Health Information Exchange in Oregon

Preparing for the Future

Building from the Present

Striving for the Triple Aim

American Recovery and Reinvestment Act

President Obama signed the American Recovery and Reinvestment ACT in February 2009. The goals relating to Health Information Exchange:

“To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America’s medical records are computerized.

This will cut waste, eliminate red tape, and reduce the need to repeat expensive medical tests. But it just won’t save billions of dollars and thousands of jobs; it will save lives by reducing the deadly but preventable medical errors that pervade our health care system.”

President Barack Obama

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Health Information Exchange:More than Technology

To encourage the adoption and use of certified electronic health record (EHR) technology by the States and providers to improve health care outcomes

The EHR technology is not an end in itself but a means to achieve the goals of improving care, ensuring quality, permitting greater access to care, and reducing costs.

Lower Per Capita CostsImproved Population Health

Oregon’s Triple Aim Goal

Improved Patient Experience

One Small Step . . . Appropriated Funds: $2 billion

Cooperative agreement programs for developing interoperable health information exchange in each state

Grant programs for developing regional extension centers for technical assistance and support to providers

Entitlement Funds: $34 billion Medicare and Medicaid payment

incentives

One Giant Leap . . .

Developing a statewide interoperable system for the exchange of health information will serve as a critical tool for implementing and measuring state and national health care reform.

Appropriated Funds

$2 billion Health Information Exchange Grants

Electronic Health Record Adoption Loan Program (no details currently)

Regional Extension Centers

Workforce Training Grants

New Technology Research and Development Grants

HIT Funding Streams

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Medicare Payment

Incentives

Medicaid Payment

Incentives

Physicians

• Acute care hospital • Children’s hospitals

Incentives through Carriers

Incentives through States• Nurse Practitioner• Midwife

FQHC

Requires 30% share of Medicaid (except Children’s Hospitals)

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CMS

CMS & States

ProgramFunding Distribution

Agency Use of Funds Fund Recipients / Beneficiaries

Ap

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$2B

Workforce Training Grants

New Technology Research and Development

Grants

Medical Health Informatics

EHR in Med School Curricula • Higher Education• Medical School• Graduate schools

Health Care Information Enterprise Integration Research

Centers• Federal Gov’t Labs

HHS, NSF

NIST, NSF

Health IT Extension Program

Health IT Research Center

Regional Extension Centers Least Advantaged Providers

• Non-profit• Consulting• Vendors

ServicesONC

HIE Planning and Development

EHR Adoption Loan Program

Planning Grants

Implementation Grants

Loan Funds for States

Loan Funds for Indian Tribes

Designated State Entity

States

Indian TribesProvider

Organizations

Loans

• Non-profit• Consulting• Vendors

ONC

ONC

Health Information Exchange Cooperative Agreements

What we know: FROM: Office of the National Coordinator for HIT TO: States or Qualified State-Designated Entities FOR: Grants for both planning and implementation WHEN: Application due October 16, 2009

Planning funds beginning January 2010 Strategic and Operational Plan due July

15, 2010 Implementation funds after Plan is

approved HOW MUCH: $8.58 million over 4 years

Regional Extension Centers

What we know: FROM: Office of the National Coordinator for HIT TO: Regional Extension Centers FOR: Supporting the centers as research and

consulting organizations that assist least-advantaged providers.

Funding will be up to 50 percent of capital and annual operating budget for two years

OCHIN has been invited to submit grant application and will be partnering with OHSU

Grant application due November 3, 2009 Award selection announcement December 11,

2009

Workforce Training Grants

What we know: FROM: HHS, National Science Foundation TO: Higher education institutions FOR: Promote HIT workforce development

New Technology Research and Development Grants

What we know: FROM: National Institute of Standards and

Technology, National Science Foundation TO: Higher education, government labs, non-

profits FOR: promoting research and innovation

Entitlement Funds

$34 billionDedicated to Medicare and Medicaid as incentives for

physician

and hospitals who purchase and use Electronic Health Records

Medicaid Incentives

States may make payments to Medicaid providers to encourage adoption and use of certified EHR technology

No duplicative Medicare and Medicaid Payments to medical providers but Childrens and Acute Care Hospitals may receive both

Medicaid providers include: Physicians, dentists, certified nurse midwives, nurse practitioners,

physicians assistants that are practicing in rural health clinics or FQHCs Children and acute hospitals

Requires a percentage of patient volume allocated to either individuals receiving medical assistance, or to needy individuals

Medicare, physicians, EHR

Funds will be available commencing in calendar year 2011

Compensation for “meaningful EHR users” in an equal amount, or up to 75% of allowable charges for professional services furnished by physicians

Incentives are for 5 years, with a declining schedule each year

Phasedown for physicians adopting after CY 2013

Beginning CY 2015, reductions in Medicare reimbursements by 1 to 3% annually will impact physicians that are not “meaningful EHR users”

Incentives are available to physicians of qualified Medicare Advantage organizations

No incentives will be available after CY 2016 when disincentives begin

Certain hospital-based professionals such as pathologists, anesthesiologists, and emergency room physicians are specifically mentioned as being ineligible.

