Public Health and Health Information ExchangeConnecting health to improve outcomes for all

Agenda

• Health Information Exchange (HIE)

• CORHIO and ARRA HITECH

• Opportunities for Public Health

• Colorado Health Information Initiatives

• Q & A

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HIE Improves Efficiency & Communication

Hospitals

Primary care physician

Specialty physician

Ambulatory center (e.g. imaging centers)

Payors

Pharmacy

Laboratory

Public health

Point to Point Interfaces

Specialty physician

Pharmacy

Laboratory

Hospitals

Primary care physician

Ambulatory center (e.g. imaging centers)

Payors

Public health

Health Information Exchange Model

HIE

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Benefits of HIE

• Saves Time & Reduces Cost– Less time searching, calling and faxing = more efficient use of

resources– Streamlined access to patient histories and discharge summaries– Decreased need for unnecessary and duplicate tests, medications and

hospitalizations– Fewer mistakes

• Improves Care– More time with patients; less time searching through paper records and

waiting for information– Increased transparency of identified patient populations thru analysis

and reporting– Longitudinal record of patient care reduces errors– Fewer delays in treatment

• Enhances Patient Privacy– Less paper; controlled and audited access to patient health information

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Why state-level HIE?

• Greater Impact– Community based focus goes beyond HIE as an IT Tool and

focuses on clinical use and workflow– Shared HIE = No Wrong Door for patients– Close alignment with State systems

• Broader Reach– Statewide connectivity increases reach of all participating

providers– Improves public system communication and interaction with

providers

• Lower Cost: – Volume based vendor contracts allow for shared cost savings

over enterprise implementation– Reduced duplication of data and processes– Reduced resource demands for collecting and analyzing data

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About CORHIO

Our Mission– To facilitate health information exchange to improve care for

all Coloradans

Our Vision– Shared health information for all individuals in every

Colorado community promoting the right care at the right time and place

Goals– Health information exchange deployed in every community– 85% of all primary care providers and safety-net providers

are meaningful users of electronic health records (EHRs)– 85% of all providers statewide are meaningful users of EHRs

*Meaningful Use described below

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About CORHIO

Current Initiatives, Projects and Progress

• State Designated Entity for HIE

• HIE Rollout Community–by–Community– Boulder, Colorado Springs, and San Luis Valley– Centura and Children’s Hospital– Integrating with QHN

• State and Federal Policy– Health Reform, CIVHC– Privacy & Security– Behavioral Health

• ARRA HITECH Act

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ARRA HITECH Act

• American Recovery and Reinvestment Act (ARRA) signed February 2009

• Included Health Information Technology for Economic and Clinical Health (HITECH) Act

Regional Extension Centers (RECs)

Updates to HIPAA Certification of EHR

Technology

Health Information Exchange (HIE)

Health IT Workforce Medicare & Medicaid

EHR Incentive Program

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ARRA HITECH Medicare & Medicaid EHR Incentive Program

Purpose

– encourage the adoption and meaningful use of health information technology to improve efficiency and quality of care

Approach

– provide financial incentives to Medicare and Medicaid providers to adopt, implement, upgrade, and become “Meaningful Users” of Electronic Health Records (EHRs) and the electronic exchange of health information

Timeline

– ARRA HITECH February 2009, Notice of Proposed Rule Making January 2010, Final Rule July 2010, Incentive payments begin 2011

Meaningful Use As a Driver to Health Care Transformation

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Quality Reporting

Clinical Decision Support

Improving Care Coordination

Engaging Patients

Managing Population Health

Meaningful Use

Quality Im

provement

Tech

nolog

y

Practice

Redesig

n

Exchange

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Meaningful Use: Who is eligible for incentives? Medicare Medicaid

Eligible Professionals (EPs) Eligible Professionals (EPs)

Doctor of Medicine or Osteopathy Physicians

Doctor of Dental Surgery or Dental Medicine Nurse Practitioners (NPs)

Doctor of Podiatric Medicine Certified Nurse-Midwives (CNMs)

Doctor of Optometry Dentists

Chiropractor Physician Assistants (PAs) who practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a PA*

Eligible Hospitals Eligible Hospitals

Acute Care Hospitals Acute Care Hospitals, CAHs

Critical Access Hospitals (CAHs) Children’s Hospitals

* FQHC or RHC considered “PA-led” if PA is clinical or medical director at clinical site of practice, is the primary provider at a clinic, or if PA owns the RHC.

