Welcome to the Commonwealth of Virginia Health Information Technology Grant Applicant Conference

1
Welcome to the Commonwealth of VirginiaHealth
Information Technology GrantApplicant Conference
Office of Health Information Technology August
31, 2006
2
Our Purpose Today

• Overview the Commonwealths strategy for
  information technology improving health care for
  all Virginians
• Continue and expand the marketplace dialogue
  around electronic health records
• Describe near term action steps

3
Agenda

• Opening Remarks
• Electronic Health Records Context and Vision
• Project Organization
• Request For Information (RFI) Desired Outcomes
• Our Process
• Lunch
• Discussion

4
Opening Remarks
The Honorable Aneesh P. Chopra Secretary of
Technology The Honorable Marilyn B.
Tavenner Secretary of Health and Human
Resources August 31, 2006
5
Healthcare IT Investment Atop the National, State
Agenda
Virginias Approach
A Lofty (National) Goal

• President Bush calls for most Americans to have
  an electronic health record by 2014
• Goal to develop a nationwide interoperable health
  information technology infrastructure
• House passed Health Information Technology
  Promotion Act on July 27th, 2006 following
  similar passage in the Senate in 2005

• The Legislature has elevated the importance of
  this issue by calling for the creation of an
  Advisory Committee on Electronic Health Records
• Allocates 1.5 Million over the biennium for
  encouraging Electronic Medical Records Adoption
  through grants issued to providers
• The Governor has signed Executive Order 29 which
  creates the Health Information Technology
  Council

Warner Report in Brief
Establish an ongoing statewide Virginia Health
Care Innovations Group, Establish incentives for
EHR adoption in the states role as a purchaser
Appropriate state monies to facilitate increased
eHealth initiatives, Identify and support the
implementation of a master patient index, Address
the health information management workforce
shortage
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Myriad Opportunities to Spur the Adoption of
Healthcare IT
Public-Private Partnerships to Drive Physician
Adoption Rate Communities develop innovative
solutions with the private sector to lower the
cost, maximize marketing communication to area
physicians, and boost adoption
Virginia Health Information Network Commonwealth
establishes standard to ensure data
interoperability with sufficient protections for
patient privacy, including the consideration of a
master patient index
Pilot Projects to Lower Health Care
Costs Commonwealth invests in pilot projects to
demonstrate cost savings in its capacity as a
large employer, with particular emphasis on
rewarding quality healthcare
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Framing Virginias 2007 Health IT Investment
Agenda
I Improving Virginias Health IT Infrastructure
II Extending the Enterprise
III Seeding Global Reform
Office of Health Information Technology Virtual
Office combining staff from both the Health and
Technology Secretariats serves as support staff
for the Health IT Council in its mission to
review proposals for funding from 1.5 Million
appropriation
Medicaid Transformation Grants Proposing to
fund web-based PHR populated by claims data and
electronic billing for smaller providers Electron
ic Master Patient Index Seed capital available
for developing a statewide Electronic Master
Patient Index in current biennial Budget
Virginia Department of Health EMR Electronic
Medical Record to serve Health Department clinics
approved by IT Investment Board Department of
Mental Health, Mental Retardation, and Substance
Abuse Services EMR Medication Management and EMR
Systems Also approved
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Governors Health IT Council Membership

• Corporate
• Gil Minor, Owens and Minor
• Bob Johnson, Sprint Nextel
• Balan Nair, AOL
• Home Healthcare
• Ron DeCesare, Professional Healthcare Resources
• Hospital Members
• Barbara Baldwin, UVA
• Golden Bethune, Riverside
• Joe Roach, Martinsville Memorial Hospital
• Insurance
• Megan Philpotts Padden, Sentara Health Plans
• Legislative
• Hon. Janet Howell, VA Senate
• Hon. Sam Nixon, VA House of Delegates
• Hon. John OBannon, VA House of Delegates
• Long-Term Care
• Elizabeth Brown, Sentara Healthcare

