1 Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010

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Technology, Members Technology, Members and Things That Start and Things That Start

with the Letter “H”with the Letter “H”

Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010

John Calabro, CIO

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Key DefinitionKey DefinitionHEALTH INFORMATION INFRASTRUCTURE ADVISORY BOARDHEALTH INFORMATION INFRASTRUCTURE ADVISORY BOARD

The Authority shall operate as a hub for health information The Authority shall operate as a hub for health information exchange between health related state agencies and other exchange between health related state agencies and other health information organizations. Information exchange health information organizations. Information exchange shall be implemented through interagency agreements shall be implemented through interagency agreements among all health related agencies. The agreement shall among all health related agencies. The agreement shall ensure, but shall not be limited to:ensure, but shall not be limited to:

• confidentiality of information confidentiality of information • funding and implementation of the plan, which may include phased-in funding and implementation of the plan, which may include phased-in

implementation, and procedures for coordinating, monitoring, andimplementation, and procedures for coordinating, monitoring, and• improving data exchange that is compatible with current adopters of improving data exchange that is compatible with current adopters of

electronic medical record systems and health information electronic medical record systems and health information technologies.technologies.

Oklahoma Health Care AuthorityOklahoma Health Care Authority Oklahoma State Department of Health,Oklahoma State Department of Health, Oklahoma Department of Mental Health and Oklahoma Department of Mental Health and

Substance Abuse ServicesSubstance Abuse Services Oklahoma Department of Human ServicesOklahoma Department of Human Services Oklahoma State and Education Employees Group Oklahoma State and Education Employees Group

Insurance BoardInsurance Board

Oklahoma Insurance DepartmentOklahoma Insurance Department Oklahoma Department of CorrectionsOklahoma Department of Corrections Oklahoma State Department of Oklahoma State Department of

Rehabilitative ServicesRehabilitative Services Oklahoma City-County Health DepartmentOklahoma City-County Health Department Tulsa-County Health DepartmentTulsa-County Health Department

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Electronic Health Record (EHR) - An electronic record Electronic Health Record (EHR) - An electronic record of health-related information on an individual that of health-related information on an individual that conforms to conforms to nationally recognized interoperability nationally recognized interoperability standardsstandards and that can be created, managed, and and that can be created, managed, and consulted by authorized clinicians and staff across consulted by authorized clinicians and staff across more than one health care organization.more than one health care organization.

EHR is associated with the ‘HIT’ initiatives.EHR is associated with the ‘HIT’ initiatives.

Key DefinitionKey Definition

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Health Information Exchange (HIE) is the actual Health Information Exchange (HIE) is the actual electronic mobilization or movement of healthcare electronic mobilization or movement of healthcare information information across organizationsacross organizations within a region or within a region or community. HIE is the capability to move clinical community. HIE is the capability to move clinical information electronically between disparate information electronically between disparate healthcare information systems while maintaining healthcare information systems while maintaining the accuracy of the information being exchanged. the accuracy of the information being exchanged. Its goal is to facilitate access to and retrieval of Its goal is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, clinical data to provide safer, more timely, efficient, effective, and patient-centered care. The term does effective, and patient-centered care. The term does not define the governance of the exchange model not define the governance of the exchange model or the purpose of the information in the exchange.or the purpose of the information in the exchange.

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HUB: HUB: The primary vehicles to accomplish the mission will be the application of The primary vehicles to accomplish the mission will be the application of web based technologies, data warehouse functions, personalized assistance web based technologies, data warehouse functions, personalized assistance centers, “agent partner” advocates and professional communications and centers, “agent partner” advocates and professional communications and marketing efforts. The website would be a resource available to all Oklahomans, marketing efforts. The website would be a resource available to all Oklahomans, not just those without insurance coverage. The HUB should also emphasize not just those without insurance coverage. The HUB should also emphasize patient motivation through use of this website, and stress its importance as a patient motivation through use of this website, and stress its importance as a means to drive down health care costs by patient involvement in chronic means to drive down health care costs by patient involvement in chronic condition management, and improved compliance with provider condition management, and improved compliance with provider recommendations. Similar results are also possible for primary and preventative recommendations. Similar results are also possible for primary and preventative carecare..

