Arizona Health Information Exchange (HIE) Strategic Update August 23, 2010 Governor’s Office of Health Information Exchange (GOHIE) hie@az.gov 1 WELCOME Beth Kohler Lazare – Deputy Policy Director 2 Agenda • Welcome – Beth Kohler Lazare • Governor’s Office of Health Information Exchange – James Apperson • Objectives – Aaron Sandeen • Arizona Health-e Connection – Regional Extension Center – Benton Davis – Melissa Rutala • Arizona HIE Strategy Review – Aaron Sandeen • AHCCCS State HIT Strategy / HIE Alignment – Lorie Mayer • Next Steps – Aaron Sandeen 3 GOVERNOR’S OFFICE OF HEALTH INFORMATION EXCHANGE James Apperson – Director, Governor’s Office of Economic Recovery 4 GOHIE • Governor Brewer’s Office of Economic Recovery – Responsible for the reporting and tracking of $2.5+ billion of ARRA stimulus money – 24 State agencies & Universities – 473 Grants including State Fiscal Stabilization Fund, Broadband Technology Opportunity Program, State Energy Program, etc. • Governor’s Office of Health Information Exchange – New office responsible for the oversight and implementation of the HIE program in Arizona • Aaron Sandeen – Deputy Director, Office of Economic Recovery – State Health Information Technology Coordinator, Arizona HIE 5 OBJECTIVES Aaron Sandeen – State Health Information Technology (HIT) Coordinator 6 Arizona HIE Award Department of Health and Human Services (HHS) Office of the National Coordinator (ONC) for Health Information Technology (HIT) Award Amount – $9,377,000 7 State HIE Program: Purpose Secure, Electronic Movement & Use of Health Information Nationwide HIE Interoperability Facilitate and expand the secure, electronic movement and use of health information among organizations according to nationally recognized standards Federal-state collaboration aimed at the longterm goal of nationwide HIE and interoperability Statewide Policy, Develop the statewide policy, governance, Governance, Technical technical infrastructure and business practices Infrastructure & needed to support the delivery of HIE services Business Practices 8 State Responsibilities • Transparent multi-stakeholder process • Monitor and track meaningful use HIE capabilities in the state • Assure trust of information sharing (privacy & security) • Set Strategy to Meet Gaps in HIE Capabilities for Meaningful Use • Ensure consistency with national policies and standards • Align with Medicaid and public health programs 9 Guiding Principles • • • • Support privacy and security Represent special populations Focus on desired outcomes Support HIE services and adoption for all relevant stakeholder organizations • Be operationally feasible, achievable and sustainable, building on what is already working • Remain vigilant, foster innovation and adapt to emerging trends, standards and developments 10 2011 Key Deliverables & Objectives E-Prescribing Receipt of Structured Lab Results Patient Care Summaries HIE Fundamental Capabilities 11 Monitor & Track Meaningful Use • % health plans supporting electronic eligibility and claims transactions • % pharmacies accepting electronic prescribing and refill requests • % clinical laboratories sending results electronically • % health departments electronically receiving immunizations, syndromic surveillance, and notifiable laboratory results 12 Federal Government Participation • Collaborate with states and SDEs to promote, monitor and share efficient, scalable and sustainable mechanisms for HIE within and across states. • Help to coordinate and share information regarding federal health IT investments and programs across agencies (e.g., CDC, CMS, HRSA, AHRQ, ONC and non-HHS federal agencies). • Conduct a national program evaluation and offer technical assistance for state-level evaluations. • Adopt standards and certification criteria to enable interoperability and HIE. • Coordinate information sharing across states. • Advance standards-based HIE through Nationwide Health Information Network (NHIN) standards, services and policies. 13 Initial Deliverables – August 31 Strategic Plan Comprehensive strategy tailored to Arizona’s vision, goals and capacities as well as the particular opportunities presented by HITECH. The Strategic Plan defines priorities and sequencing of activities, performance measures and risk mitigation strategies. Operational Plan Outlines details for how and when Arizona’s strategy will be executed to meet specific HIE implementation targets in 2 years, 4 years and beyond as HITECH related incentives evolve. 