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1 Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010.

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Presentation on theme: "1 Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010."— Presentation transcript:

1 1 Technology, Members and Things That Start with the Letter “H” Oklahoma Health Care Authority Board Retreat Midwest City, Oklahoma - August 25-27, 2010 John Calabro, CIO

2 2 Key Definition HEALTH INFORMATION INFRASTRUCTURE ADVISORY BOARD The Authority shall operate as a hub for health information exchange between health related state agencies and other health information organizations. Information exchange shall be implemented through interagency agreements among all health related agencies. The agreement shall ensure, but shall not be limited to: confidentiality of informationconfidentiality of information funding and implementation of the plan, which may include phased-in implementation, and procedures for coordinating, monitoring, andfunding and implementation of the plan, which may include phased-in implementation, and procedures for coordinating, monitoring, and improving data exchange that is compatible with current adopters of electronic medical record systems and health information technologies.improving data exchange that is compatible with current adopters of electronic medical record systems and health information technologies. Oklahoma Health Care Authority Oklahoma Health Care Authority Oklahoma State Department of Health, Oklahoma State Department of Health, Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma Department of Mental Health and Substance Abuse Services Oklahoma Department of Human Services Oklahoma Department of Human Services Oklahoma State and Education Employees Group Insurance Board Oklahoma State and Education Employees Group Insurance Board Oklahoma Insurance Department Oklahoma Insurance Department Oklahoma Department of Corrections Oklahoma Department of Corrections Oklahoma State Department of Rehabilitative Services Oklahoma State Department of Rehabilitative Services Oklahoma City-County Health Department Oklahoma City-County Health Department Tulsa-County Health Department Tulsa-County Health Department

3 3 Electronic Health Record (EHR) - An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care organization. EHR is associated with the ‘HIT’ initiatives. Key Definition

4 4 Health Information Exchange (HIE) is the actual electronic mobilization or movement of healthcare information across organizations within a region or community. HIE is the capability to move clinical information electronically between disparate healthcare information systems while maintaining the accuracy of the information being exchanged. Its goal is to facilitate access to and retrieval of clinical data to provide safer, more timely, efficient, effective, and patient-centered care. The term does not define the governance of the exchange model or the purpose of the information in the exchange.

5 5 Key Definition HUB: The primary vehicles to accomplish the mission will be the application of web based technologies, data warehouse functions, personalized assistance centers, “agent partner” advocates and professional communications and marketing efforts. The website would be a resource available to all Oklahomans, not just those without insurance coverage. The HUB should also emphasize patient motivation through use of this website, and stress its importance as a means to drive down health care costs by patient involvement in chronic condition management, and improved compliance with provider recommendations. Similar results are also possible for primary and preventative care. Establish a system of certification for insurance programs offered in this state to be recommended by the HUB Establish a system for the credentialing of insurance producers who intend to market insurance programs certified by the state in accordance with this section Establish a system of counseling, including a website, for those individuals who are without health insurance and are not covered by Medicaid, that includes but is not limited to: (a) educating consumers about insurance programs certified by the state in accordance with this section, (b) aiding consumers in choosing policies that cover medically necessary services for that consumer, and (c) educating consumers on how to utilize primary and preventative care in order to reduce the unnecessary utilization of services by the consumer Establish a system whereby if an individual qualifies for a subsidy under the premium assistance program, established in Section 1010.1 of Title 56 of the Oklahoma Statutes, that person is able to become enrolled through the HUB in conjunction with local, qualified insurance producers.

6 6 H i i A BH i i A B H A NH A N H i TH i T H i EH i E H U BH U B Health Information Infrastructure Advisory BoardHealth Information Infrastructure Advisory Board Health Access NetworkHealth Access Network Health Information TechnologyHealth Information Technology Health Information ExchangeHealth Information Exchange Health Insurance ExchangeHealth Insurance Exchange

7 7 MOST FAMOUS BASEBALL LINEUP WHY BECAUSE NATURALLY TOMORROW DON’T CARE TODAY WHO I DON’T KNOW WHAT

8 8 Technology Enablers Health Information Technology Health Access Network Health Information Exchange Health Insurance Exchange “H”

