In the Thick of ARRA

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In the Thick of ARRA HITECHIts only just
begun

• NC Medical Society
• Quality of Care and Performance Improvement
  Committee
• August 7, 2009
• Presented by
• Sam Spicer, MD
• CMO, New Hanover Regional Medical Center
• President, NCHICA

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    H.R. 1The American Recovery and
Reinvestment Act of 2009(ARRA) The Health
Information Technology for Economic and Clinical
Health Act(HITECH)    
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19 billion allocated to Health IT

• 17 Billion
• incentive bonuses for providers meeting
  Meaningful Use as determined by HHS secretary.
• 2 Billion to HHS / ONC
• standards development, evaluation and validation
• infrastructure for health information exchange
  (HIE)
• grants to states for the purpose of furthering
  EHR adoption
• improvements in HIT manpower
• the establishment of Regional Health IT Resource
  Centers, Extension Programs, Enterprise
  Integration Research Centers, etc.

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Estimate of Potential Stimulus Impact on NC

• Hospital Incentives for EHR - 300M 400M
• Physician Incentives for EHR - 396M 792M
• HIE / HIT Competitive Grants ? (2B)
• Regional Extension Center - ?
• EHR Adoption Loan Funds - ?
• Broadband Infrastructure Proposals
  (7.2B)
• Workforce Training Grants - ? ( ? )
• Medical Health Informatics - ? ( ? )
• EHR in Medical School Curricula - ? ( ?
  )
• Worker Training - ?
  (250M)
• Comparative Effectiveness Research - ?
  (1.1B)
• Community Health Centers - 2.6M ?
  (2B)
• Prevention Wellness (CDC) - ? (1B)
• SSA - ? (500M)

(17.2B)
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HITECH OverviewPhysicians
Medicare Incentive Payments - 75 add-on to fee
schedule payments
Maximum Medicare Incentive Payments
Penalty for failure to implement by FY15 gt
reduction of reimbursements by 1 in 2015, 2 in
2016, etc..
2011 2012 2013 2014 2015 2016 Total
18,000 12,000 8,000 4,000 2,000 0 44,000
- 18,000 12,000 8,000 4,000 2,000 44,000
- - 15,000 12,000 8,000 4,000 39,000
- - - 12,000 8,000 4,000 24,000
Medicaid Incentive Payments - (requires Medicaid
share of 30 )
Maximum Medicaid Incentive Payments
Can receive Medicare OR Medicaid Incentives
Not to exceed 63,750
2011 2012 2013 2014 2015 2016 2017 2018 Total
25,000 10,000 10,000 10,000 10,000 0 0 0 65,000
- 25,000 10,000 10,000 10,000 10,000 0 0 65,000
- - 25,000 10,000 10,000 10,000 10,000 0 65,000
- - - 25,000 10,000 10,000 10,000 10,000 65,000
- - - - 25,000 10,000 10,000 10,000 55,000
- - - - - 25,000 10,000 10,000 45,000
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EHR HIE Quality Reporting
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NC HIT Strategic Planning Task Force

• Established by Governor Bev Perdue
• Part of NC Recovery Office
• Task Develop a Strategic Plan for ARRA
  Healthcare Stimulus Funding investment
• Weekly meetings in April and May
• Draft Outline of plan established
• Draft Plan out for public comment until June 17th
• Final Plan delivered after incorporating comments
• Governor announces NC HWTFC as Qualified
  State-Designated Entity on July 16th and will
  appoint NC HIT Collaborative to make
  recommendations on implementing the NC HIT Action
  Plan.