14 High-Level Strategy • The State is not building an HIE platform • Limited amount of funding – focus on getting the biggest Return On Investment (ROI) that we can • Focus on meeting Meaningful Use and meeting Federal HIE requirements • Leverage 2006 Roadmap and work that is currently happening in the state • Inline with Federal communications and standards • Outreach to other states 15 High-Level Approach • Hire Core Project Team • Form Stakeholder Committee & Executive Steering Committee – Ongoing Feedback • Leverage Resources to Develop Plans – ONC Plan Guidelines – Approved Plans – 2006 Health-e Connection Roadmap • Submit Plans – August 31 16 Stakeholder Engagement • Stakeholder Committee – Open Public Forum • Executive Steering Committee – Limited Members for Decision Making • Stakeholder Meetings – Ongoing • Specific Subject Working Group Meetings 17 ONC Guidelines http://statehieresources.org 18 ONC – Strategic Plan Guidelines General Components – – – – – – – Environmental Scan HIE Development and Adoption HIT Adoption Medicaid Coordination Coordination of Medicare and Federally Funded, State Programs Participation with Federal Care Delivery Organizations Coordination with other ARRA Programs Domain-Specific Components – – – – – Governance Finance Technical Infrastructure Business and Technical Operations Legal/Policy 19 ONC – Operational Plan Guidelines General Components – Project Schedule – Coordination with ARRA Programs – Coordination with Other States Domain-Specific Components – Governance – Finance – Technical Infrastructure – Business and Technical Operations – Legal/Policy 20 ONC – Approved Plans (3) • New Mexico • Utah • Maryland 21 Health-e-Connection 2006 Roadmap • Excellent starting point – most content still applicable to ONC guidelines • Gap Analysis – many sections to be refreshed & a few missing • Incorporate applicable content into new strategic & operational plans leveraging other approved plans 22 AZHEC Benton Davis – Board Chair, Arizona Health-e Connection Melissa Rutala, MPH – Acting Executive Director, Arizona Health-e Connection 23 Arizona Regional Extension Center August 23, 2010 Melissa Rutala, MPH Acting Executive Director Director, Regional Extension Center Advancing health and wellness through information technology Page 24 Agenda • Arizona Health-e Connection • Arizona Regional Extension Center – The purpose – The structure – The services – The collaborations • Collaborating with AHCCCS and GOHIE • Opportunities to Get Involved! Advancing health and wellness through information technology Page 25 Arizona Health-e Connection Advancing health and wellness through information technology Page 26 Arizona Health-e Connection (AzHeC) exists to Convene, Coordinate & Communicate for Health Information Infrastructure improvements that affect every Arizonan Advancing health and wellness through information technology Page 27 Governor’s Office AHCCCS ADHS AzHHA ArMA AOMA GITA Arizona Health-e Connection Board Health Plans/Insurers Employers Hospitals Pharmacy Clinical Labs Higher Education Medical Trading Areas At-Large Seats Additional Permanent AzHeC Governance Structure and Strategic Direction Arizona Health-e Connection Staff Information Clearinghouse Policy Development Support for HII Development 28 Advancing health and wellness through information technology Page 28 Definitions- HII, HIE and HIT HII Health Information Infrastructure The wider arena of policies, procedures, technologies and industry standards that facilitate secure and accurate online sharing of electronic medical information between providers, payors and ultimately, patients and their guardians via HIE/HIT. HIE HIT Health Information Exchange “The Network” Health Information Technology “The Record” The electronic movement of health-related information among organizations according to nationally recognized standards. Use of technology to support storage, retrieval, sharing, and use of healthcare information for communication and decision making within healthcare organizations. Advancing health and wellness through information technology Page 29 Health Information Infrastructure Personal Health Health Care Delivery Public Health Advancing health and wellness through information technology Page 30 Arizona Regional Extension Center Advancing health and wellness through information technology Page 31 Regional Extension Centers • Nationwide… – Goal to assist 100,000 primary care providers reach Meaningful Use (MU) in 2 years – 60 Regional Extension Centers (RECs) funded – $635 million awarded • Each REC has exclusive geographic area… so no overlap! Advancing health and wellness through information technology Page 32 General REC Services Advancing health and wellness through information technology Page 33 What is a PPCP? Advancing health and wellness through information technology Page 34 Arizona HIT Extension Center Overview • Grant Recipient – Arizona Health-e Connection • Organization Background – Statewide non-profit leading Arizona’s establishment of health information infrastructure (HII), including adoption of EHRs and HIE. • Key Subrecipients – Health Services Advisory Group (HSAG) – Purchasing & Assistance Collaborative for EHRs (PACeHR) – Arizona State University Department of Biomedical Informatics (ASU-BMI) Advancing health and wellness through information technology Page 35 Arizona HIT Extension Center Target & Value • Provider Target – Target of 1,958 PPCPs to MU by April 2012 • Mission / Value Statement – To create a trusted, neutral entity that offers the tools, resources and communities of practice that Arizona healthcare providers need to foster Meaningful Use of electronic health records. Advancing health and wellness through information technology Page 