Policy Landscape for Health Information Technology National Governors Association Washington, DC Meeting with Washington Representatives May 12, 2006 Sharon F. Canner Vice President, Government Affairs eHealth Initiative - PowerPoint PPT Presentation


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Policy Landscape for Health Information Technology National Governors Association Washington, DC Meeting with Washington Representatives May 12, 2006 Sharon F. Canner Vice President, Government Affairs eHealth Initiative


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Title: Policy Landscape for Health Information Technology National Governors Association Washington, DC Meeting with Washington Representatives May 12, 2006 Sharon F. Canner Vice President, Government Affairs eHealth Initiative

Policy Landscape for Health Information
Technology National Governors
AssociationWashington, DCMeeting with
Washington RepresentativesMay 12, 2006 Sharon
F. CannerVice President, Government
AffairseHealth Initiative
eHI and Foundation Mission and Focus
  • Improve the quality, safety, and efficiency of
    healthcare through information and information
    technology by
  • Developing and disseminating knowledge or common
    principles, policies and best practices for
    supporting transformation through HIT and health
    information exchange
  • Providing seed funding for emerging state,
    regional and community-based multi-stakeholder
  • Providing hands-on help or technical assistance
    to emerging collaborative efforts at the state,
    regional and local level
  • Advocating for continued favorable national
    policies related to HIT and health information

Our Diverse Membership
  • Consumer and patient groups
  • Employers, healthcare purchasers, and payers
  • Health care information technology suppliers
  • Hospitals and other providers
  • Pharmaceutical and medical device manufacturers
  • Pharmacies, laboratories and other ancillary
  • Practicing clinicians and clinician groups
  • Public health agencies
  • Quality improvement organizations
  • Research and academic institutions
  • State, regional and community-based health
    information organizations

eHI is the Go-to Organization For State and
Regional HIT and Health Information Exchange
eHealth Initiative and Foundation
Hands-on Help
eHI Work Supporting States and Communities
  • eHI Connecting Communities Membership Over 260
    state, regional and community-based
    collaboratives engaged in health information
  • many RHIOs/HIEs (health information exchanges)
  • eHI directly supports HIT planning and policy
    initiatives in 13 states
  • eHI provides funding to communities to support
    health information exchange Connecting
    Communities Awards Program nine funded so far,
    a handful being awarded in next month
  • eHI supports AHRQs National Resource Center for
    HIT as a subcontractor to NORC

What is Health Information Exchange?
Infrastructure to enable data sharing between
  • Health information exchange provides the
    capability to electronically move clinical
    information between disparate healthcare
    information systems while maintaining the meaning
    of the information being exchanged.
  • The goal of health information exchange is to
    facilitate access to and retrieval of clinical
    data to provide safer, more timely, efficient,
    effective, equitable, patient-centered care
  • There is no single definition of a health
    information exchange (aka RHIO, CHINs, )!
  • YOU define what health information exchange means
    to you based upon your needs and priorities!

Value of Health Information Exchange
  • Standardized, encoded, electronic HIE would save
  • Net Benefits to Stakeholders
  • Providers - 34B
  • Payers - 22B
  • Labs - 13B
  • Radiology Centers - 8B
  • Pharmacies 1B
  • Reduces administrative burden of manual exchange
  • Decreases unnecessary duplicative tests
  • (Source Center for Information Technology
    Leadership, 2004)

Hub of Best Practice Development for
Transformation through Health Information Exchange
  • On January 31, 2006 launched eHIs Connecting
    Communities Toolkit, with modules in key areas
  • Getting started Assessing environment, engaging
    stakeholders, developing shared vision and goals
  • Organization and governance, legal issues
  • Value creation, financing and sustainability
  • Policies for information sharing
  • Practice transformation and quality improvement
  • Technical implementation
  • Policy and advocacy

Hub of Best Practice Development for
Transformation through Health Information Exchange
  • Launched four new working groups to support
    ongoing development of principles, tools and
  • Getting Started, Organization and Governance
  • Guide for Securing Non-Profit Tax Exempt Status
  • Toolkit http//toolkit.ehealthinitiative.org
  • Value Creation and Financing
  • Market readiness assessment
  • Annual Survey of State, Regional and
    Community-based Health Information Exchange
    Initiatives and RHIOs http//www.ehealthinitiativ
  • Practice Transformation and Quality
  • Guide for clinicians to interface with health
    information exchange efforts
  • Technical Aspects