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Meaningful Use Incentives

• Eligible hospitals can participate in Medicare and Medicaid programs

• Eligible professionals (EPs) must choose between Medicare or Medicaid incentives

– Allowed to switch between programs one time

• Medicaid EPs must serve at least 30% Medicaid patient volume to receive incentive payments

– Pediatrician threshold at 20% Medicaid volume– For EPs working in FQHCs or RHCs, organization only needs to meet

threshold of 30% “needy individuals” (Medicaid, CHP, uninsured, sliding scale)

• Medicare payment reductions begin 2015 for non-meaningful users

• Incentive payments based on cost for implementing– Medicaid maximum for EPs is $63,750 over 6 years– Medicare maximum for EPs is $44,000 over 5 years– Eligible hospitals receive $2M base + calculation based on discharges

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Meaningful Use: Stage 1 Overview

• To meet certain objectives/measures, 80% of all providers’ patients must have records in the certified EHR technology

• EPs have to report on 20 of 25 MU objectives– 15 “core” objectives, select 5 more from “menu set”

• Eligible hospitals have to report on 19 of 24 MU objectives– 14 “core” objectives, select 5 more from “menu set”

• Medicare / Medicaid same requirements, except states have option of moving 4 public health objectives from “menu set” to “core” for Medicaid incentives

– generate lists of patients by specific conditions– provide electronic syndromic surveillance data to public health agencies– submit electronic data to immunization registries/systems– provide electronic submission of reportable lab results to public health

agencies

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Meaningful Use: Clinical Quality Measures (CQM)

• Eligible Professionals must report on 6 total CQM: – 3 required core measures (substituting alternate core measures where

denominator would be zero on 3 required) and 3 additional measures from a set of 38 CQM

• Eligible hospitals must report on 15 CQM

• Alignment with other quality programs / initiatives– coordinating with PQRI, RHQDAPU, CHIPRA, and PPACA development

NQF Measure & PQRI Implementation Number

Clinical Quality Measure Title

Core Set for EPs

NQF 0013 Hypertension: Blood Pressure Measurement

NQF 0028 Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention

NQF 0421PQRI 128

Adult Weight Screening and Follow-up

Alternate Core Set for EPs

NQF 0024 Weight Assessment and Counseling for Children and Adolescents

NQF 0041PQRI 110

Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older

NQF 0038 Childhood Immunization Status

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Meaningful Use:Stages 2 & 3 Overview

• Centers for Medicare and Medicaid Services (CMS) intends to propose Stages 2 & 3 through future rulemaking

• Stage 2 will build upon Stage 1– Current “menu set” will be transitioned into “core”– Possibly higher thresholds for objective measures– Greater emphasis on HIE across entities– Possibly greater state flexibility– Possibly include administration simplification (i.e. electronic eligibility

and claims transactions)

• Stage 3 will emphasize use of EHR technology and HIE to improve quality, safety, and efficiency

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Why Meaningful Use Matters

• Medicaid and Medicare incentive payments– Time-limited opportunity to encourage EHR adoption and begin progress toward

HIE

• Administrative efficiencies and savings

• EHRs and electronic info exchange have potential to:– Improve quality, safety, efficiency, and reduce health disparities– Engage patients and families in their health care– Improve care coordination– Improve population and public health – Ensure adequate privacy and security protections for personal health

information

• Realizing the benefits of EHRs and HIE only possible with broad participation

• As Meaningful Use advances to Stages 2 & 3, those who are not participating will get left behind

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What is CORHIO Doing to Support Meaningful Use?

• Colorado Regional Extension Center www.CO-REC.org

– Technical assistance, guidance, and information on best practices to support and accelerate Colorado health care providers' efforts to become meaningful users of EHRs

– Help qualified primary health care providers implement and meaningfully use: EHRs, HIE, clinical workflow, process redesign, local workforce development and quality improvement

• Health Information Exchange– CORHIO building statewide HIE and partnering with Quality Health

Network (QHN) on Western Slope

– HIE can facilitate Meaningful Use requirements including eRx, drug formulary checks, structured lab results, medication reconciliation, structured care summaries, public health

• State Medicaid HIT Plan– CORHIO working with HCPF and stakeholders to create comprehensive

strategic vision for state support of Meaningful Use and HIE, including developing Medicaid EHR Incentive program administration

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Opportunities for Public Healthpresented by HIE and EHRs

• Easier access to better quality, more up-to-date, more flexible, longitudinal data

• Reduced resource needs to collect and store data–surveys, databases, etc.

• One interface for results delivery / immunization tracking– One interface for providers

– One interface for the State / counties

• Possible direct provider communication (i.e. public health alerts) through single portal

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Opportunities for Public Healthpresented by HIE and EHRs

• Clinical Decision Support tools customized for public health – (i.e. prompts about flu shots for at-risk populations, chronic disease

management guidelines, etc.)

• Personalized care plans, information, and reports with development and adoption of Personal Health Records

• Possibility for secure, limited, auditable exchange of sensitive health information to provide for better health outcomes and simultaneously protect vulnerable populations

– (i.e. substance abuse, HIV, etc.)

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Other Colorado State Health Information Initiatives

• CDPHE

– Public health data improvements - immunization registry, etc.*

• HCPF

– Accountable Care Collaborative (RCCOs, SDAC)*

– CBMS modernization

– State Medicaid HIT Plan – MMIS strategic planning*

– EHR (Meaningful Use) Incentive Program Administration*

• DHS

– Focus on integrating behavioral and physical health*

• CIVHC

– All Payer Health Claims Database*

– Delivery System / Payment Reform*

• Government Data Advisory Board

– Interdepartmental state data standards*

• National Health Reform

– Insurance exchanges, grant opportunities, etc.*

• State Health IT Strategic Planning*

• Colorado Telehealth Network

• Colorado Beacon Consortium*

*indicates CORHIO involvement

Section Break 2

Questions?