36 Advancing health and wellness through information technology Page 37 Advancing health and wellness through information technology Page 38 Conceptual Approach to Meaningful Use Advancing health and wellness through information technology Page 39  Meaningful Use: Core Set of Objectives for Eligible Professionals (1-5) Computerized physician order entry (CPOE) > 30% of unique pts seen with meds listed have at least one ordered by CPOE  E-prescribing (eRx) > 40% permissible scripts written sent electronically    Report ambulatory clinical quality measures to CMS/States 6 measures (3 required, 3 elective) Implement one clinical decision support rule yes/no Provide patients with an electronic copy of their health information, upon request >50% who request within 3 business days Advancing health and wellness through information technology Page 40 Meaningful Use: Core Set of Objectives for Eligible Professionals (6-10)   Provide clinical summaries for patients for each office visit provide for > 50% all office visits w/in 3d Drug-drug and drug-allergy interaction checks enabled   Record demographics > 50 % seen (5 specific items) Maintain an up-to-date problem list of current and active diagnoses > 80% pts seen have at least one structured entry  Maintain active medication list > 80% pts seen have at least one structured entry Advancing health and wellness through information technology Page 41  Meaningful Use: Core Set of Objectives for Eligible Professionals (11-15) Maintain active medication allergy list > 80% pts seen with at least one structured entry  Record and chart changes in vital signs > 50% > age 2 seen have ht, wt BP (structured)   Record smoking status for patients 13 years or older > 50% unique pts seen (structured data) Ability to exchange key clinical information among providers electronically At least one test  Protect electronic health information security risk analysis, security updates and deficiency correction Advancing health and wellness through information technology Page 42 Meaningful Use: Menu Set of Objectives for Eligible Professionals (1-5)  Drug-formulary checks using –at least one formulary  Incorporate clinical lab test results as structured data >40% of all ordered labs return as structured data  Generate lists of patients by specific conditions at least one list of EP with a specific condition  Send reminders to patients per patient preference for preventive/follow up care > 20 % (>64 or <6) sent one  Provide patients with timely electronic access to their health information >10% supplied access within 4 days Advancing health and wellness through information technology Page 43 Meaningful Use: Menu Set of Objectives for Eligible Professionals (6-10)  Use certified EHR technology to identify patientspecific education resources and provide to patient, if appropriate provided to > 10% seen  Medication reconciliation for >50% of transitions  Summary of care record for each transition of care/referrals provide summaries for > 50% of referrals  Capability to submit electronic data to immunization registries/systems* perform one test  Capability to provide electronic syndromic surveillance data to public health agencies* one test *At least 1 public health objective must be selected. Advancing health and wellness through information technology Page 44 Arizona Regional Extension Center Advancing health and wellness through information technology Page 45 REC Range of Services Number of Providers Served Paper to Meaningful Use 1……………………………750……………………………1500………………1,958 Service #9: Meaningful Use Accomplished Service #8: Interoperability & Health Information Exchange Service #7: Privacy & Security Service #6: Practice & Workflow Redesign Service #5: Project Management & Implementation Service #4: Vendor Contracting Service #3: Vendor Selection Service #2: Readiness Assessment Service #1: REC Sign-Up Sample Menu of Services REC May Provide Advancing health and wellness through information technology Page 46 Arizona HIT Extension Center Strategy Number of Providers Served Paper to Meaningful Use 1……………………………750……………………………1500………………1,958 Az REC Services Az REC Services Az REC Services Strategic Partners Services Already Provided/Completed Current EHR Users Services Already Provided/Completed This strategy leaves a much smaller scope of services overall that the REC will need to provide for its clients, allowing the REC to leverage current EHR initiatives. Advancing health and wellness through information technology Page 47 Arizona HIT Extension Center Spectrum of Services All PPCPs Membership General Education Member Community User Groups #1 Practice Transform’n & Workflow Planning IT Infrast. Assessment & Readiness EHR Vendor Assessment & Matching Service Readiness Assessment & Planning Stage Ancillary Product & Services Matching Service Vendor Contracting Education EHR Implement’n Facilitation/ High Project Mgmt EHR System Selection, Deployment & Implementation Optimization to Meaningful Use Meaningful Use Attestation #3 #2 Paper to MU PPCPs Advancing health and wellness through information technology EHR to MU PPCPs Page 48 Funnel Approach