall contract managed by RTI International in
    partnership with NGA
  • 18-month period 11.5 million
  • RTI will subcontract with up to 40 states to
  • Identify within the state business practices that
    affect electronic health information exchange
  • Propose solutions and implementation plans
  • Collaborate on regional and national meetings to
    develop solutions with broader application
  • Provide final report on overall project outcomes
    and recommendations

18
Contract Purposes
  • Identify variations in organization-level
    business privacy and security policies and
    practices that affect electronic clinical health
    information exchange (HIE)
  • For those that are best practices, document and
    incorporate into proposed solutions
  • For those with a negative impact, identify source
    of the policy or practice and propose
    alternatives
  • Preserve privacy and security protections as much
    as possible in a manner consistent with
    interoperable electronic health information
    exchange
  • Incorporate state and community interests, and
    promote stakeholder identification of practical
    solutions and implementation strategies through
    an open and transparent consensus-building
    process
  • Leave behind in states and communities a
    knowledge base about privacy and security issues
    in electronic health information exchange that
    endures to inform future HIE activities

19
Connecting for HealthCommon Framework
  • A set of free resources 16 policy guides and
    technical documents designed to advance HIE in a
    private and secure manner.
  • Technology neutral
  • Includes model contract language for HIE
    agreements
  • The Common Framework puts forth a model of HIE
    that
  • Protects patient privacy by allowing health
    information to remain under local control
    avoiding the need for a large, centralized
    database or creation of a national patient ID
  • Avoids large-scale disruption and huge up-front
    capital investments by making use of existing
    hardware and software
  • Supports better informed policymaking around HIE
  • Establishes trust among collaborating
    organizations by applying well-vetted model
    contract language to fit their needs
  • Series of activities to disseminate and provide
    education for how to use AHRQ website,
    teleconferences, workshops
  • healthit.ahrq.gov and www.connectingforhealth.org

20
Vanderbilt Center for Better Health Model
  • Developed workshop design to explore trust
    issues, come to consensus, and make
    recommendations or develop workplan for moving
    forward
  • Goal state/community controls the process and
    the outcome
  • Statewide used principles in CFH model as
    kickoff for discussion about privacy and trust
    among stakeholders in disparate HIEs across state
  • Another new statewide initiative used workshop
    to do concrete planning for both technology and
    governance in new HIE
  • http//www.volunteer-ehealth.org/AHRQ/12142005/ind
    ex.htm
  • http//www.mc.vanderbilt.edu/vcbh/ds/0606_privacy/
  • Working with AHRQ to make the workshop portable

21
Differing Approaches Legal Issues
  • Recognize that one approach, i.e., legislation,
    is not appropriate for every issue
  • Federal legislation and mandates
  • National or regional consensus
  • Model state laws
  • State innovation through demonstrations or
    regulation
  • Model contracts
  • Private agreements
  • Coordinate among initiatives use them in
    combination

22
Summary
  • Communities can and should make their own choices
    about HIE
  • The decision process on policies and
    implementation is as much a part of the solution
    as the technology
  • Call on national initiatives for what they can
    offer to save money and accelerate the process

23
http//healthit.ahrq.gov
  • For additional information
  • Susan Christensen
  • susan.christensen_at_ahrq.hhs.gov

24
Case Study One State
  • Workgroup of stakeholders assumed time frame two
    years hence
  • Identified potential key legal, regulatory, and
    policy areas that could still be of concern as
    regional health information exchange
    implementation progresses
  • Stratified issues by national, regional, local or
    private in nature (i.e., best resolved at what
    level to be most effective?), and split them into
    technical and non-technical categories
  • Identified proposed approach legislation,
    rule-making, consensus, private agreement, or
    some combination
  • Model legislation would be appropriate for many
    of the consensus issue areas, except data and
    communication standards

25
Technical Issues
Issue Area National Regional/State Private
Data and communication standards Adopted at the national level potential public/ private collaboration for identification mandatory for Medicare to drive take-up common standards identified for Medicaid Adopted for Medicaid by state programs Participation in identification and incorporation into product
Safety standards for items like drugs and devices Same Same Same
Standards enforcement Enforcement by regional exchanges as requirement for use possibly mandatory for Medicaid
Certification Requirements and administration/enforcement at regional level possibly mandatory for Medicaid
Bioterrorism/ defense systems Developed and funded federally Portions developed and funded at state/regional level in collaboration with federal efforts
26
Non-Technical Issues
Issue Area National Regional/State Private
Research on HIT policy, standards and value Funding, dissemination and oversight demonstrations Funding and adoption Funding and adoption
Payment reforms Medicare payment reform Medicaid reform FEHBP contracts Adopt Medicaid reforms SCHIP and employee coverage reforms Pay for performance and IT utilization
Startup funding Tax incentives, loans, grants, and demonstrations
Licensure for health professionals Leader in developing standardized content that supports information exchange Adoption and enforcement of licensure rules Professional organization and payer support of model rules
Liability protections/ accountability Leader in developing standardized content Adoption and enforcement
Underserved populations Model legislation that supports interoperability Outreach, funding and enforcement
27
HIE Structure
Issue Area National Regional/State Private
Governance/ structure Leadership in developing standardized options that support regional health information exchange State option to adopt by statute or rulemaking Private agreements can supplement or reflect state option, or may be stand-alone in absence of state action
Responsibility/ accountability Leadership in developing standardized options that support regional health information exchange and interoperability State option to adopt by statute or rulemaking
Taxing authority Leadership in developing options that support regional health information exchange State option to adopt by statute
Funding authority Leadership in developing options that support regional health information exchange State option to adopt by statute or rulemaking Private agreements can supplement or reflect state option, or may be stand-alone in absence of state action
Liability Leadership in developing standardized content to support interoperability State option to adopt by statute
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