Health Information Technology Summit

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Health Information Technology Summit August 23,
2007Ramkota HotelSioux Falls, SD
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Laurie Gill Deputy Secretary South Dakota
Department of Health 600 East Capitol
Avenue Pierre, SD 57501 605-773-3361 Laurie.gill_at_
state.sd.us
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Driving Force

• Governor Rounds
• Health Care Commission
• Electronic Health Record Subcommittee

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First steps.
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(No Transcript)
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Steering Committee

• Doneen Hollingsworth, Co-Chair, South Dakota
  Department of Health
• Deb Bowman, Co-Chair, South Dakota Department of
  Social Services
• Dave Hewett, SD Association Healthcare
  Organizations
• Dr. Stephen Schroeder, SD Foundation for Medical
  Care
• John Porter, Avera
• Kelby Krabbenhoft, Sanford Health
• Dana Darger, Rapid City Regional
• Kristie Fiegen, Junior Achievement of SD
• Bill Nelson, Coteau des Prairies Hospital
• Barb Smith, SD State Medical Association
• Dr. Jim Reynolds, North Central Heart Institute
• Dr. Charles Hart, Rapid City Regional Hospital
• Dr. Jim Szana, Dentistry at the St. Charles
• Otto Doll, Bureau of Information and
  Telecommunications

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SDEHRA Goals

• Assess variations in organization-level business
  policies and state laws that affect health
  information exchange (HIE)
• Identify barriers and best practices relating to
  HIE
• Identify privacy and security issues relating to
  HIE
• Investigate HIE possibilities for South Dakota
  and surrounding region

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Two-prong approach

• Online surveys for payers, providers, and
  consumers
• Over 350 received
• 210 Consumers
• 155 Providers
• 2 Payers
• Four regional focus groups
• Rapid City, Aberdeen, Pierre, Sioux Falls
• 75 representatives from multiple disciplines

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SDEHRA Participants

• Clinicians
• Physician Groups
• Federal Health Facilities
• Hospitals
• Payers
• Community Clinics
• Pharmacies
• Laboratories
• Long-Term Care Facilities
• Hospice
• Correctional Facilities
• Professional Associations
• Consumer Organizations
• Consumers
• Etc.

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Prepare to Share...Share for better Care!
Kick-Off conference held in October. Laura Adams
from the Rhode Island Quality Institute gave the
keynote address. Over 100 participants around
the state were a part of the conference.
Presentation is available on the www.SDEHRA.org
website.
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Timeline

• October 2006
• Kick Off Conference
• November 2006
• Focus / Work Groups Designated
• December 2006
• Survey Process Begins
• January 2007 March 2007
• Focus / Work Group Meetings
• Surveys Finalized
• April 2007 June 2007
• Results Analyzed
• Final Report Preparations
• July 2007
• Final Report Issued
• August 2007
• Health Information Technology Summit

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SDEHRA Outcomes

• South Dakota focused
• Prepare to Share, Share for Better Care
• Address barriers
• Legal, Organizational-Level, Financial
• Provide a roadmap for future IT initiatives in SD
• Website www.SDEHRA.org
• Multiple resources including slides from todays
  presentations are available

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Dakota State University 820 North Washington
Avenue Madison, SD 57042
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Data Collection

• Survey Instruments
• Provider
• Consumer
• Payer
• Focus Groups
• Legal Analysis

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Survey Development

• Consumer Survey
• AARP (national/state)
• Payer Survey
• SD Division of Insurance
• Provider Survey
• RHIO task force
• Selected providers
• Kick-Off Conference attendees

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Survey Distribution

• Email and newsletter announcements
• SDAHO, SDHIMA, etc.
• Letters to associations and providers
• News releases (print, radio, television)
• Television coverage
• KSOO Viewpoint University Talkshow
• Newspaper articles
• Reminders
• News releases
• Postcards
• Association newsletters

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Provider Surveys
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Provider Respondents
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Does your facility currently have an electronic
health record (EHR)?
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When do you plan to implement an EHR?
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Providers with no current plans to implement an
EHR
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What was a driving force in implementing an EHR?
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What are the major barriers to your plans for
implementation of an EHR?
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Provider IT Infrastructure

• 36 have redundancy hardware for information
  systems
• 51 system provides redundancy (backup) of data
• 86 facility systems are accessible with
  authentication
• 87 facilitys employees use a unique user
  identifier to access their information systems
• 100 main authentication method currently used is
  passwords
• 60 employee training for password authentication
  and auditing to maintain password security
• 69 facility-forced password changes
• 77 physical access to computing resources by
  employees is NOT considered a barrier to
  increasing use of electronic records

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Consumer Surveys
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Consumer Surveys (age)
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Consumer Surveys (income)
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Do you have a personal health record?
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EHR Benefits
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EHR Accuracy
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EHR Confidentiality
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Focus Groups
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Locations
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Scenarios

• Treatment/patient care
• Payment
• Regional health information organizations
• Law enforcement
• Prescription drugs
• Operations/marketing
• Public health/bioterrorism
• Employee health information
• State government oversight