Actively Helping More than 150 Communities
  • Built a Connecting Communities Membership
    stakeholders involved in state, regional and
    community-based health information exchange
    initiatives and RHIOs
  • Stakeholders in states, regions and communities
    have become Connecting Communities members
  • Monthly calls to share insights and bring
    national experts to the communities to support
  • Holding regional and national face to face
    learning forums Ohio and Florida completed,
    Kansas coming
  • Will vet and pilot rapidly emerging tools for
    health information exchange

Actively Helping States
  • Providing direct technical assistance support to
    several states through HIT state policy
  • Arizona
  • Kansas
  • Louisiana
  • Michigan
  • Minnesota
  • New Hampshire
  • New York
  • Wisconsin
  • Others

Actively Helping Gulf Coast States
  • Providing direct technical assistance support to
    the Gulf Coast states through contract with DHHS
  • Alabama
  • Florida
  • Louisiana
  • Mississippi
  • Texas
  • Focus is on supporting development of health
    information exchange networks
  • Media and communications strategy also part of
    the work

State Technical Assistance
  • Increasing understanding of activities,
    viewpoints, and key barriers within the state to
    inform strategy
  • State environment landscape
  • HIT / HIE inventory
  • Providing education and increasing awareness
    across states
  • Making connections with peers in other states
    cooperative model
  • Laying the foundation for ongoing collaboration
    and forward movement within the state
  • Providing national and industry expert review and
  • Providing stakeholders with a high-level roadmap
    that states have created themselves to catalyze
    HIT and HIE movement within the state

Understanding the National Agenda
Administration and Congress
  • Enormous momentum around HIT and health
    information exchange both within Administration
    and Congress
  • Key themes
  • Role of government, role of private sector
  • Need for standards and interoperability
    technical AND privacy and security
  • Need for alignment of incentives with BOTH
    quality and efficiency goals and the HIT
    infrastructure to support them

Administration Initiatives/Developments
  • President George W. Bush created new sub-cabinet
    level position 4/04 (Office of National
    Coordinator/ONC for HIT
  • Strategic Framework released by ONC in 7/04
  • Summary of over 500 Responses to RFI for National
    Health Information Network released in 5/05
  • Secretary Michael Leavitt released four RFPs re
    Interoperability and Health Information Sharing
    Policies in 6/05
  • American Health Information Community (AHIC)
    Commissioners announced 9/05
  • Change of Leadership at ONC April 2006
    (National Coordinator Dr. David Brailer resigns)

Strong Momentum for HIT and Health Information
Exchange Activities in Administration
  • AHIC public-private community to provide input
    to Sec. Leavitt re how to make health records
    digital and interoperable and assure that privacy
    and security are protected
  • AHIC reviewed break-through areas that will
    create realizable benefits to consumers in two to
    three years and established workgroups with final
    recommendations May 16
  • Consumer empowerment
  • Electronic heath records
  • Chronic disease
  • Biosurveillance

AHIC Commissioners
  • Craig R. Barrett, Chairman, Intel Corporation
  • Nancy Davenport-Ennis, CEO, National Patient
    Advocate Foundation
  • Lillee Smith Gelinas, R.N., Chief Nursing
    Officer, VHA Inc
  • Douglas E. Henley, M.D., Executive Vice
    President, American Academy of Family Physicians
  • Kevin D. Hutchinson, CEO, SureScripts
  • Charles N. Kahn III, President, Federation of
    American Hospitals
  • Steven S Reinemund, CEO and Chairman, PepsiCo
  • E. Mitchell Roob, Secretary, Indiana Family and
    Social Services Administration
  • Scott P. Serota, President and CEO, Blue Cross
    Blue Shield Association
  • Government Secretary Leavitt and CMS, CDC, VA,
    DoD, Treasury, OPM, Commerce and IFSSA

HIT and Health Information Exchange Activities
in Administration
  • Four awards emerged from DHHS
  • Standards harmonization process awarded by ONC
    to ANSI in Oct 2005
  • Compliance certification process for EHRs
    awarded by ONC to Certification Commission for
    HIT in Oct 2005
  • Variations in organization-level business
    policies and state laws that affect privacy and
    security practices (including HIPAA) awarded by
    AHRQ to RTI International in Oct 2005
  • Nationwide health information network prototypes
    ONC awarded four projects in November covering
    12 communities

