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Electronic Health Records and Exchange of Health Information

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Electronic Health Records and Exchange of Health Information Anthony Rodgers, Director Arizona Health Care Cost Containment System August 28, 2009 – PowerPoint PPT presentation

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Title: Electronic Health Records and Exchange of Health Information


1
Electronic Health Records and Exchange of
Health Information
  • Anthony Rodgers, Director
  • Arizona Health Care Cost Containment System
  • August 28, 2009

2
Definitions- HII, HIE and HIT
HII Health Information Infrastructure The wider
arena of policies, procedures, technologies and
industry standards that facilitate secure and
accurate online sharing of electronic medical
information between providers, payors and
ultimately, patients and their guardians via
HIE/HIT.
HIE Health Information Exchange The
Network The electronic movement of
health-related information among organizations
according to nationally recognized standards.
HIT Health Information Technology The
Record Use of technology to support storage,
retrieval, sharing, and use of healthcare
information for communication and decision making
within healthcare organizations.
3
Definitions- Network Terms
HIE Health Information Exchange The electronic
movement of health-related information among
organizations according to nationally recognized
standards.
HIO Health Information Organization An
organization that oversees and governs the
exchange at health-related information among
organizations according to nationally recognized
standards.
RHIO Regional Health Information Organization A
health information organization that brings
together healthcare stakeholders within a defined
geographic area and governs health information
exchange among them for the purpose of improving
health and care in that community.
Source National Alliance for Health Information
Technology Report to HHS/ONC
4
Definitions- E-Records Terms
EMR Electronic Medical Record An electronic
record of health-related information on an
individual that can be created, gathered, managed
and consulted by authorized clinicians and staff
within one healthcare organization.
EHR Electronic Health Record An electronic
record of health-related information on an
individual that conforms to nationally recognized
interoperability standards and that can be
created, managed and consulted by authorized
clinicians and staff across more than one
healthcare organization.
PHR Personal Health Record An electronic
record of health-related information on an
individual that conforms to nationally recognized
interoperability standards and that can be drawn
from multiple sources while being managed, shared
and controlled by the individual.
Source National Alliance for Health Information
Technology Report to HHS/ONC
5
State Opportunities for Funding HIT
Hospitals
Appropriation
Program Area
Agency
Categories of Funds
Medicare EHR Incentive Program 23.1 B
CMS Medicare 745 M
EHR Incentives via Carriers TPA
Doctors
EHR Incentive Funds 46.8 Billion
Medicaid EHR Incentive Program 21.6 B
CMS Medicaid 300 M
State Medicaid 1.05B
Incentive via State Medicaid
Health Centers
HITECH FUNDING PROVISIONS
ONC
Planning Grants

HIE Planning Implementation 300 M
Implementation Grants
State Designated Entity
Loan Funds for States
Other Providers
Appropriated Grant Funds 2.0 B
EHR Adoption Loan Program TBD
Health IT Research
States
Regional Tech Program
Regional Tech Centers
Universities
Medical Informatics
HHS NSF
Workforce Training
Tribes
EHR For Med Education
GME Training
New Technology Research
HIT Enterprise Research
Research
6
State Readiness Check List
  • Has an state level environmental scan and gap
    analysis been completed?
  • Is there a comprehensive state level strategic
    HIT plan with specific measurable goals and
    project accountabilities?
  • Is the public and private health care leadership
    engaged and organized?
  • Do you have key stakeholder involvement in HIT
    adoption and governance?
  • Has the State established a supportive regulatory
    environment for adoption of HIT?
  • Has the Governor identified the states
    designated entity and states agency level
    coordinator for HIT?
  • Has the role of the Medicaid agency in EHR
    adoption been clarified and properly resourced?
  • Is there and organized HIE governance structure
    for statewide exchange of health information?
  • Is there a common technology platform for HIE?
  • Will you have adequate public and private capital
    for financial sustainability of the statewide
    health information system infrastructure and HIE
    operations?
  • Has the state identified potential regional
    centers to provide the technical and user support
    resources for provider EHR adoption and support
    to achieve meaningful use?