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Focus Group Assignment

• Identify the issues of the scenario
• Describe how the situation in the scenario was
  handled in their particular work setting
• Describe the ideal practice standard
• Identify barriers that could possibly prevent the
  ideal practice standard from occurring

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Ideal Practice Recommendations

• Easy, secure access to patient information
• Interoperability (between computer systems)
• Medication prescribing
• Standardized regulations

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Easy, secure access to patient information

• Common patient identifier
• Online patient authorization to release medical
  information
• Use of a Continuity of Care Record (CCR)
• Use of an EHR by all healthcare providers with a
  standardized format
• Use of a Picture Archiving and Communication
  System (PACS) for easy access to all types of
  images
• Use of a data repository
• Automatic alert for reportable diseases
• Access to information by third party payers for
  reimbursement only

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Interoperability (between computer systems)

• Universal or standardized formats
• Use of a Computerized Physician Order Entry
  (CPOE) system by all healthcare practitioners

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Medication prescribing

• Online formulary list of all third party payers
• Computerized alert system when ordering
  medications to prevent interactions, overdosing,
  etc.

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Standardized regulations

• Uniformity of laws between states
• Federal laws do not conflict with state laws

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Common Barriers Identified

• Lack of resources
• Technology issues
• Legislation
• Interoperability
• Consumer issues

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Lack of resources

• Cost of
• staff education and training
• the need for specific knowledge of HIPAA
  regulations regarding Release of Information
  (ROI) in an emergency such as bioterrorism
• time to train staff on new policies and
  procedures regarding the use of the EHR system
  and hardware
• needed hardware
• upgrading of hardware as technology and
  requirements change
• needed software
• maintaining support once implementation is
  complete

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Technology issues

• All facilities not utilizing the EHR, CPOE, PACS,
  etc.
• Physician/staff resistance to new technology
• Concern for security, confidentiality, and access
• Password maintenance
• Network maintenance
• Planned and unplanned down time of the system
• Unavailability of broad-band transmission in some
  areas

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Legislation

• State-to-state differing regulations
• Conflict with federal and state laws
• Ownership of the medical information
• Legal medical record

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Interoperability

• Many EHR vendors and lack of interoperability
  between the systems
• Lack of universal standards for different systems
  communicating with each other

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Consumer issues

• Consumer education
• Internet availability in rural areas
• Security and confidentiality concerns
• Ability to opt out of a Regional Health
  Information Organization (RHIO)

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Legal Analysis
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Information Reviewed

• SDHIMA Legal Manual
• Focus Group Scenarios
• Relevant journal and Law Review articles
• Additional information from related websites

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Findings

• Current South Dakota statutes and administrative
  rules governing health information exchange need
  refining to better comply with federal HIPAA
  standards.
• There is a need for plain English wording or
  interpretation to HIPAA compliance within South
  Dakota. Such a wording will help South Dakota
  physicians, hospitals, clinicians, insurers,
  researchers and managed care organizations limit
  the opportunity for legal and financial risk.
• South Dakota should implement a system of
  balanced interests between patients and
  providers.

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Recommendations
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Recommendations

• Purpose of study was gathering information.
• This section represents an effort to analyze,
  interpret, and condense that information.
• Goal
• Clear, well-motivated, broad, actionable items
• address the issues as South Dakota migrates
  toward electronic health information systems
• Context
• Electronic Health Information Systems are coming

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Recommendations

• Quick Summary
• Develop a Center
• Continue Research
• Develop and Deliver Education
• Design and Develop Prototype Systems
• Begin to Address Legal Issues

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Develop a Center supporting Electronic Health
Information Exchange

• Develop a center or organization to provide
  united and focused leadership as well as provide
  continuity to the EHR adoption process, along
  with information, support and resources for
  electronic health care in South Dakota.
• Keys
• Balance among disparate stakeholders
• Broad view supporting exchange of electronic
  health information without other agenda

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Continue Research and Investigation

• Need to fill gaps
• Need to increase participation
• Need to examine resources both internal and
  external which can help to smooth the path to
  effective electronic health information

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Education and Training

• An unavoidable issue with new technology
• understanding and using it effectively
• Affects consumers and service providers
• Mitigate this through advance preparation
• Education and Training
• From broad and general (What is an EHR?)
• To focused and specific (e.g., choose a privacy
  option or enter a chosen option for a consumer)

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Prototype

• Build systems to provide some of the services to
  some of the stakeholders
• Focus on opportunities
• Leverage existing systems -- extending or
  combining
• Focus on gaps
• What pieces arent being addressed elsewhere?
• Where is there a failure to communicate?
• Champion a complete, balanced solution
• Focus on standardization

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Begin to Address Legal Environment

• Slow process
• Need leaders, perseverance and constituency
• Goals Clarity and Balance
• Uncertainty can be a serious impediment
• Build on South Dakotas advantage a relatively
  small, agile, cooperative environment for health
  care information systems among the industry,
  consumers, and government

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Recommendations Review

• Develop a center to lead the effort.
• Conduct more research to understand the
  challenges and possibilities.
• Develop and deliver education to prepare both
  consumers and service providers.
• Prototype systems to design, combine, and extend
  functionality.
• Address health care information law to bring
  greater clarity and certainty to the environment.

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Thank you!