Centers for Medicare Medicaid Services Linking
Quality and HIT
  • Section 649 Pay for Performance Demonstration
    Programs link payment to better outcomes and
    use of HIT launched in early 2005
  • Quality Improvement Organizations playing a
    critical role. Doctors Office Quality
    Information Technology Program (DOQ-IT)
    technical assistance for HIT in small physician
    practices included in eighth scope of work

Centers for Medicare Medicaid Services
  • Chronic Care Demonstration Program (Medicare
    Support) linking payment to better outcomes IT
    a critical component
  • Section 646 area-wide demonstration announced
    in September 2005
  • Physician Voluntary Program Reporting Program
    regarding quality of care began January 2006

AHRQ Focus on HIT and Health Information Exchange
  • Over 150 million in grants and contracts for HIT
  • Over 100 million supporting approx 110 grants in
    38 states approximately 50 focus on health
    information exchange
  • Contracts to six states to help develop statewide
    health information exchange networks CO, DE,
    IN, RI, TN, UT - 29 million over five years
  • National HIT Resource Center collaboration led
    by NORC and including eHealth Initiative, CITL,
    Indiana University, Vanderbilt and CSC - 18.5
    million over five years

In Summary
  • Administration
  • AHIC focuses national attention on standards
    development and private-public sector
  • Workgroups to deliver final recommendations in
  • RFPs key in advancing Interoperability and Health
    Information Sharing Policies awarded details to
  • Activity in several agencies details on CMS to

Signs of Momentum for HIT and Health Info
Exchange Activities in Congress
  • 13 bills introduced in 2005, 4 in 2006
  • Most bi-partisan
  • Unprecedented collaboration between the
    Republicans and Democrats on the importance of
    leveraging HIT and the mobilization of
    information to address healthcare challenges

Common Themes of Legislation
  • The need for standards creation of a
    public-private sector body designed to achieve
    consensus on and drive adoption of
    interoperability standards
  • Grant and loan programs, for providers and
    regional health information technology networks
    most link to use of standards and adoption of
    quality measurement systems
  • Role of government catalyst, driver of change
  • Value-based purchasing programs measures
    related to reporting of data, process measures
    including HIT, and eventually outcomes

HIT Legislation
  • HIT Bills Pending Action
  • S 1418 (Wired for Health Care Act) passed Senate
    in 2005
  • HR 4157 Ways Means (Johnson R-CT/Deal R-GA)
    HIT bill
  • HR 4642 Same as S 1418 (introduced in House,
    Issa R-CA)
  • HR 4641 - Assisting Doctors to Obtain Proficient
    and Transmissible Health Information Technology
    (Gingrey R-GA) tax credits

HIT Legislation
  • HR 4859 -Federal Family Health 4 Information
    Technology Act (Porter R-NV)
  • Federal Employee Personal Health Records Act
    (Carper D-DE) - draft
  • HR 4832 (Clay D-MO, Porter R-NV) - would codify
    ONC, create national interoperable health
    information infrastructure, fund provider loans,
    create Stark/Anti-kickback safe harbor
  • S. 2772 - Health Partnership Act (Voinovich
    R-OH/Bingaman D-NM)- grants to states and others
    to improve coverage and healthcare infrastructure

Progress on Moving Legislation
  • Energy and Commerce Markup scheduled for week of
    May 22/floor week of June 19
  • Draft language has similarities to HR 4157
  • Ways and Means has yet to schedule markup
  • Conference on House-passed legislation (big
    assumption) with S 1418
  • - Major differences in approach
  • - S 1418 more prescriptive with funding
  • - House bare bones with no funding

Senate 1418 Wired for Healthcare Quality Act
Passed in Nov. 2005
  • Key Elements
  • Authorizes ONCHIT
  • Authorizes public-private AHIC to advise
    Secretary, recommend actions, and standards
  • Grants to providers, states and for
    regional/local HIT plans
  • Demonstration program to integrate IT into
    clinical education
  • Development of quality measures and government
    capability to accept electronically reported
  • Creation of health information technology
    resource center