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Governors Health IT Council Membership

• Patient Advocate
• Nancy Davenport-Ennis, Patient Advocate
  Foundation
• Pharmacy
• Michele Vilaret, National Association of Chain
  Drug Stores
• Physician Members
• Dr. Gopinath Jadhav, Southside Gastroenterology,
  Richmond
• Dr. Keith Newby, Cardiology and Arrhythmia
  Consultants, Norfolk
• Dr. Larry T. Wilson, Holston Medical Group, Gate
  City
• Privacy Expert
• Anna Slomovic, Revolution Health Group
• Thought Leaders
• David Merritt, Center for Health Transformation
• Chas Roades, Advisory Board Co.
• Don Detmer, American Medical Informatics
  Association / UVA

10
Our Process

• Greg Walton
• Executive Advisor

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Office of Health Information Technology - A
Virtual Team

• Betty Jolly Department of Health Professions
• Heidi Dix Asst. Sec. of Health and Human
  Resources
• Thomas Gates Assistant Secretary of Technology
• Tristen Pegram Special Assistant for Technology
• Kim Barnes Virginia Department of Health
• Greg Walton Executive Advisor to the Council

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Health Human Resources Priorities

• Medicaid Reform
• Healthy Virginians
• Health Workforce Issues
• Uninsured in Virginia
• Quality Health Initiatives

13
Our Process

• Subcommittees of the Technology Council
• Regional Approach
• Project Sweet Spots
• Guidelines to the Statement of Interest
• Applicant Dialogue

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Technology Council Sub Committees

• Business Case and Partnerships
• Privacy and Security
• Physician Communications
• Order of Merit Confirmation

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Economic Development Regions
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VIRGINIAS EHR ADOPTION IN PHYSICIAN OFFICES
Given that physicians in small practices account
for 88 percent of all outpatient visits and
four-fifths of physicians work in small
practices, this group represents a sizable
adoption gap. From Information Technologies.
When Will They Make It into Physicians Black
Bags? Medscape General Medicine 6, no. 4 (2005)
17
Health Regions in Virginia
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Number of MDs by Health Region

• Total licensed MDs
• 3346 Central Region
• 4167 Eastern Region
• 7966 Northern Region
• 2464 Southwest Region

Source Department of Health Professions BOM,
2006 data
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Physician Adoption

• 33 of respondents in a recent Virginia survey of
  physician offices said they have an EHR in use
  today.
• Of those who said they had an EHR, 36.6 utilized
  3 components or fewer. 12 reported 3 components
  or fewer 17 reported 4 to 6 components 4
  reported 7 or more components
• Those in a hospital setting (60) were more
  likely than those in large group practice (3 or
  more doctors 33) and small group practice (2 or
  less doctors 17) to have and EHR.

Source VDH Survey, 2005
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Most Adopted Feature of an EHR

• Receipt of lab results 62
• Entry of progress notes 57
• Decision support such as online material 56
• Images 55
• Lab ordering 50
• Alerts to drug interactions 40
• Image ordering 38
• Records transmitted/received from other offices
  38
• Electronic Prescriptions 24
• Alerts to deviations from patient care protocol
  14
• Patients can access part or all of the record 5

Source VDH Survey, 2005
21
On average, how many patient records are
currently in your system?
Source VDH Survey, 2005
22
How many years have you had your current
electronic health record system?
Source VDH Survey Early Adopters, 2005
23
Virginias Hospitals
24
Virginia Hospital Statistics Compared Nationally
Note Data based on most recent hospital Medicare
cost reports access from http//www.ahd.com/state
_statistics.html on August 30, 2006.
25
Acute Care Hospitals
76 Acute Care Hospitals (2003)
Source Department of Health Professions BOM,
2006 data
Source Virginia State Planning Grant Phase One,
Final Report to the Secretary of Health and Human
Services, September 2005 FP-Proprietary
Hospitals NFPNot-for-Profit Hospitals
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Trauma Centers Serving Virginians
27
Additional Providers