7
Developing State Specific Strategies
  • States need to plan and implement their specific
    strategies for achieving wide spread adoption and
    meaningful use of electronic health records
    including
  • Strategies for building state HIT infrastructure
    development and governance
  • Strategies for supporting successful provider EHR
    adoption
  • Strategies for financing and sustaining HIT at
    the state level

8
Federal Grant Program for State HIE Cooperative
Agreements
  • Requires states to
  • Identify State Designate Entity or State
    Authority,
  • Appoint a agency level HIT coordinator
  • Develop and implement strategic and operational
    plans for HIE development,
  • Develop state level directories and enable state
    wide technology platform for HIEs,
  • Develop HIE business and operational processes
  • Be committed to removing barriers to health
    information exchange and interoperability between
    electronic health information system.
  • For meeting those requirements states will be
    eligible to receive 4 to 40 million in federal
    support over the next four years.

9
Building State Wide HIT Infrastructure
  • HIT infrastructure development process
  • Health information data sources
  • Establish Health Information Organizations
  • Build data exchange systems
  • Identify health information business associates
  • Identify most commonly used electronic health
    record systems
  • Clinical Data Repositories
  • Organize health information users community
  • HIT business and operational processes
  • Security and Privacy
  • Operations management and accountability
  • Reliability and State wideness
  • State designated authority
  • Governance
  • Long range HIT planning and development
  • Policy setting and removing barriers to health
    information exchange
  • Standards verification
  • Project and funding priority setting
  • Oversight

10
State-wide HIT Strategic Alignment
11
Return on Investment From HIT
12
Return on Investment Wide Spread Adoption of
Electronic Health Information (EHI) Technologies
Can Better Outcomes and Lower Cost
  • Improving Health Care Quality and
  • Cost Performance

Better Outcomes
13
Statewide Health Information Exchange
14
Building the State Level HIT Infrastructure
EHR1
HIE
EHR2
EHR3
EHRn
Labs
EHR1
EHR2
EHR3
Rxs
EHR4
PHR5
Aggregate Database
Other
PHRn
  • Highly desirable to couple with HIE

15
Nationwide Health Information Network
16
Adoption and Meaningful Use of Electronic Health
Records
17
Regional Centers to Support EHR Adoption and
Meaningful Use
  • Non-profit organizations are eligible to be
    awarded federal funds to create a regional
    center(s) for the purpose of providing on-going
    EHR user support, education, and outreach.
  • Regional centers
  • Must serve a minimum of 1,000 priority primary
    care providers
  • Disseminate knowledge about best practices, how
    to select an EHR, how to achieve meaningful use
    and improve quality.
  • Participate in a national learning consortium
  • Partner with local resources such as community
    colleges.
  • Provide EHR user support for practice and
    workflow redesign
  • Assist provides to connect to HIE
  • Assist provider with EHR vendor evaluation and
    selection
  • Support EHR implementation project management
  • Assist provider with meeting meaningful use
    requirements
  • State are eligible to receive 1.0 to 30.0
    million dollars in federal funding for Regional
    Centers

18
Electronic Health Records Incentive Program
  • Medicare will manage the Medicare EHR incentive
    program possibility through contract Quality
    Improvement Organizations (QIO)
  • The Medicaid will manage the Medicaid EHR
    incentive program.
  • The incentive payments can be made to qualifying
    providers and hospitals starting January 2011.

19
Medicare Medicaid EHR Incentives for Hospitals
  • Criteria
  • Demonstrates meaningful use of a certified EHR in
    the hospital setting
  • Demonstrates that Hospital EHR is connected to a
    statewide health information exchange
    infrastructure that support care coordination
  • Provides specified clinical quality reports and
    outcome performance