Defining Terms - The Health IT Policy Advisory Committee:Meaningful Use [mee-ning-fuh l yoos] –

“ultimate goal of meaningful use of an Electronic Health Record is to enable significant and measurable improvements in population health through a transformed health care delivery system. The ultimate vision is one in which all patients are fully engaged in their healthcare, providers have real-time access to all medical information and tools to help ensure the quality and safety of the care provided while also affording improved access and elimination of health care disparities.”

Medicare and Medicaid Timeline

2009 2010 2011 2012 2013 2014 2015 2016 2017….. 2021

Medicare Incentives begin Jan 2011 for

non-hospital based physicians

Medicaid: non-hospital basedphysicians no payments after

2021 or more than 5 yrs.

Medicare penalties begin for non-meaningful users

FY15 for hospitalscalendar 2015 for physicians

HHS develop interoperability standards end of 2009

Medicare (FY2011)Incentives begin Oct. 2010

for hospitals

Medicaid: hospitals that adopt after 2017 not eligible for incentives

Medicaid Incentives beginMedicaid: non-hospital

based physicians1st yr cost no later than 2016

Medicare IncentivesEnd 2016

Medicare phase down incentive payments for physicians

Medicare: Physicians who 1st paymentIs after 2014 receive no incentives

Setting of standards complete

Sources: HIMSS http://www.himss.org/ASP/index.asp and AHIMA http://www.ahima.org/

“The Authority establishes a Health Information Technology Oversight Council charged with focusing state, federal and private sector resources and activities to accelerate the adoption of personal health records (PHR), electronic health records (EHR) and electronic data exchange among healthcare providers, patients and consumers.”

HITOC charter and mission18

States will play a critical leadership role by determining a unified path and a model for exchange of health information. States will be expected to use their authority, programs, and resources to:

Determine roles and responsibilities of State Designated Entity (SDE), (if desired) Develop and implement Strategic and Operational Plans Develop state level directories and enable technical services for HIE within and across  states.  Remove barriers and create enablers for HIE, particularly those related to interoperability across 

laboratories, hospitals, clinician offices, health plans and other health information trading partners

Convene health care stakeholders to ensure trust in and support for a statewide approach to HIE Ensure that an effective model for HIE governance and accountability is in place Coordinate an integrated approach with Medicaid and state public health programs to enable

information exchange and support monitoring of provider participation in HIE as required for Medicaid meaningful use incentives. 

Develop or update privacy and security requirements for HIE within and across state  borders. 

Federal Grant Opportunity requirements

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September 2009-HITOC nominations announced September 2009-States Letter of Intent filed September 2009-OHSU and OCHIN file application for Regional

Extension Center September 2009-State systems environmental scan complete September 2009-Contingent attends National Governors

Association education conference October 2009-HITOC appointees confirmed October 2009 HITOC launch October 2009 ONC Cooperative Agreement application submitted

Progress to date20

HITOC Members

Chair:Steve Gordon, M.D., Eugene, VP, Chief Quality Officer, PeaceHealthVice Chair:Rick Howard, Salem, CIO, Oregon Department of Human Services & Oregon Health Authority

Bob Brown, Portland, Retired, Board member, Oregon Health Action CampaignBrian DeVore, Hillsboro, Director of Industry Affairs, IntelGreg Fraser, Sublimity, Medical Director of Information Systems and Informatics, Mid-Valley IPABridget Haggerty, Portland, VP, CIO, Oregon Health & Sciences UniversityBill Hocket, Portland, Director, Web Strategy, ODS Marie Laper, Corvallis, Coordinator of Quality Improvement & Clinical Care, Benton County Health ServicesRobert Rizk, Hermiston, Director, Information Technology, Good Shepherd Health System Sharon Stanphill, Roseburg, Clinic Director, Cow Creek Band of Umpqua Tribe of IndiansDave Widen, Dayton, Director of Pharmacy, Safeway

“If information is the lifeblood of this effort, then IT infrastructure is the circulatory system.”

“Translating thoughts into a concrete plan and paying for it in a politically charged environment is difficult to do.”

From the NGA e-health Learning Conference September 2009

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