• Establish a system of certification for insurance programs offered in this state to be recommended by the HUB

• Establish a system for the credentialing of insurance producers who intend to market insurance programs certified by the state in accordance with this section

• Establish a system of counseling, including a website, for those individuals who are without health insurance and are not covered by Medicaid, that includes but is not limited to: (a) educating consumers about insurance programs certified by the state in accordance with this section, (b) aiding consumers in choosing policies that cover medically necessary services for that consumer, and (c) educating consumers on how to utilize primary and preventative care in order to reduce the unnecessary utilization of services by the consumer

• Establish a system whereby if an individual qualifies for a subsidy under the premium assistance program, established in Section 1010.1 of Title 56 of the Oklahoma Statutes, that person is able to become enrolled through the HUB in conjunction with local, qualified insurance producers.

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• H i i A BH i i A B

• H A NH A N• H i TH i T• H i EH i E• H U BH U B

• HHealth ealth IInformationnformationIInfrastructure nfrastructure AAdvisory dvisory BBoardoard

• HHealth ealth AAccess ccess NNetworketwork• HHealth ealth IInformation nformation TTechnologyechnology• HHealth ealth IInformation nformation EExchangexchange• Health Insurance ExchangeHealth Insurance Exchange

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MOST FAMOUS BASEBALL LINEUPMOST FAMOUS BASEBALL LINEUP

WHYWHYBECAUSEBECAUSE

NATURALLYNATURALLY

TOMORROWTOMORROW

DON’T CAREDON’T CARE

TODAYTODAY

WHOWHOI DON’T KNOWI DON’T KNOW

WHATWHAT

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Technology Technology EnablersEnablers

Health Health Information Information TechnologyTechnology

Health Access Health Access NetworkNetwork

Health Health Information Information

ExchangeExchange

Health Health Insurance Insurance ExchangeExchange

““H”H”

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TECHNOLOGY BASEBALL LINEUPTECHNOLOGY BASEBALL LINEUP

HANHAN

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HITHIT

HANHAN


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HITHIT

HANHANHIEHIE


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HITHIT

HANHAN

HUBHUB

HIEHIE


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HITHIT

HANHAN

HUBHUB

HIEHIE

Affordable Affordable Care ActCare Act


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HITHIT

HANHAN

HUBHUB

HIEHIE

Recovery ActRecovery ActAffordable Affordable Care ActCare Act


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HITHIT

HANHAN

HUBHUB

HIEHIE

Recovery ActRecovery ActNew MMIS New MMIS Fiscal AgentFiscal Agent



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HITHIT

HANHAN

HUBHUB

HIEHIE



HIPAA 5010HIPAA 5010


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HITHIT

HANHAN

HUBHUB

HIEHIE



ICD - 10ICD - 10

HIPAA 5010HIPAA 5010


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HEALTH CARE INDUSTRY ROADBLOCKHEALTH CARE INDUSTRY ROADBLOCK

0

1

2

3

4

Y2K ICD-10

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TARGETSTARGETS

PlanningPlanning

CY 2010CY 2010

ImplementImplement

CY 2011CY 2011

ImplementImplement

CY 2012CY 2012

ImplementImplement

CY 2013CY 2013

Operations + Operations + SustainabilitySustainability

CY 2015CY 2015ImplementImplement

CY 2014CY 2014

ICD-10ICD-10HIPAAHIPAA

HUBHUB

HANHAN

HITHITHIEHIE

MMISMMIS

ACAACA

ARRAARRA

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Who is on First? State Designated Entities.Who is on First? State Designated Entities.