Payment Component Base Year Year 1 Year 2 Year 3 Year 4 Year 5
Incentive Payment Medicare Incentive Payment Medicaid 2.0 M 2.0 M Variable Variable Variable Variable Variable Variable Variable Variable 0 Variable
Variable Reimbursement Per Discharge 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th 0 For the first through 1,149th discharge 200 For the 1,150th through 23,000th discharge 0 For any discharge greater than 23,000th
20
Medicare Incentives for Non-Hospitals/Providers
  • Criteria
  • For eligible professionals in a healthcare
    professional shortage area (HPSA),
  • the incentive payment amounts will be
    increased by 10
  • Payments are not available to hospital-based
    professionals, such as
  • pathologist, emergency room physician,
    or anesthesiologists)
  • 3. In 2015 Medicare starts reducing provider
    Medicare payments for not having EHRs

Payment Component Base Year Maximum of 85 of EHR Acquisition and Implementation Costs Year 2 Year 3 Year 4 Year 5 Total
Physician 18,000 If first payment year Is 2011 or 2012 15,000 If first payment year Is 2013 12,000 If first payment year Is 2014 12,000 8,000 4,000 2,000 44,000 41,000 38,000
21
Medicaid EHR Incentives for Non-Hospitals/Provid
ers
  • Criteria
  • Must demonstrated meaningful use for certified
    electronic health record
  • Must have at least 30 Medicaid volume
    (pediatrician must have only 20 workload
  • volume).
  • 3.Ability to produce quality reports and
    demonstrate improved quality outcomes

Payment Component Base Year Maximum of 85 of EHR Acquisition and Implementation Costs Year 2 Year 3 Year 4 Year 5 Year 6 Total
Physician 21,250 8,500 8,500 8,500 8,500 8,500 63,750
Certified Nurse Mid-Wife 21,250 8,500 8,500 8,500 8,500 8,500 63,750
Dentist 21,250 8,500 8,500 8,500 8,500 8,500 63,750
Nurse Practitioner 21,250 8,500 8,500 8,500 8,500 8,500 63,750
Physician Assistant in FQHCs 21,250 8,500 8,500 8,500 8,500 8,500 63,750
22
Managing the Medicaid EHR Incentive Program
  • Definition of Meaningful Use in Medicaid
  • Office of National Coordinators meaningful use
    requirements establishes the states minimum
    standards
  • A clear set of meaningful use requirements for
    each category of eligible provider must be
    approved by the Secretary HHS
  • Create a process to audit and validate provider
    EHR meaningful use
  • Medicaid EHR incentive program administration
  • Develop state specific policies and procedures
    for administration of Medicaid EHR incentive
    program
  • Develop and implement Medicaid provider education
    and EHR adoption assistance coordinate with
    regional extension centers.
  • Identify providers/hospitals that will be
    participating in EHR incentive program and track
    progress
  • Phase in of meaningful use requirements over
    three to five years
  • Establish a specific payout schedule for Medicaid
    incentives payments
  • Consider providing other recognitions for
    physician EHR adoption especially for providers
    that dont qualify for Medicaid or Medicare EHR
    incentive.
  • Validate return on investment in quality
    improvement and cost containment

23
Developing a Performance Outcomes for HIT
Performance Outcomes
Strategic HIT Focus Areas
HIT Strategic Performance Metrics
Reduced Unnecessary Cost/Utilization Reduced
PMPM Lower Admin Cost
Meaningful Use of EHR to reduce Duplication,
Errors and improve Admin Efficiency
Cost Containment
Quality Improvement
Meaningful Use of EHR to better coordinate care
and Quality Performance
Improved Quality Against HEDIS and Other
Benchmarks
Strategic Planning Logic Map
Higher Provider Satisfaction Reduction in
Admin. Cost
Administrative Efficiency
Meaningful use of EHR to Reduce Admin. Process
Cycle Times
Public Health Research
Meaningful Use of EHR to build Population Health
Mgmt. Research
Public Health Responsiveness Reduction in
Health Disparities
Meaningful USE Barrier
PERFORMANCE Management Barrier
24
Strategies to Support Provider EHR Adoption and
Meaningful Use
  • Regional Centers for EHR technical support and
  • Medicaid program EHR support of provider adoption
  • Graduate medical education training programs EHR
    adoption
  • Federal outreach and education
  • Other state agencies
  • Hospitals and major group practices