Senate 1418 Wired for Healthcare Quality Act
  • Competitive Grants for Qualified HIT
  • For not-for-profit hospitals, federally qualified
    health centers, individual or group practices or
    other health care providers
  • Must adopt standards, implement and report
    quality measures, agree to notify patients of
    wrongful disclosure, demonstrate need, and
    provide matching funds (1 for every 3)
  • Preference given to rural, frontier or
    underserved areas or eligible entities that will
    link qualified HIT to local or regional health
    information plans

Health Information Technology Promotion Act
(Johnson R-CT/Deal R-GA) HR 4157
  • Codifies ONCHIT headed by National Coordinator,
    responsible for activities, such as
  • Principal advisor to Secretary on development and
    use of HIT
  • Standards harmonization for use in exchange of
    health information
  • Certification/inspection of HIT products,
    services and architecture
  • Requires study for harmonization of state
  • laws and regulations regarding security and
    confidentiality of health information
  • Requires rule-making for adoption of ICD 10 codes

Johnson-Deal HIT contd
  • Provides exemption from Stark, Anti-Kickback and
    other statutes for any non-monetary remuneration
  • Requires remuneration without regard to the
    number or value of physician referrals
  • Effective 180 days after bill enactment
  • Requires HHS Secretary to conduct a study on safe
    harbor effectiveness in increasing HIT adoption

Increasing Interest in Pay for Performance and
  • Medicare Value Based Purchasing legislation
    introduced in both House and Senate n 2005 and
    included in Senate Budget Reconciliation
  • Health plans including, BCBSA, and RWJ grants
  • National Quality Forum getting consensus on
    ambulatory care measures
  • Large private sector purchasers and CMS
    increasing interest in quality within ambulatory
    care Bridges to Excellence a key player

Action on Pay for Performance Legislation
  • Medicare Value Purchasing Act of 2005 (Grassley
    R-IO, Baucus D-MT D, S 1356) incorporated in
    Senate Deficit Reduction Omnibus Reconciliation
    Act of 2005 (S 1932)
  • Establishes phased-in value-based purchasing
    programs for physicians and other providers
  • Ties reimbursement to reporting of data on
    quality measures
  • Requires development/updating of quality
    measurement system to guide value-based
  • Requires HHS to contract/consult with diverse
    stakeholders to build
  • consensus around sets of measures
  • Funding not considered sufficient to encourage
    physician participation
  • House Deficit Reduction bill (HR 4241) did not
    include Medicare P4P provision
  • P4P provisions dropped in conference

HIT Appropriations FY 2007
  • Presidents budget requests
  • 169 million, an increase of 58 million over
    2006, for ONC
  • 50 million to AHRQ for health IT, the same as
    the FY2006 amount. These funds would be used to
    advance the use of health IT to enhance patient
  • As part of the FY 07 Budget Resolution approved
    March 16, the Senate voted to create a reserve
    fund for HIT, which allows scoring over 5 years
  • Requires HIT legislation for implementation

Hearings 2nd Session
  • House Ways and Means Subcommittee March 1 on
    Medpac Recommendations
  • House Government Reform Subcommittee March 15 re
  • House Energy and Commerce Subcommittee March 16
    re standards, interoperability and privacy eHI
  • Ways and Means Health Subcommittee April 6 4th
    hearing re Medicare adoption of HIT
  • House Small Business Committee/ Subcommittee on
    Regulatory Oversight and Reform April 6 -
    feasibility of small physician practices adopting
    electronic medical records
  • Senate Commerce Subcommittee May 17
    Accelerating the Adoption of HIT

  • Strong bi-partisan interest in HIT enabling
    legislation re standards and infrastructure
  • House Energy and Commerce leadership on mark-up
    and floor strategy
  • President proposes 169M to fund ONC, double FY
    2006, although limited funds to support seed fund
  • Election year favors HIT as strategy to address
    issues of cost and patient safety, yet few
    legislative days and diverse House-Senate
    approaches hinder action
  • Privacy and Stark/Anti-kickback pose challenges

  • Sharon F. Canner
  • Vice President, Government Affairs
  • eHealth Initiative
  • www.ehealthinitiative.org
  • 818 Connecticut Avenue, N.W., Suite 500
  • Washington, D.C. 20006
  • 202.624.3269
  • Sharon.canner_at_ehealthinitiative.org
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