• Other Hospitals
• 4 State or Locally Owned Hospitals
• 6 Psychiatric Hospitals
• 4 Rehabilitation Hospitals
• 36 Ambulatory Surgery Centers

• Other Providers
• 245 Licensed Nursing Facilities
• 4 Health Regions (Northern, SW, Central, and
  Eastern)
• 35 Local Health Districts

Source Virginia State Planning Grant Phase One,
Final Report to the Secretary of Health and Human
Services, September 2005 and Virginia Department
of Health www.vdh.virginia.gov/LHD Full list of
Virginia Hospitals available at
http//www.ahd.com/states/hospital_VA.html
28
Virginia Local Health Districts
Source Virginia Department of Health,
http//www.vdh.virginia.gov/LHD/LocalHealthDistric
ts.asp
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Project Sweet Spots
Key Attributes
Demonstrate
Innovate
Automate
Validate
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Guidelines to the Statement of Interest

• Contact Information
• Project Overview
• Partnership History
• Timeline and Work plan
• Description of Technical Approach
• Special Commonwealth Considerations
• Business Model

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Guidelines to the Statement of Interest - Contact
Information

• Recommended Length 1 Paragraph
• Required Information
• Organization(s)
• Contact Persons Name, Address, Phone Numbers
  E-mail
• Suggested
• Company Web Site

32
Guidelines to the Statement of Interest - Project
Overview

• Recommended Length 3 Pages
• Suggested
• What Will Be Done
• Roles of the Partners
• Regional Orientation and Impact

33
Guidelines to the Statement of Interest -
Partnership History

• Recommended Length 2 Pages
• Suggested
• Virginia Partnership Activity
• Institutional Physician
• Challenges Overcome

34
Guidelines to the Statement of Interest -
Timeline and Work Plan

• Recommended Length 2 Pages
• Required
• Start Date from Award
• Project Phases
• Suggested
• Project Sub-phases
• Work Load by Partner

35
Guidelines to the Statement of Interest -
Description of Technical Approach

• Recommended Length 1 Page
• Required
• Multiple Choice/Fill in the Blank Questions

36
Guidelines to the Statement of Interest -
Description of Technical Approach

• Network, Systems Architecture, Hardware,
  Operating Environment, Database, etc.
• What deployment models are available for your
  product? (check all that apply
• o Application Service Provider (Vendor Hosted)
• o Software Product (User Hosted)
• o Third Party Site
• What operating system(s) does your product use?
  (check all that apply)
• o Windows
• o Linux
• o Unix
• o Mac OS
• o Other
• What minimum client application does your product
  require?
• o Thick client
• o Browser-based
• o Rich Browser-based (e.g., Applets)

37
Guidelines to the Statement of Interest -
Description of Technical Approach

• What other client applications does your product
  provide? (check all that apply)
• o Thick client
• o Browser-based
• o Applet-based
• What underlying database management software is
  supported? (check all that apply)
• o Oracle
• o Microsoft SQL Server
• o Open Source (MySQL, Firebird, Ingres)
• o DB2
• o OODBMS
• o Other
• List other required 3rd party software____________

38
Guidelines to the Statement of Interest -
Description of Technical Approach

• Scalability features (check all that apply)
• Database/Server Replication
• Server Clustering
• SMP computing
• Grid Computing
• Other please fill in _______________________
• What types of access points does your product
  support for physicians, nurses, other caregivers
  and non-clinical reviewers (check all that apply)
• Desktop computers
• Laptop computers
• Wireless tablet computers
• Text message
• Cell phone
• IM
• Remote Access
• Other

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Guidelines to the Statement of Interest -
Description of Technical Approach

• What additional data entry mechanisms are
  supported (check all that apply)
• o Bar code readers
• o OCR
• o Scanning (?)
• o Web forms
• o Patient monitoring equipment
• o Laboratory analysis equipment
• o Voice
• o Handwriting recognition
• o RFID
• o Biometrics
• o Smart Cards
• o Proximity Badges
• o Other fill in