• Affordable Care ActAffordable Care Act• CMS Medicaid EHR CMS Medicaid EHR

Incentive ProgramIncentive Program• Health Information Health Information

ExchangeExchange• Loan ProgramLoan Program• ARRA Regional Extension ARRA Regional Extension

CenterCenter• Workforce GrantsWorkforce Grants• Broadband GrantsBroadband Grants• ARRA Beacon Community ARRA Beacon Community

GrantGrant• Meaningful UseMeaningful Use

• TBDTBD• Oklahoma Health Care Oklahoma Health Care

Authority (Authority (SoonerCareSoonerCare))• Oklahoma Health Information Oklahoma Health Information

Exchange TrustExchange Trust• TBDTBD• Oklahoma Foundation for Oklahoma Foundation for

Medical QualityMedical Quality• Several schoolsSeveral schools• Office of State Finance et alOffice of State Finance et al• The Community Council of Tulsa The Community Council of Tulsa

– GTHAN– GTHAN• Oklahoma Health Care Oklahoma Health Care

Authority + Oklahoma State Authority + Oklahoma State Department of HealthDepartment of Health

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Incremental Approach to HIE ImplementationIncremental Approach to HIE Implementation

• How to meet health information exchange when HIE How to meet health information exchange when HIE organizations do not currently exist or do not connect all organizations do not currently exist or do not connect all clinical trading partners in my town?clinical trading partners in my town?

CY 2015 should include required participation in CY 2015 should include required participation in statewide - nationwide HIEstatewide - nationwide HIE

Require capability and data exchange where possible in Require capability and data exchange where possible in CY 2011CY 2011

Defer to OHIET the requirements and roadmap specific to Defer to OHIET the requirements and roadmap specific to OklahomaOklahoma

Seek Federal approvals in CY 2010Seek Federal approvals in CY 2010

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OHIETOHIET

LegalLegal

Oklahoma HIT Oklahoma HIT CoordinatorCoordinator

Oklahoma Health Oklahoma Health Information Information

Exchange TrustExchange Trust

Supporting State Supporting State AgenciesAgencies

Advisory BoardAdvisory Board

Taskforces and Taskforces and WorkgroupsWorkgroupsTaskforces and Taskforces and

WorkgroupsWorkgroupsTaskforces and Taskforces and



WorkgroupsWorkgroups

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OHIET Advisory Board• Oklahoma Health Care Authority, Oklahoma Health Care Authority, • Oklahoma State Department of Health, Oklahoma State Department of Health, • Oklahoma Department of Mental Health and Substance Abuse Services,Oklahoma Department of Mental Health and Substance Abuse Services, • University of Oklahoma Health Sciences Center, University of Oklahoma Health Sciences Center, • Oklahoma State University Center for Health Sciences, Oklahoma State University Center for Health Sciences, • A nominee of the Indian Health Service Office responsible for Oklahoma,A nominee of the Indian Health Service Office responsible for Oklahoma,• A representative of Tribal interests,A representative of Tribal interests,• Oklahoma Hospital Association, Oklahoma Hospital Association, • Oklahoma Osteopathic Association, Oklahoma Osteopathic Association, • Oklahoma Pharmacy Association, Oklahoma Pharmacy Association, • Oklahoma State Medical Association, Oklahoma State Medical Association, • Oklahoma State Chamber of Commerce, Oklahoma State Chamber of Commerce, • Oklahoma Association of Health Plans. Oklahoma Association of Health Plans. • Security and privacy representative nominated by the OKHISPC, Security and privacy representative nominated by the OKHISPC, • A health information exchange representative as nominated by the Health Information A health information exchange representative as nominated by the Health Information

Exchange workgroup, Exchange workgroup, • A consumer appointed by the Governor, A consumer appointed by the Governor, • A nominee of the Oklahoma Regional Extension Center steering committee (HITREC)A nominee of the Oklahoma Regional Extension Center steering committee (HITREC)

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OHIET – Network of Networks

• OHIET wants local health information exchanges to develop where feasible

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• Common data standards will allow network-network data communications

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• Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated

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• Chain together local HIE into a statewide system across Oklahoma

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• Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al]

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• Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al]

• Do state agencies need to have an HIE?