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DRAFT
DRAFT
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NC HIT Collaborative

• Members
• Chair
• 2 Vice Chairs
• NC Dept. of HHS
• NC Medical Society
• NC Nurses Assn.
• NC Hospital Assn.
• Community Care of NC
• NC Assn. of Health Plans
• NC Health Quality Alliance
• NC AHEC Centers
• NCHICA

• Ex-Officio Members
• NC HWTFC Chair
• NC HWTFC Executive Director
• Rep. from Office of the Governor
• NCHICA Executive Director

• Advisory Group
• Public Sector Representatives
• Private Sector Representatives

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EHR HIE Quality Reporting
By meaningful use of certified systems
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Meaningful UseEstimated Timeframes
2009 2009 2009 2009 2010 2010 2010 2010
Jan Apr July Oct Jan Apr July Oct
NPRM issued by HHS/CMS (fall)
Final rule issued (spring)
Interim final rule issued (Dec 31)
Public comment (Fall/Dec)
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Meaningful User - Draft Sample Provider
Requirements
Outcome 2011 (Oct 1, 2010) 2013 2015
Improve quality, safety, and efficiency CPOE for all order sets Drug-drug allergy formulary checks Problem list of diagnosis based on ICD-9 or SNOMED e-prescribing Active medication list Active medication allergy list Record demographics, advanced directives, vital signs, smoking status Patient reminders One clinical decision rule Progress note for each encounter Online eligibility verification Evidence-based order sets Clinical documentation Chronic condition management using patient lists and clinical decision support CDSS at point of care Specialists report to registries Closed loop medication management CDS for national high-priority conditions Medical device interoperability Multi-media support
Engage patients and families Electronic copy of health information (PHR, patient portal, CD, USB drive) Clinical summaries for each encounter Real-time populated PHR Patient preferences Family medical history Home monitoring device uploads Self-management tools Electronic reporting on experience of care
Improve care coordination Capability to exchange key clinical information among providers Medication reconciliation at relevant encounters and each transition of care Retrieve/act on e-Rx fill data Summary care record for every care transition Medication reconciliation at each transition from all settings Comprehensive patient data from all available sources
Improve population public health Data to immunization registries Reportable lab results to public health Electronic syndromic surveillance data to public health Receive immunization histories from registries Receive health alerts from public agencies Electronic syndrome surveillance data with capacity to link to personal identifier Use epidemiologic data Automated real-time surveillance Clinical dashboards
Ensure privacy and security of PHI Compliance with HIPAA and NHIN data sharing practices Use summarized or de-identified data for population health reporting Full accounting of TPO disclosures
Complete draft requirements in the appendix
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Meaningful User - Draft Sample Measures for
Providers
Outcome 2011 (Oct 1, 2010) 2013 2015
Improve quality, safety, and efficiency diabetics with A1c under control hypertensive patients with BP under control offered smoker cessation patients with recorded BMI CPOE orders Many other preventative screenings (mammogram, flu vaccine, etc.) Additional NQF-endorsed quality reports Inappropriate use of imaging report Critical outcomes measures (TBD) Efficiency measures (TBD) Safety measures (TBD)
Engage patients and families patients with access to electronic PHI encounters with clinical summaries of patients with real-time populated PHR patients with recorded preferences patients with secure patient messaging of transitions with shared summary care record Ability to upload home monitoring device data NPP quality measures related to patient and family engagement
Improve care coordination encounters with med reconciliation Implemented HIE capability of transitions in care where summary care record is shared Improved NQAF-endorsed measures Clinical summary aggregation from multiple sources NQF Care coordination measures (TBD)
Improve population public health Childhood immunizations report of electronically submitted reportable lab results patients with immunization assessment completed during visit patients where public health alert needed to be triggered/audit evidence that trigger occurred HIT enabled population measures HIT enabled surveillance measures
Ensure privacy and security of PHI Conduct/update security risk assessment Summarized de-identified data for health reporting Timely accounting of TPO Technology to segment sensitive data
Complete draft requirements in the Appendix
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Bi-directional Exchanges Within a Community
(example)
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A Community may create a Community HIE
Utility(example)
Note Reduction of 50 of point-to-point
Connections
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A Community may choose to qualify their HIE to
connect to the NHIN as an NHIN-HIE or NHIE
NHIE
DURSA
NHIN
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Thank You
www.nchica.org/ARRA/intro.htm