to Meaningful Use General Education No EHR PPCPs EHR – Gap to MU EHR – Optimized for MU MU Attestation 1,958 PPCPs to Meaningful Use! Advancing health and wellness through information technology Page 49 Arizona HIT Extension Center Provider Offerings PPCPs Core Membership Provider Membership Non-PPCPs Estimated $200-400/provider/year Includes general education, member community user groups EHR Assistance Packages Basic Package Includes phone support & coaching w/ readiness, workflow redesign and IT assessments, vendor selection & contracting tools, implementation and project management TBD (subsidized) TBD (not subsidized) TBD (subsidized) TBD (not subsidized) Premium Package Includes Basic Package plus additional phone support and on site assistance with above services Other Offerings- Add On Services EHR Optimization to Meaningful Use Meaningful Use Attestation On Site IT Assessment Other Services Advancing health and wellness through information technology Page 50 Core Subrecipients • Purchasing & Assistance Collaborative for Electronic Health Records (PACeHR) – Business strategy & ramp-up activities • Health Services Advisory Group (HSAG) – EHR technical assistance • Arizona State University Department of Biomedical Informatics – Education and workforce development Advancing health and wellness through information technology Page 51 Marketing & Outreach Subrecipients • Marketing and Outreach – Arizona Medical Association (ArMA) – Arizona Osteopathic Medical Association (AOMA) – Arizona Hospital and Healthcare Association (AzHHA) – University of Arizona (Rural Health Office and College of Public Health) Advancing health and wellness through information technology Page 52 Web Portal • Web Portal will be a One-Stop-Shop for: – General Education Resources – Readiness Assessment & Planning Self Assessment Tools – EHR Vendor Selection tool – Detailed Education Resources – Communities of Practice, based on: • Geography, EHR vendor, provider specialty and more… – Connecting REC providers to vendor community via REC Vendor Directory! Advancing health and wellness through information technology Page 53 Next Steps! • Goal to open doors in September/October • Finalizing: – Provider pricing structure – Strategic partnerships – Web portal technology – Vendor value program – EHR “supported” vendor selection – Core educational content – Business process development Advancing health and wellness through information technology Page 54 Coordination with AHCCCS and GOHIE Advancing health and wellness through information technology Page 55 Strategic Alliance is Key! GOHIE HIE Community HIE & Technology Vendors Healthcare Providers Health Plans Patient Consumer Organizations Education and Research AzHeC Public Health AHCCCS Advancing health and wellness through information technology Page 56 2011 Meaningful Use Key Deliverables E-Prescribing Receipt of Structured Lab Results Patient Care Summaries Advancing health and wellness through information technology Page 57 Addressing the Key Deliverables • Set statewide goals that align the Meaningful Use objectives of GOHIE, AHCCCS and REC – E-Prescribing – Structured Lab Results – Patient Care Summaries • Ensure key messages around each goal are developed and communicated to all stakeholders Advancing health and wellness through information technology Page 58 E-Prescribing • Capitalize on the EAzRx Initiative – Tracking of eRx metrics with assistance from Surescripts • Possibly integrate REC with eRx Utilization Program to ensure technical issues addressed • Consider incentive opportunities to get independent pharmacies on board • Coordinate with HIOs to ensure eRx Meaningful Use metrics are met Advancing health and wellness through information technology Page 59 Structured Lab Results • GOHIE – Primary responsibility for 2011 HIE priorities • REC and AHCCCS – Incorporation of clinical lab test results as structured data “menu” objective in 2011/12 – Likely will become a “core” objective in Meaningful Use Stage 2, so need to be prepared – Assist in tracking metrics for overall statewide strategies Advancing health and wellness through information technology Page 60 Patient Care Summaries • GOHIE – Primary responsibility for 2011 HIE priorities • REC and AHCCCS – Providing clinical summaries to patients part of Meaningful Use Stage 1 – Likely more stringent HIE requirements in future stages, so need to be prepared – Can assist in tracking the metrics for overall statewide strategies Advancing health and wellness through information technology Page 61 Overall AzHeC Support for GOHIE and AHCCCS • Utilize infrastructure already in place – Education event coordination & speakers bureau – Information distribution to Az HIT community – Leverage REC team for HIE efforts, when possible • Committees to support GOHIE work group needs – – – – Clinical/Technical Committee Legal Committee E-Prescribing Steering Committee Consumer Advisory Council Advancing health and wellness through information technology Page 62 Opportunities to Get Involved! Advancing health and wellness through information technology Page 63 Meaningful Use Forums • Regional MU Provider Sessions – Yuma: Tuesday, August 10th, 5:30-8pm – Tucson: Wednesday, August 11th, 7-9am, 12-1:30pm, 6-8pm – Flagstaff: Tuesday, August 24th, 6-8pm – Phoenix: Wednesday, August 25th, 7-9am, 12-1:30pm, 6-8pm & Thursday, August 26th, 12-1:30pm • FREE for providers, practice managers, and AzHeC members! Advancing health and wellness through information technology Page 64 AzHeC Calendar of Events Arizona Health-e Connection 2010 Calendar of Events February 24, 8–9 AM Webinar: Use of Electronic Medical Records and Physicians' Attitudes toward a Health Information Exchange August 25, 5:30-7:30 PM Forum: Meaningful Use of Electronic Health Records March 31, 8–9 AM Webinar: Dr. John Halamka, Co-Chair of the (Federal) HIT Standards Committee September 22, 8–9 AM Webinar: International Perspective on HIT April 12-13 Western States Health-e Connection Summit & Trade Show October 27, 5:30-7:30 PM Forum: EHR Implementation “How To” Workshop May 26, 8–9 AM Webinar: Health Transformation Institute Overview November 17, 8–9 AM Webinar: Personal Health Records June 23, 5:30-7:30 PM Forum: Healthcare Informatics December 15, 6-8 PM Holiday Gathering July 28, 8–9 AM Webinar: ARRA, HITECH – Arizona Projects Update *Please note that with the exception of November, all AzHeC events are held on the fourth Wednesday of the month (Webinars, 8-9AM; Forums, 5:307:30PM). **Webinars are complimentary for AzHeC members; $20 for non-members. Forums are $40 for AzHeC members, $55 for non-members. Advancing health and wellness through information technology Page 65 Save the Date! Western States Health-e Connection Summit & Trade Show April 11-12, 2011 Phoenix Convention Center Advancing health and wellness through information technology Page 66 Stay Informed! • Sign up for free AzHeC email newsletters – Email contact information to info@azhec.org • Sign up for free Az Regional Extension Center updates – Email contact information to ehr@azhec.org • Check out our website for latest updates and links to REC information! – www.azhec.org Advancing health and wellness through information technology Page 67 Arizona’s Point of Coordination www.azhec.org www.azhecblog.org 602.288.5130 info@azhec.org ehr@azhec.org Advancing health and wellness through information technology Page 68 ARIZONA STRATEGIC PLAN SUMMARY Aaron Sandeen – State Health Information Technology (HIT) Coordinator 69 Arizona Environmental Scan • HIE delivery to the 6.6 million Arizona’s in all 4 corners of our state • 86 Hospitals, 16 FQHCs, 6 Regional Health Centers, 13,000+ Practitioners • Arizona Health Care Cost Containment System (AHCCCS) – State HIT Plan • Arizona Health-e Connection – Regional Extension Center grant • Health Information Network of Arizona (AMIE/SAHIE) • Governor’s Office of Health Information Exchange – Health Information Exchange grant General Components 70 HIE Development & Adoption Vision Implement a sustainable statewide Health Information Exchange (HIE) that enables the sharing of health care data across organizational boundaries to improve patient safety, security, quality, and cost. General Components 71 HIE Development & Adoption - Objectives • Implement an HIE platform across the state in a “phased” approach focusing on specific milestones and ensure ONC requirements are fulfilled by 2014. • Initial stages of the HIE platform in 2011 will include the capabilities for E-Prescribing, receipt of structured lab results, and sharing patient care summaries across unaffiliated organizations. • Ensure meaningful use outcomes for health systems and providers by providing viable HIE capabilities. • Prioritize privacy and security. • Represent underserved and rural populations. General Components 72 HIE Development & Adoption - Objectives • Effectively manage grant resources as a one-time investment and deliver long-term value to the state of Arizona. • Support HIE services and adoption for all relevant stakeholder organizations, including providers in small practices, across a broad range of uses and scenarios. • Be operationally feasible, achievable, and sustainable, building on what is already working. • Remain vigilant, foster innovation and adapt to emerging trends, standards and developments both locally and nationally. General Components 73 HIE Development & Adoption - Strategies • Governance of privacy and security • Partner with existing Arizona entities and build upon existing solutions • Form strategic alliance between GOHIE, Arizona Health-e Connection (AzHeC), and Arizona Health Cost Containment System (AHCCCS) • Build the sustainable future • Strategic Infrastructure Partnerships General Components 74 GOHIE HIE Community HIE & Technology Vendors Healthcare Providers Health Plans Patient Consumer Organizations Education and Research Public Health AzHeC General Components AHCCCS 75 Other HIE (CAPAZ-MEX) NHIN Federal Agencies Nationwide Health Information Network Health Registries –e.g. Immunizations Public Agencies Physician Practices Radiology Centers • • • • • • • • • • • • Service Oriented Architecture Federated, Centralized, and Hybrid model Community Master Entity