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8/8/2019 State HIE Update Barrows
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Deloitte Touche Tohmatsu 2006. All rights reserved.
8/8/2019 State HIE Update Barrows
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2004 Deloitte & Touche LLP. Private and Confidential2004 Deloitte & Touche LLPMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
State HIE Cooperative
Agreement Program
Update On
Columbia University
Center for Advanced Information Management,
Annual Informatics Update
Oct 5 2011
8/8/2019 State HIE Update Barrows
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Discussion Plan
Overview of State HIE Cooperative AgreementProgram
Role in HITECH and MU
Essential domains for statewide HIE planning,
implementation, evaluation
Current Status & Activities
Approved Plans
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
State HIE CA Program: Overview
Fund sustainable expansion of HIE within andbetween states
Awards to state agencies or SDEs
Support provider meaningful use requirements
Statutorily-mandated State Plan requirement
Cooperative Agreement assistance instrument
Anticipates ONC involvement in performance of work
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
FROM: Linder, Ma, Bates, Middleton, et al; Electronic Health Record Use and the Quality of Ambulatory Care in the United
States.
ARCH INTERN MED/VOL 167 (NO. 13), JULY 9, 2007.
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
MU Objectives Supported by HIE 170.304(b) Generate/transmit permissible prescriptions
170.302(b) Implement drug-formulary checks 170.302(j) Medication reconciliation at encounters/transition of care
170.302(h) Incorporate structured/coded clinical lab results into EHR-S
170.304(i) Exchange key clinical info among providers/authorized entities
170.304 (h) Provide summary of care record for transitions/referrals
170.304(h) Clinical summaries to patient after each visit
170.304(f) Provide patients with copy of health info/discharge instructions
170.304(g) Provide patients with timely access to health info 170.302(k) Submit data to immunization registries
170.306(g) Submit reportable lab results to public health
170.302(l) Submit syndromic surveillance data to public health
170.304(j) Report ambulatory quality measures
170.302(i) Generate lists of patients by condition
170.302(m) Patient-specific health education resources
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Cooperative Agreement Awards
Based on CA/grant applicationRequirements in Federal Opportunity Announcement (FOA)
40/56 states/territories awarded February 2010
1 year Anniversary of HITECH
Remainder awarded March 2010
Total 56 states and territories: $547,703,438
Cooperative Agreement includes
Terms & Conditions
Milestones
Possible funds restriction pending remediation or milestoneachievement
Milestone for release of implementation funding
Approval of State Plan by HHS Secretary (ONC)
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
State Plan
HITECH Sec 3013 requires State PlanActivities to facilitate HIE according to national standards
In public interest
c/w ONC strategic plan
Implementation activities (operational plan)
Elements as specified by HHS (as per FOA)
FOA defines State Plan
Strategic Plan
Address vision, goals, objectives, and strategies, to promote statewide HIE
Operational Plan Execution and implementation details of strategic plan
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Program/Plan Domains & HIE Services
Essential Domains for incremental progress
Governance
Finance (sustainability)
Technical Infrastructure
Operations (business & technical)
Legal & Policy (challenges & solutions)
HIE Servicese-eligibility & e-claims transactions
eRx and e-refill requests
Medication fill Hx and Rx fill status
Clinical lab e-orders and results e-deliveryClinical summary exchange (care coordination, patient engagement)
Quality Reporting
Public health e-reporting (immunizations, notifiable lab results)
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Governance
Collaborative, multi-stakeholder modelHITECH 3013(g) statutory consultation requirement
Sustain trust and participation
Resource allocationOversight & accountability
Provide transparency
State HIT Coordinator and rolePublic-Private Partnership ?
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Legal entity name 2006. All rights reserved.
Public Governance Models for HIE
From: Report to the State Alliance for eHealth, prepared by U. Mass Med School CHPR, NORC, and NGA Center for Best Practices
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Finance
Financial Sustainability beyond Program4-year period of CA Program (HITECH/ARRA) funding
Cost estimates
Staffing planProject plan
Risk analysis & mitigation strategies
Financial procedures and controlsCompliance with GAAP and OMB circulars
Required reporting
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Technology Infrastructure
Alignment with HHS interoperability standardsArchitecture
Reflects business/clinical requirements
Statewide HIE forProviders
Public Health
Patient engagement
Protects health dataNHIN alignment
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Business & Technical Operations
Leverage resources
Bandwidth
Workforce
HIOs/HIEs
EHR-S installations
Registries
Repositories
Reach all providers/geographies
Standard operating procedures
Project/Program Management
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Legal & Policy
HHS Privacy & Security Framework
Nationwide Privacy and Security Framework for Individually Identifiable HealthInformation [December 15, 2008]
Legal analyses
Statutory changes
Policies and Procedures
Trust Agreements
Oversight and enforcement
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Program Information Notice
Review
One-time investment
Concern with mandated provider participation
Clarify
State/SDE responsibilities
Roles of HIT Coordinator
Elements of S & O Plans (State Plan)
Focus
Operationally feasible plan to enable
eRx
Receipt of structured lab results
Sharing patient care summaries
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2004 Deloitte & Touche LLP. Private and ConfidentialMember ofDeloitte Touche Tohmatsu Legal entity name 2006. All rights reserved.
Status
Approved state plansCA, DE, MD, ME, NM, UT (__, __)
State HIE Toolkit website (MD, NM, UT)
State/SDE website (CA, ME, others)
Other plans: under reviewExamples
Discussion
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2004 Deloitte & Touche LLP. Private and Confidential
Deloitte Touche Tohmatsu 2006. All rights reserved.
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