9 9 TECHNOLOGY BASEBALL LINEUP HAN

10 10 HIT HAN TECHNOLOGY BASEBALL LINEUP

11 11 HIT HAN HIE TECHNOLOGY BASEBALL LINEUP

12 12 HIT HAN HUB HIE TECHNOLOGY BASEBALL LINEUP

13 13 HIT HAN HUB HIE Affordable Care Act TECHNOLOGY BASEBALL LINEUP

14 14 HIT HAN HUB HIE Recovery Act Affordable Care Act TECHNOLOGY BASEBALL LINEUP

15 15 HIT HAN HUB HIE Recovery Act New MMIS Fiscal Agent Affordable Care Act TECHNOLOGY BASEBALL LINEUP

16 16 HIT HAN HUB HIE Recovery Act New MMIS Fiscal Agent Affordable Care Act HIPAA 5010 TECHNOLOGY BASEBALL LINEUP

17 17 HIT HAN HUB HIE Recovery Act New MMIS Fiscal Agent Affordable Care Act ICD - 10 HIPAA 5010 TECHNOLOGY BASEBALL LINEUP

18 18 HEALTH CARE INDUSTRY ROADBLOCK

19 19 TARGETS Planning CY 2010 Implement CY 2011 Implement CY 2012 Implement CY 2013 Operations + Sustainability CY 2015 Implement CY 2014 ICD-10HIPAA HUB HAN HIT HIE MMIS ACA ARRA

20 20 Who is on First? State Designated Entities. Affordable Care ActAffordable Care Act CMS Medicaid EHR Incentive ProgramCMS Medicaid EHR Incentive Program Health Information ExchangeHealth Information Exchange Loan ProgramLoan Program ARRA Regional Extension CenterARRA Regional Extension Center Workforce GrantsWorkforce Grants Broadband GrantsBroadband Grants ARRA Beacon Community GrantARRA Beacon Community Grant Meaningful UseMeaningful Use TBDTBD Oklahoma Health Care Authority (SoonerCare)Oklahoma Health Care Authority (SoonerCare) Oklahoma Health Information Exchange TrustOklahoma Health Information Exchange Trust TBDTBD Oklahoma Foundation for Medical QualityOklahoma Foundation for Medical Quality Several schoolsSeveral schools Office of State Finance et alOffice of State Finance et al The Community Council of Tulsa – GTHANThe Community Council of Tulsa – GTHAN Oklahoma Health Care Authority + Oklahoma State Department of HealthOklahoma Health Care Authority + Oklahoma State Department of Health

21 21 Incremental Approach to HIE Implementation How to meet health information exchange when HIE organizations do not currently exist or do not connect all clinical trading partners in my town?How to meet health information exchange when HIE organizations do not currently exist or do not connect all clinical trading partners in my town?  CY 2015 should include required participation in statewide - nationwide HIE  Require capability and data exchange where possible in CY 2011  Defer to OHIET the requirements and roadmap specific to Oklahoma  Seek Federal approvals in CY 2010

22 22 OHIET Legal Oklahoma HIT Coordinator Oklahoma Health Information Exchange Trust Supporting State Agencies Advisory Board Taskforces and Workgroups

23 23 OHIET Advisory Board Oklahoma Health Care Authority,Oklahoma Health Care Authority, Oklahoma State Department of Health,Oklahoma State Department of Health, Oklahoma Department of Mental Health and Substance Abuse Services,Oklahoma Department of Mental Health and Substance Abuse Services, University of Oklahoma Health Sciences Center,University of Oklahoma Health Sciences Center, Oklahoma State University Center for Health Sciences,Oklahoma State University Center for Health Sciences, A nominee of the Indian Health Service Office responsible for Oklahoma,A nominee of the Indian Health Service Office responsible for Oklahoma, A representative of Tribal interests,A representative of Tribal interests, Oklahoma Hospital Association,Oklahoma Hospital Association, Oklahoma Osteopathic Association,Oklahoma Osteopathic Association, Oklahoma Pharmacy Association,Oklahoma Pharmacy Association, Oklahoma State Medical Association,Oklahoma State Medical Association, Oklahoma State Chamber of Commerce,Oklahoma State Chamber of Commerce, Oklahoma Association of Health Plans.Oklahoma Association of Health Plans. Security and privacy representative nominated by the OKHISPC,Security and privacy representative nominated by the OKHISPC, A health information exchange representative as nominated by the Health Information Exchange workgroup,A health information exchange representative as nominated by the Health Information Exchange workgroup, A consumer appointed by the Governor,A consumer appointed by the Governor, A nominee of the Oklahoma Regional Extension Center steering committee (HITREC)A nominee of the Oklahoma Regional Extension Center steering committee (HITREC)

