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


1
Policy Landscape for Health Information
Technology National Governors
AssociationWashington, DCMeeting with
Washington RepresentativesMay 12, 2006 Sharon
F. CannerVice President, Government
AffairseHealth Initiative
2
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
    initiatives
  • 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
    exchange

3
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
    providers
  • Practicing clinicians and clinician groups
  • Public health agencies
  • Quality improvement organizations
  • Research and academic institutions
  • State, regional and community-based health
    information organizations

4
eHI is the Go-to Organization For State and
Regional HIT and Health Information Exchange
Efforts
Advocacy
Grants
eHealth Initiative and Foundation
Knowledge
Hands-on Help
5
eHI Work Supporting States and Communities
  • eHI Connecting Communities Membership Over 260
    state, regional and community-based
    collaboratives engaged in health information
    exchange
  • 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

6
What is Health Information Exchange?
Infrastructure to enable data sharing between
organizations
  • 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!

7
Value of Health Information Exchange
  • Standardized, encoded, electronic HIE would save
    78B/yr
  • 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)

8
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

9
Hub of Best Practice Development for
Transformation through Health Information Exchange
  • Launched four new working groups to support
    ongoing development of principles, tools and
    resources
  • 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
    e.org/pressrelease825main.mspx
  • Practice Transformation and Quality
  • Guide for clinicians to interface with health
    information exchange efforts
  • Technical Aspects

10
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
    efforts
  • 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

11
Actively Helping States
  • Providing direct technical assistance support to
    several states through HIT state policy
    initiative
  • Arizona
  • Kansas
  • Louisiana
  • Michigan
  • Minnesota
  • New Hampshire
  • New York
  • Wisconsin
  • Others

12
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

13
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
    assistance
  • Providing stakeholders with a high-level roadmap
    that states have created themselves to catalyze
    HIT and HIE movement within the state

14
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

15
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)

16
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

17
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
    representatives

18
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

19
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

20
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

21
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

22
In Summary
  • Administration
  • AHIC focuses national attention on standards
    development and private-public sector
    collaboration
  • Workgroups to deliver final recommendations in
    May
  • RFPs key in advancing Interoperability and Health
    Information Sharing Policies awarded details to
    come
  • Activity in several agencies details on CMS to
    come

23
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

24
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

25
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

26
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
    (5/9/06)

27
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

28
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
    measures
  • Creation of health information technology
    resource center

29
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

30
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

31
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

32
Increasing Interest in Pay for Performance and
Quality
  • 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

33
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
    purchasing
  • 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

34
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
    safety.
  • 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

35
Hearings 2nd Session
  • House Ways and Means Subcommittee March 1 on
    Medpac Recommendations
  • House Government Reform Subcommittee March 15 re
    PHRs
  • House Energy and Commerce Subcommittee March 16
    re standards, interoperability and privacy eHI
    testified
  • 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

36
Summary/Outlook
  • 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
    grants
  • 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

37
  • 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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