25
State Level HIT Financing Strategies
  • Federal EHR incentive funds for Medicare and
    Medicaid
  • Pool EHR provider financing support
  • Payers
  • Hospitals
  • Others
  • Transaction or user fees to support HIE
    sustainability
  • Health plan tax or fee for HIE support
  • 90/10 federal Medicaid funding
  • Regional Center Grants
  • Research fund assessment

26
Gartner Consulting EHR Findings
  • Key Findings
  • Physicians in small practices need help
    financial and logistical to implement EHRs.
  • Organizations that help physicians implement
    EHRs often overlook the need to select and
    implement products in a way that enhances the
    physician's day-to-day effectiveness.
  • Used properly, an EHR subsidy or implementation
    support can assist hospital organizations in
    physician bonding.

27
Gartner Consulting Recommendations
  • Those setting the approach to assisting
    physicians in choosing or implementing EHRs
    should follow these recommendations.
  • Establish partnerships with EHR vendors that
    place the overall responsibility for
    implementation on the subsidizing and assisting
    organization.
  • Don't rely on vendors to determine the
    readiness of practices for EHR implementation.
  • Maintain a continued, central role in advising
    physicians, monitoring progress, and sustaining
    the ongoing relationship between the practice and
    the vendor.
  • Choose products that integrate practice
    management and EHR capabilities.
  • Strongly encourage practices to replace
    practice management systems with an integrated
    product.
  • Evaluate and advocate products that facilitate
    reliability, networking options, and remotely
    hosted EHRs that do not require a thick client.

28
Logical Phases of State Level HIT
Development2010 thru 2015
  • Phase 1 HIT infrastructure planning and
    development phase
  • Phase 2 EHR initial implementation and initial
    meaningful use
  • Practice workflow redesign
  • Training and EHR user technical and system
    support
  • Phase 3 EHR managed performance phase
  • Improved coordination of care and care
    integration
  • Process improvement outcomes
  • Phase 4 EHR meaningful use optimization
  • Improved quality and cost effectiveness outcome
  • Maximized return on investment

29
Structural Development Phase2010 thru 2012
  • Acquisitions and Installation of a certified EHR
  • E-prescribing
  • Computerize order entry results reporting
  • Quality reporting capabilities
  • Clinical Decision Support capability
  • Building the exchange health information
    infrastructure, interfaces and operational
    processes
  • Development of clinical data repositories and
    disease registries
  • Providing ongoing User support for provider
    practices, and hospitals and process
    reengineering

30
EHR Initial Use Phase2011 thru 2013
  • Building EHR Meaningful Use Competency (EHR
    System Burn In)
  • On-going technical assistance and support for
    provider practice EHR adoption
  • Focus shifts to process and practice productivity
    improvement
  • Data conversion assistance and support
  • Implement EHR system failure risk reduction
    strategies
  • Continue to build health information exchange
    interfaces with various external healthcare data
    sources

31
EHR Managed Performance Phase2012 thru 2014
  • Develop quality networks for comparable
    performance analysis and improvement
  • Enhance specific EHR configuration to achieve
    effective use of clinical decision support
  • Build web based health-e learning programs and
    personal health records for patients and to
    improve self management (electronic reminders,
    instant messaging, and telehealth)
  • Enhance use of telemedicine
  • Electronic performance reporting
  • Enhance disease registries

32
EHR Optimized Use Phase2014 and Beyond
  • System configuration for optimization of
    integrated patient management
  • Optimization of system configuration for episode
    of care management
  • Patient center care
  • Best practice
  • Improved patient and provider engagement and
    connectivity
  • Advanced messaging and alerts
  • Integration of Web 2.0 functionality for patient
    support and care management
  • Integration of remote monitoring tools,
    telemedicine, telehealth and health e-learning
    functionality and tools
  • Integration of health plan care management
    systems
  • Translational research and enhanced quality
    network infrastructure

33
The Connected Healthcare System
Hospital Care Coordination
Diagnostics
Specialist Referral
Primary Care Medical Home Provider
Order Entry Lab Result Reporting
EHR/HIE
Research
E-Prescribing
Remote Patient Self Monitoring
MCO Medical Medical Mgmt.
34
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