1. Accelerating Reform Initiative February 2010 Learning Session Critical Factors Influencing Implementation: Information Systems Presented by: Rebecca Novak Healthcare Perspective, LLC

2. Agenda Understanding Current Initiatives related to Healthcare Information Systems – Setting the Stage for Health Care Reform is Already Underway ARRA/HITECH – Meaningful Use – What Does it Mean? – Health Information Exchange Other Federal Initiatives – HIPAA 5010 – ICD-10 Steps to Survival

3. ARRA/HITECH ARRA – American Resources for Recovery Act – This is the stimulus package that was passed in February 2009. – Set aside $19.2 Billion Dollars for Health Care IT – Infrastructure Grants – another $7-$8 Billion. – Reimbursement Incentives - $17 Billion HITECH Section - Health Information Technology for Economic and Clinical Health Act includes: – Meaningful Use – Reimbursement Enhancement – Health Information Exchange – Health Information Technology Exchanges – New Privacy and Security Provisions

4. Major Goals and Objectives for Healthcare IT Goals: – Increase national adoption of Health IT – Assure systems are interoperable, improve quality and improve care coordination Tactics: – Government to lead and promulgate standards development – Over $19 Billion for HIT Infrastructure – Significant savings of Federal dollars long term – Updates and strengthens HIPAA regulations.

5. ARRA/HITECH Provisions Codifies Office of the National Coordinator (ONC) Creates an HIT Policy Committee Creates an HIT Standards Committee Introduces new Privacy and Security standards Creates $17 Billion dollars in Medicare and Medicaid incentives – Focus of funds is on Meaningful Use adoption – No upfront funds – based on use of certified products – Requirements increase over time and money follows

6. Components of ARRA/HITECH Medicare/Medicaid incentive begin as early as 2011 and can flow as late as 2016 Early adoption is incentivized by payments Late adoption is discouraged by: – Reduction incentive payments – Eventually (2016) by penalties Medicaid payments are based on minimum volumes and will flow through the States Payments require important conditions based on “Meaningful Use” and “Certified EHR Products”

7. Components of ARRA/HITECH Privacy and Security – HIPAA applies to business associates same as to covered entities (CE) – Covered entity must notify individuals within 60 days if breach occurs and if affects > 500 – then both HHS and Media must be notified – Patients have right to accounting of disclosures – New CE – PHR (Personal Health Record) Vendors and HIE (Health Information Exchange) Vendors – Introduces “minimum necessary” data sets for uses and disclosures. – Suggestion: Make sure Privacy Officers are aware of these changes. – http://www.himss.org/ASP/topics_privacy.asp http://www.himss.org/ASP/topics_privacy.asp

8. Message from ONC

9. Interoperability through HIE and CCD

11. CCD Contents

12. CCD - Human Readable Format

13. CCD - Machine Readable Format

14. EMR Adoption Rates

15. HITECH Priority Grants State Health Information Exchange Grant Programs – Grants are being issues early in 2010 to begin development of Local and State HIEs – CMS is requiring state Medicaid agencies to participate – Focus initially on electronic labs and eprescribing – Focus eventually on full EHR interoperability – Must address needs of special populations…including…those with mental and substance abuse disorders…medically underserved… – Build trust in and support for a statewide HIE – http://www.hhs.gov/recovery/programs/hitech/stateinfo exch.html http://www.hhs.gov/recovery/programs/hitech/stateinfo exch.html

16. HITECH Priority Grants Health Information Technology Extension Program – Offer technical assistance, guidance and information on best practices to support and accelerate health care provider’s efforts to become meaningful users of EHRs – Established at least 70 regional centers that will offer technical assistance. – HITECH acts clearly prioritizes access to health information technology for historically underserved and other special- needs programs. – Regional centers will focus…community health centers and in other settings that predominantly serve uninsured, underinsured and medically underserved populations. – Full operations by December 2010. – http://www.hhs.gov/recovery/programs/hitech/factsheet.html http://www.hhs.gov/recovery/programs/hitech/factsheet.html

17. ARRA/HITECH Quick Notes Meaningful Use – Still being defined but generally understood Electronic lab data Electronic prescribing Electronic order entry by clinicians (CPOE) – Increasing standards between 2011 and 2015 Health Information Exchange – Electronic exchange of clinical data – Appears to be following HL-7 CCD/CCR Clinical Care Document/Continuity of Care Record – State driven process with linkage to NHIN (National Health Information Network) – Fully operational by 2015

18. ARRA HIT Incentive Stages

19. Other Federal Initiatives HIPAA 5010 and ICD-10 – Final Rule issued January 2009 – Convert from HIPAA Version 4010 to 5010 by January 1, 2012 – Convert from ICD-9 to IDC-10 by October 1, 2013

20. Other Federal Initiatives HIPAA 5010 and ICD-10 – Final Rule issued January 2009 – Convert from HIPAA Version 4010 to 5010 by January 1, 2012 – Convert from ICD-9 to IDC-10 by October 1, 2013

21. 5010 and IDC-10 5010 – Major changes to 837 (claims), 835 (remittance), 270/271 (eligibility) and other HIPAA transactions – Required for ICD-10 – Major testing efforts between providers and payers ICD-10 – Coding involves more specificity, more codes, more complexity – Core billing systems will need to change – All interfaces that include diagnosis will need to change and be tested

24. Steps to Survival Fully Implement EHR at your Agency – Must first digitize the core EMR at your agency – Clinical Care, Assessments and Clinical Orders Implement e-Prescribing as soon as possible (2011) – Important first step towards meaningful use criteria Implement the CCD/CCR as soon as possible (2011) – Look for opportunities for grants – Look for HIEs in your area – pay attention – Look to state and especially Medicaid for information Talk your vendors – New releases and technology will most likely be needed to meet the requirements for Meaningful Use Begin preparing individuals providing services – timeliness of documentation is key……

25. Strategies Strategic Synergy Focus and Defer Manage Through Outsource

26. Strategic Synergy Approach: View the changes as strategic investments, look for opportunities to create synergies among the efforts Appropriate for Organizations:Aging or inadequate infrastructure Ability to make strategic investment Strong in-house or outsourced project management Risks:Ability to meet short timeframes Ability to maintain multi-year investment

27. Focus and Defer Approach: Prioritize initiatives and defer, where possible, less critical initiatives Appropriate for Organizations: Have significant challenges Limited Resources Risks:Lack of long term strategy may require revisiting tactical investments Ongoing deferral of strategic solutions will create backlog

28. Manage Through Approach: Work through the changes as a typical project effort with modest investment of resources Appropriate for Organizations: Where infra-structure is in place and changes are less dramatic and more incremental Strong project management Risks: May underestimate changes required More difficult to up-size after setting initial stakeholder expectations of modest level of effort Example: Provider with current HER and PMS

29. Outsource Approach: Outsource all major initiatives to a strategic partner (or partners) Appropriate for Organizations:Minimal current capabilities Able to find a trusted strategic partner Risks:Ability to manage vendor who will have many competing clients all with similar deadlines

30. Industry Resources Department of Health and Human Resources NIATx National Council for Behavioral Health (NCCBH) Bazelon Center Healthcare Information and Management Systems Society (HIMSS)

31. Final Comments & Questions