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HEALTH INFORMATION EXCHANGE OF HEALTH INFORMATION EXCHANGE OF ELECTRONIC HEALTH RECORD DATAELECTRONIC HEALTH RECORD DATA

Pharmacy

Lab

Patient

Provider Insurance

Hospital

FEDERAL PROGRAMSFEDERAL PROGRAMS

Regional HIE

STATESTATE

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HEALTH INFORMATION EXCHANGEHEALTH INFORMATION EXCHANGEeMPI finds a patienteMPI finds a patientRLS know the location of dataRLS know the location of dataHIE retrieves the dataHIE retrieves the data• Lab informationLab information• Clinical case summaryClinical case summary• ePrescribingePrescribing

INITIAL ONC PRIORITYINITIAL ONC PRIORITY

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HEALTH INFORMATION EXCHANGEHEALTH INFORMATION EXCHANGEeMPI finds a patienteMPI finds a patientRLS know the location of dataRLS know the location of dataHIE retrieves the dataHIE retrieves the data• Lab informationLab information• Clinical case summaryClinical case summary• ePrescribingePrescribing• Medication historyMedication history• Insurance coverage Insurance coverage • ImmunizationsImmunizations

INITIAL ONC PRIORITYINITIAL ONC PRIORITY

LATERLATER

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SoonerCare and HIESoonerCare and HIE1) The OHCA ePrescribing strategy

should merge into HIE approach

2) No LAB results within OHCA

3) SoonerCare has a need for clinical case summary from the HIE; OHCA has no clinical case summary data to contribute to HIE

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SoonerCare and HIESoonerCare and HIE1) The OHCA ePrescribing strategy

should merge into HIE approach2) No LAB results within OHCA3) SoonerCare has a need for clinical case

summary from the HIE; OHCA has no clinical case summary data to contribute to HIE

4) OHCA does have medication history5) OHCA has real time insurance data6) OSDH has immunization data; OHCA

has ‘some’ data to contribute to HIE

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HIE Strategic and Operations PlanHIE Strategic and Operations Plan

1) SoP being written2) Deadline for ONC submittal is

August 31, 20103) OSDH + OHCA must sign the SoP4) Must get ONC prior approval of the

SoP before any future funding

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PATIENT-CENTRICPATIENT-CENTRIC

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Tangible BenefitsTangible Benefits1) Quantify and measure health care quality2) Give providers more reliable data helping to

avoid medical errors and make better decisions3) Avoid redundant testing4) Lower consumer hassles5) Help reduce provider administrative burdens6) Engage consumers 7) Minimize drug seeking behaviors8) Statewide detection of infectious disease9) Lead to value based on evidence10) Rural areas have access to data

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Technology Must Have a CustomerTechnology Must Have a Customer

• PatientsPatients

• Reduced hasslesReduced hassles

• Improved qualityImproved quality

• Providers - FacilitiesProviders - Facilities

• Practice EnvironmentPractice Environment

• Improved qualityImproved quality

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Donated TalentDonated Talent• consumersconsumers• hospitalshospitals• medical associationsmedical associations• state agenciesstate agencies• medical schoolsmedical schools• health planshealth plans• tribestribes• IHSIHS• whole host of otherswhole host of others

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Oklahoma EHR Incentive ProgramOklahoma EHR Incentive Program1) State Medicaid HIT Plan formally sent to

CMS/RO on July 28, 20102) SMHP already reviewed informally3) OHCA will execute a contract amendment

with HP for fiscal agent services to pay the incentives

4) An I-APD is being written which will authorize the federal draw

5) OHCA aiming for January 2011 start6) Medicare aiming for May 2011

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Oklahoma EHR Incentive ProgramOklahoma EHR Incentive Program

PANELIST WILL GO THROUGH THE HIT PROGRAM DETAILS

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Documents

1 Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010