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Guidelines to the Statement of Interest -
Description of Technical Approach

• Data and System Security Requirements
• What provisions are made for compliance with
  Privacy standards and regulatory requirements
  (fill in URL or less than 50 words)
  _______________________________________
• What provisions are made for compliance with
  requirements for legally sound medical records
  (fill in URL or less than 50 words))
  ______________________________________
• What features exist for data protection and
  disaster recovery (fill in URL or less than 50
  words) ___________________________
• What data security measures does your system
  support (check all that apply)?
• SSL
• 3rd party SSL accelerators
• Event logging to support auditing and strict user
  accountability
• Rollback

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Guidelines to the Statement of Interest -
Description of Technical Approach

• Data and System Security Requirements
• All information is time-stamped (Y/N)
• All data entry is associated with a particular
  user (Y/N)
• Users have unique login (Y/N)
• Users can be assigned particular roles (Y/N)
• Provides unique patient identifier (Y/N)
• Supports electronic signature where permitted by
  Virginia law (Y/N)
• Routine Maintenance Procedures
• What is the expected downtime per week for
  maintenance under normal utilization?
• lt1 hr o 1-4 hrs o 4-8 hrs o gt 8 hrs

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Guidelines to the Statement of Interest -
Description of Technical Approach

• Tools for Computer Operators and Support Staff
• What tools does your product support (check all
  that apply)?
• Data migration from legacy medical records
  systems
• Workflow management?
• Customizable (Y/N)
• Statistical Data Analysis
• OLAP
• Custom Reports
• Data Mining Tools
• Flat file import (CSV, etc.)
• XML input
• XML export

43
Guidelines to the Statement of Interest -
Description of Technical Approach

• Required or Suggested Staffing
• Requires dedicated administrator (Y/N)
• Use of standards
• What standards are supported for information
  exchange (check all that apply)?
• HL7 2.3.1 HL7 2.4 CVX MVX
• NCDCP ICD-9 CDISC CABIG
• IEEE 1073 IHE PIX X12N ELINCS
• DICOM HUGN NDF-RT HIPAA
• LOINC SNOMED RXNORM
• Other (list) _______________________________

44
Guidelines to the Statement of Interest -
Description of Technical Approach

• What underlying database management software is
  supported? (check all that apply)
• Oracle
• Microsoft SQL Server
• Open Source (MySQL, Firebird, Ingres)
• DB2
• OODBMS
• Other
• List other required 3rd party software
  requirements ________________
• Scalability features (check all that apply)
• Database/Server Replication
• Server Clustering
• SMP computing
• Grid Computing
• Other please fill in _______________________

45
Guidelines to the Statement of Interest - Special
State Considerations

• Recommended Length 1 Page
• Required
• Highlight commitments to any of the following,
  Small(SBE), Women (WBE), and Minority owned (MBE)
  businesses ((SWAM)).

46
Guidelines to the Statement of Interest -
Business Model

• Recommended Length 1 Page
• Required
• State your dollar request for the Grant
• State any assumptions/plans about other funding
  sources you expect to pursue

47
Guidelines to the Statement of Interest
-Diagrams and Pictures

• Suggested
• High-level Architecture
• High-Level Systems/Applications
• Project Organization Chart

48
Applicant Dialogue

• Web Postings from OHIT www.healthitcouncil.vi.v
  irginia.gov
• Frequently Asked Questions FAQs
• Staff Dialogue and Coaching
• Weekly Project Updates
• Supporting Material
• SOI applicant survey and Proposal Repository
  on-line as of Sept 11th

49
Time Table

• RFI issued - August 21st
• Applicant Conference - August 31st
• Statements of Interest Due - September 15th
• Technology Council Meetings - September 15th,
  29th and October 12th
• Order of Merit List Ranking Released October 15th
  -30th
• Stage 2 Begins

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LUNCH
51
Discussion
52
ADJOURN

• http//www.healthitcouncil.vi.virginia.gov