24 24 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible

25 25 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible Common data standards will allow network- network data communications

26 26 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible Common data standards will allow network- network data communications Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated

27 27 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible Common data standards will allow network- network data communications Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated Chain together local HIE into a statewide system across Oklahoma

28 28 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible Common data standards will allow network- network data communications Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated Chain together local HIE into a statewide system across Oklahoma Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al]

29 29 OHIET – Network of Networks OHIET wants local health information exchanges to develop where feasible Common data standards will allow network- network data communications Geographic gaps in coverage anywhere in Oklahoma will be OHIET facilitated Chain together local HIE into a statewide system across Oklahoma Link to federal programs [NHIN, VA, IHS, Medicare, TriCare, DoD, SSA, et al] Do state agencies need to have an HIE?

30 30 HEALTH INFORMATION EXCHANGE OF ELECTRONIC HEALTH RECORD DATA Pharmacy Lab Patient Provider Insurance Hospital FEDERAL PROGRAMS Regional HIE STATE

31 31 HEALTH INFORMATION EXCHANGE eMPI finds a patient RLS know the location of data HIE retrieves the data Lab information Lab information Clinical case summary Clinical case summary ePrescribing ePrescribing INITIAL ONC PRIORITY

32 32 HEALTH INFORMATION EXCHANGE eMPI finds a patient RLS know the location of data HIE retrieves the data Lab information Lab information Clinical case summary Clinical case summary ePrescribing ePrescribing Medication history Medication history Insurance coverage Insurance coverage Immunizations Immunizations INITIAL ONC PRIORITY LATER

33 33 SoonerCare and HIE 1)The OHCA ePrescribing strategy should merge into HIE approach 2)No LAB results within OHCA 3)SoonerCare has a need for clinical case summary from the HIE; OHCA has no clinical case summary data to contribute to HIE

34 34 SoonerCare and HIE 1)The OHCA ePrescribing strategy should merge into HIE approach 2)No LAB results within OHCA 3)SoonerCare has a need for clinical case summary from the HIE; OHCA has no clinical case summary data to contribute to HIE 4)OHCA does have medication history 5)OHCA has real time insurance data 6)OSDH has immunization data; OHCA has ‘some’ data to contribute to HIE

35 35 HIE Strategic and Operations Plan 1)SoP being written 2)Deadline for ONC submittal is August 31, 2010 3)OSDH + OHCA must sign the SoP 4)Must get ONC prior approval of the SoP before any future funding

36 36 PATIENT-CENTRIC

37 37 Tangible Benefits 1)Quantify and measure health care quality 2)Give providers more reliable data helping to avoid medical errors and make better decisions 3)Avoid redundant testing 4)Lower consumer hassles 5)Help reduce provider administrative burdens 6)Engage consumers 7)Minimize drug seeking behaviors 8)Statewide detection of infectious disease 9)Lead to value based on evidence 10)Rural areas have access to data

38 38 Technology Must Have a Customer PatientsPatients Reduced hasslesReduced hassles Improved qualityImproved quality Providers - FacilitiesProviders - Facilities Practice EnvironmentPractice Environment Improved qualityImproved quality

39 39 Donated Talent consumersconsumers hospitalshospitals medical associationsmedical associations state agenciesstate agencies medical schoolsmedical schools health planshealth plans tribestribes IHSIHS whole host of otherswhole host of others

40 40 Oklahoma EHR Incentive Program 1)State Medicaid HIT Plan formally sent to CMS/RO on July 28, 2010 2)SMHP already reviewed informally 3)OHCA will execute a contract amendment with HP for fiscal agent services to pay the incentives 4)An I-APD is being written which will authorize the federal draw 5)OHCA aiming for January 2011 start 6)Medicare aiming for May 2011

41 41 Oklahoma EHR Incentive Program PANELIST WILL GO THROUGH THE HIT PROGRAM DETAILS

42 42


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