Index Health Plan Eligibility Files Data Translation & Interoperability Services Community Nomenclature Service Authentication, Authorization and Patient Consent Advanced Clinical Decision Support Data Repository Security and Auditing Services User Portals - Providers, Patients, Care Mangers Patient-Centered Medical Home Process Model Physician Portal Health Plan Surescripts Laboratories Patient Portal EMR with CPOE, CCD capabilities and advanced decision support Medical Home General Components 76 HIT Adoption • AHCCCS – GOHIE – AzHeC • Monitor/Track – HIE Infrastructure – EHR Education & Adoption • Leverage Arizona Telemedicine Program to provide specialized care to rural and underserved populations • Ensure EHR connectivity to HIE infrastructure General Components 77 Medicaid Coordination • Medicaid HIE Representation • AHCCCS’ Meaningful Use Education Strategies – Leverage established communication channels – Extensive website for incentive education – Test pilot to ensure AHCCCS’ ability to register, verify, pay and audit providers • AHCCCS’ 5 Year HIT/HIE Goals and Objectives • Long-term Approach for Meaningful Use • Lorie will provide greater details General Components 78 Federal Care Delivery Organizations • 16 FQHCs – many have begun or completed EHR implementations • HIE implementation will be incorporated into the detailed Operational plan • Indian Health Services (IHS) and the Veterans Affairs (VA) is part of the long-term HIE strategy and will leverage the NHIN – GOHIE will work with IHS and VA on statewide strategy on stakeholder participation General Components 79 Coordination of Other ARRA Programs • Governor’s Office of Economic Recovery (GOER) – Grants Awarded • • • • • State Fiscal Stabilization Fund-Education (Phase I) State Fiscal Stabilization Fund-Government Services Health Information Exchange State Fiscal Stabilization Fund-Education (Phase II) Broadband Technology Opportunities Program (BTOP) II – Public Computing Centers – Grants Submitted • Race to the Top • Education Jobs Fund Program • Arizona Health-e Connection – Regional Extension Center General Components 80 Governance • Collaborative Governance Model – – – – Transparent, Collaborative Stakeholders Engagement AHCCCS AzHeC HINAz • Accountability & Transparency • Arizona HIT Coordinator – Champion Statewide HIT Implementation – Coordinate Efforts with Medicaid, Public Health and Other Federally Funded Programs • National Health Information Network (NHIN) Strategy • Continued Activities – HIE Grant and Beyond Domain-Specific 81 Finance • HIE Grant Impact – $9,377,000 – one-time investment to accelerate HIE implementation – Community participation to supplement federal funds for implementation – Phased implementation over 4 years for statewide HIE adoption • Long-term Sustainable Plan – $7,428,000 – estimated annual cost of fully implemented solution – Need balanced long-term community participation – Health Information Network of Arizona (HINAz) has been building consensus and is building on past success towards next HIE solution Domain-Specific 82 Technical Infrastructure – Standards Based • Standards based - Integrated Healthcare Enterprise (IHE) approach for infrastructure components for the HIE solution • Embrace the Health Information Technology Standards Panel (HITSP) • Support incremental and risk/cost/benefit-driven approach to the roll-out of the HIE • Provide world class components for core HIE capabilities • Align with Office of the National Coordinator (ONC) and the National Health Information Network (NHIN) Domain-Specific 83 Other HIE (CAPAZ-MEX) NHIN Federal Agencies Nationwide Health Information Network Health Registries –e.g. Immunizations Public Agencies Physician Practices Radiology Centers • • • • • • • • • • • • Service Oriented Architecture Federated, Centralized, and Hybrid model Community Master Entity Index Health Plan Eligibility Files Data Translation & Interoperability Services Community Nomenclature Service Authentication, Authorization and Patient Consent Advanced Clinical Decision Support Data Repository Security and Auditing Services User Portals - Providers, Patients, Care Mangers Patient-Centered Medical Home Process Model Physician Portal Health Plan Surescripts Laboratories Patient Portal EMR with CPOE, CCD capabilities and advanced decision support Medical Home General Components 84 Technical Infrastructure – End-to-End • Sophisticated person-centric HIE solution supporting a hybrid, federated or centralized HIE deployment model • Leverage standards for exchanging data and documents like Cross-Enterprise Document Sharing (XDS.a & XDS.b), Patient Identifier Cross-Referencing (PIX) and Patient Demographics Query (PDQ) • Implement Personal Health Record (PHR) application and/or connection to 3rd-party PHRs such as Google Health and Microsoft HealthVault via Continuity of Care Document (CCD) or Continuity of Care Record (CCR) patient summaries • Consent solution capable of supporting multiple consent models (including opt-in / opt-out) based on contributing source and other criteria Domain-Specific 85 Technical Infrastructure – End-to-End • Standards compliant Master Patient Index interfaces through PIX / PDQ profiles • NHIN integration & interoperability with other NHIN participants, including the Social Security Administration • Provider portal capabilities ensuring an easy to use vehicle for caregivers (CCHIT certified) • Eventually communicate and exchange information with other HIEs such as CAPAZMEX, IHS and Veterans Affairs via NHIN Domain-Specific 86 Authentication/ Authorization Access Control Logging/ Auditing Consent Management Care Coordination Portal Data Warehouse Deindentification Reidentification Registries Clinical Decisioning Clinical Decision Support Evidence Based Guidelines Clinical and Claims Data (pre-visit, concurrent, post-visit) Medical Home Registry Loosely Coupled Interface Routing Transoformation Access to Care Tracking ADT Event Scheduling Follow-ups Care Opportunity Management E-HR Patient Profiles NHIN NHIN Payor Trading Partners (e.g. LabCorp, Quest) NCPDP Trading Partner Surescripts RxHub NCPDP Physician eMRs Edge Server Access Management Personal Health Record Case Management Enterprise Services Bus Nomenclature Services LOINC, CPT, I CD9, ICD10, SNOMED RxNorm HCPCS Drug DB (Multum, Gold Standard) Patient Portal HL7 IHE X.12 Community Master Entity Index Persons, Physicians, Organizations Maintain relationships (e.g. Physicians to Patients HIE HL7 WdAC – Clinical Objects Community Index eMR (CCHIT) HL7 2/3 IHE eMR Lite XDS Persistent Data as required EMR-Lite, EMR, PHR SSA PIX/ PQQ Provider Portal JSPs Dispatcher Actions Page Beans Clinical Data Repository Data Access (HI72.x, KL7 3.x, IHE, NHIN, X.12, ASTM, PIX/PDQ, XDS, NCPDP, DIACOM) incl (CDA, CCD, CCR) User Interfaces Acute Care eMR Clinical Administration XDS RLS MPI Translation 87 Technical Infrastructure – System Components • Master Patient Index • Provider Identity Management • Document Registry • Document Repository • Clinical Data Repository (CDR) • Edge devices • Integration framework Domain-Specific • Authentication and Authorization • Consent Management • Subscription Management • Logging and Audit • Nomenclature Normalization • Portal / EMR- Lite / EMR • Personal Health Record (PHR) 88 Implementation Timeline Proposed implementation: a) Medications, Lab results and Patient Care Summaries for nine major hospital systems in the state, including Flagstaff and Yuma b) discharge summaries from five of the nine hospitals c) clinical care summary exchange from seven primary care practices. Domain-Specific 89 Business & Technical Operations GOHIE Vendor(s) Implementation Resources Contractual Stakeholder Participation Domain-Specific 90 Risk Management Approach Risks • Identify Risks • Engage Stakeholders, Leaders & Experts • Create Implementation Plans • Review • • • • • • • • • Domain-Specific Privacy & Security Consent Participation Agreements Liability Insurance Sustainability Cost Containment Community Data Sharing Other HIEs Platform Capabilities 91 Legal / Policy – Health Information Security & Privacy Collaboration (HISPC) • Arizona Health Privacy Project Phase One – AzHeC Legal Committee worked on proposed legislation remedy legal barriers to HIE and model policies / procedures for provider access to the HIO and an enforcement policy for inappropriate access to the HIO • Arizona Health Privacy Project Phase Two - Guide to Adoption of Uniform Security Policy – Individuals will have access to their patient health information – Governance of statewide HIE activities is open and transparent – Individuals/patients have a choice to participate in the electronic exchange of their health information – Limitations exist on the collection, use and disclosure of patient health data – Participants, including users, HIE entities and data source have a responsibility to ensure data quality and integrity – Organizations engaged in HIE activities are accountable for complying with federal and state regulations for safeguarding and securing patient health information • State Laws 92 AHCCCS Lorie Mayer – AHCCCS HIT Coordinator 93 Medicaid Coordination with State Health Information Exchange Agreement Program 94 American Recovery and Reinvestment Act (ARRA)/ HITECH Act   In February 2009, as part of the federal stimulus package, Congress enacted the Health Information Technology for Economic and Clinical Health Act ("HITECH"). The legislation included a number of provisions designed to encourage the adoption and use of health information technology including electronic health records (EHRs) and the development of a health information exchange ("HIE") infrastructure   Includes strategy for supporting rapid EHR adoption and “Meaningful Use” of certified EHR technology implemented over multi year period Use of EHR key to improving health care quality and reporting 95 Summary of Final Rule Meaningful Use: Medicaid Provider Eligibility Final Meaningful Use Rule Medicaid Eligible Professionals (EPs)      Physicians Nurse Practitioners Certified Nurse Midwives Dentists Physician Assistants working in a federally Qualified Health Center (FQHC) or rural health clinic Medicaid Eligible Hospitals    Acute Care Hospitals (now including Critical Access Hospitals) Children’s Hospital Estimate for Incentives is $500 -million over 6 years for Arizona 96 Summary of Payments: Medicaid EP Adoption Timeline 2011 2012 2013 2014 2015 2016 2011 $21,250 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 $8,500 2017 2018 2019 2020 2021 Total $8,500 $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 97 Incentive Payments for Eligible Hospitals      Federal Fiscal Year $2 M base + per discharge amount (based on Medicare/Medicaid share) There is no maximum incentive amount Hospitals meeting Medicare MU requirements may be deemed eligible for Medicaid payments Payment adjustments for Medicare begin in 2015    No Federal Medicaid payment adjustments Medicare Hospitals: No payments after 2016 Medicaid Hospitals: Cannot initiate payments after 2016 98 Stage 1 Overview of Meaningful Use Final Rule     Stage 1 (2011 and 2012) Eligible Providers (EPs) have to report on 20 of 25 MU objectives Eligible hospitals have to report on 19 of 24 MU objectives  The final rule divides the objectives into a “core” group of required objectives (15 for EPs and 14 hospitals) and a “menu set” of procedures from which providers can choose Recognized need for more sophisticated Health Information Exchange and quality reporting over time 99 AHCCCS HIT/HIE 5 Year Goals 1. Health Information Exchange    AHCCCS represented on a state level HIE governance operating entity Participation with an HIE that has a sustainable business plan and includes finance and governance resources Participates with an HIE that promotes health care quality and ensures privacy and security of data for members and providers 100 AHCCCS HIT/HIE 5 Year Goals 2. Health Information Technology for Hospitals   Hospitals representing 90 percent of inpatient days will qualify and meet meaningful use criteria 90 percent of IHS and 638 inpatient facilities will qualify and meet meaningful use criteria 3. Health Information Technology for Eligible Providers    90 percent of all eligible providers in FQHC will qualify and meet meaningful use 75 percent of all eligible providers will receive meaningful use incentive payments The percent of physicians routing e-RX would increase up to 40 percent 101 AHCCCS HIT/HIE 5 Year Goals 4. Program Integrity  Provide adequate oversight of the incentive program, resulting in no federal disallowances 5. Be prepared to pay incentives by Summer 2011 102 Overview of EHR Incentive Payment Program Processes  Medicare and Medicaid providers will be required to register with CMS  Name, NPI, business address, phone  Tax Payer ID Number (TIN)  Hospitals must provide the CCN  If Medicaid, must select one state  Eligible providers must select Medicare or Medicaid  Arizona EPs and hospitals will then register and apply thru AHCCCS website  Providers will complete and submit Incentive Payment Request forms thru an on-line process  Section I – Provider demographic information  Section II- Information needed for assessing providers meaningful use status  Section III – Payment information and provider attestation  Agency will verify eligibility, disperse payment after cross-checking for potential duplicative or inappropriate payments 103  Disburse payment to one eligible TIN- Quarterly Medicaid Incentive Program Strategies  AHCCCS website http://azahcccs.gov     Created new Health Information Tab on home page Identify preliminary list of Medicaid Eligible Providers and work with plans to target communication Identify small group of EPs and Hospitals for testing with AHCCCS between February – May 2011 Work with Regional Extension Center for education and outreach events and link interested providers to them for EHR selection and implementation support 104 NEXT STEPS Aaron Sandeen 105 Strategic & Operational Plans • Strategic Plan & presentation on website – http://azgovernor.gov/hie • Complete Operational Plan and post to website • Strategic & Operational Plan Feedback – Friday August 27 – There will be opportunities for additional feedback • Submit Plans to ONC 106 Ongoing Stakeholder Engagement • Identify Executive Steering Committee • Schedule Quarterly Stakeholder Meetings • Schedule Working Groups (looking for leaders and participants) – Risk Mitigation – Technical Infrastructure and HIE capabilities – Calendar to be posted on website starting in September – Regional meetings will be part of the plan • Finalize Vendor/Contract Selection Process 107 Communications • State HIE Website – http://azgovernor.gov/hie – Open, transparent communication – Resources, News, Completed Documents, Calendar • Centralized Contact Distribution List – Maintain communication with all interested parties – Please email me if you would like to be added to our list – hie@az.gov 108 Aaron Sandeen State Health Information Technology (HIT) Coordinator 602.501.3261 asandeen@az.gov Ryan Sommers Manager of IT Projects and Services 602.542.7000 rsommers@az.gov hie@az.gov http://azgovernor.gov/hie 109 Arizona Health Information Exchange (HIE) Strategic Update August 23, 2010 Governor’s Office of Health Information Exchange (GOHIE) hie@az.gov 110