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1 Coordination of State and Federal Policies for Health IT Implementation: A Postcard from NY Rachel Block NY eHealth Collaborative.

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Presentation on theme: "1 Coordination of State and Federal Policies for Health IT Implementation: A Postcard from NY Rachel Block NY eHealth Collaborative."— Presentation transcript:

1 1 Coordination of State and Federal Policies for Health IT Implementation: A Postcard from NY Rachel Block NY eHealth Collaborative

2 Historical Context for Health IT Policy Key Elements in New York’s Health IT Strategy Key Health IT Elements of Federal Stimulus Legislation

3 Strong Imperative for Health Care Reform US health care very costly and performs poorly compared to other countries Many studies and commissions have called for system changes to: – Improve public health – Improve quality and safety – Manage cost and care more effectively 3

4 Health Systems Change Requires Broad Use of Health IT To Err is Human (IOM) Crossing the Quality Chasm (IOM) High Performance Health System (Commonwealth Fund) Other countries (UK, Canada, Germany) 4

5 Health IT Is Necessary but Not Sufficient Health information exchange is essential complement to health IT: – Incentive to use health IT – Track care across continuum, hand-offs – Empower consumers and families – Create longitudinal information – Strengthen public health surveillance 5

6 Key Concepts in Health Information Exchange Interoperability of health information systems would facilitate exchange Broad acceptance and use of certain policies is required – Technical standards: data structure, communications – Clinical imperatives: quality, safety, care management – Protections re access and use: consent, disclosure of breach – Security policies: audit, authorization, authentication – Governance and accountability – Financing and incentives 6

7 7 Framework for New York’s Health IT Strategy ACCESS AGGREGATE&ANALYZE APPLY Statewide Health Information Network – NY (SHIN-NY) Clinical Informatics Services Aggregation MeasurementReporting “Cross-Sectional” Interoperability Clinician/EHR Consumer/PHR Community

8 8 What will get us “there” in NYS? Policy alignment Support of increased adoption of certified and interoperable EHRs in all care settings Increased adoption of patient/consumer programs including secure PHRs Coordination of care, including medication management, across care settings Disease prevention, early detection and other public health initiatives Monitoring and ongoing support of implementation to ensure safety and success Sustainable reimbursement models to promote HIT Clinical Practice/Delivery Model Reimbursement Model Patient Engagement Health Information Model

9 Governance and Accountability Public trust is key underpinning for these systems Need authority, structure and means to set policy, monitor use, enforce standards Federal government has established some policies and mechanisms but not comprehensive Establish organizational capability and accountability at state and regional levels 9

10 10 Governance and Organizational Components: Policy Development and Implementation Framework NYS Dept of Health Fund health IT Oversee contracts Enforce regulations NYeC Statewide collaborative process Deliberate & decide policies Assist RHIOs/CHITAs Implementation guides, tools, other resources RHIO Patients Providers Payers Purchasers Local Region State RHIO Patients Providers Payers Purchasers Funding and contractual obligations $ HITEC Create evaluation tools Assess sustainability Measure progress $ RHIO Patients Providers Payers Purchasers CHITAs Evaluation tools, other resources Statewide Health Information Network for NY (SHIN-NY) CHITAs RHIO Patients Providers Payers Purchasers CHITAs RHIO Patients Providers Payers Purchasers CHITAs CHITA: A collaboration supporting adoption of health ITRHIO: A governance entity that oversees HIE in its region

11 Statewide Collaboration Process NYeC Board Clinical Priorities Privacy & Security EHR Collaborative Protocols & Services Policy & Operations Council DOH NHIN Project HEAL Projects CDC Project MSSNY Projects Collaborative Work GroupsImplementation Education & Communication Committee Consumer Advocacy Council Financial Sustainability Work Group Governance/ Oversight Policy/Standards Cross-Cutting Activities HITEC

12 Policies Governing Access to and Use of Data Current law and practices protects privacy and confidentiality – need to translate and adapt to health care enabled by HIE – consent, review of disclosures, notification and remedies for breach Policies Governing Disclosure and Use – Treatment, Public Health, Research, etc 12

13 Technical Standards Data definitions and record structure Product certification requirements Strategy for connectivity – Hard coded interface specifications versus… – Open source, service oriented architecture as in what we use for the internet 13

14 Policies and Standards for Technical Security Authentication of users (clinicians, consumers) Authorization (role-based rights to access patient data) Audit (tracking disclosures) 14

15 Vision for New York’s Health Information Infrastructure Costly, High Risk and non- Interoperable EHRs Interoperable EHRs Clinician EHR SHIN-NY Consumers Payers Government/ Medicaid LabsHospitals PharmaciesRadiology

16 16 MedicaidUPHN RadLabDocuments Hospital system Results Reporting DOH Node NYS Department of Health Service Oriented Architecture Model Clinician EHR Clinician EHR Clinician EHR SHIN-NY** Integrated Child Health Record EHR Multiple Clinics (CHCs & FHQCs) PharmacyHealth Plan eRx & Med Hx SureScriptsRx Hub EHR Grouped Physician Offices EHR

17 Clinical Imperatives for HIE Clinical uses structured around “use cases” which cross walk to technical requirements – Continuum of care – medication management – Safety and efficiency – e-prescribing – Quality Improvement – quality measures for decision support and public reporting – Population health surveillance and management 17

18 Clinical Priorities: Definitions, Requirements and Applications Clinical Scenarios that illustrate value proposition Create scenarios based on use cases and subgroup priorities Reconciliation relies on cross- continuum data 2.Coordination with NHIN projects 3.Promote e-prescribing in context of advancement to a full EHR with CDS 4.Prioritization of clinical needs for financial incentive models 1.Reconciliation relies on cross- continuum data 2.Coordination with NHIN projects 3.Promote e-prescribing in context of advancement to a full EHR with CDS 4.Prioritization of clinical needs for financial incentive models Medicaid / Medication Management Quality Reporting 1.Statewide quality standards 2.Locus of aggregation 3.Key data elements/specifications 4.CDS across care settings 5.Intersection with medication management 6.Physician adoption/trust 1.Statewide quality standards 2.Locus of aggregation 3.Key data elements/specifications 4.CDS across care settings 5.Intersection with medication management 6.Physician adoption/trust 1.PHR and medication management crossover 2.Emergency services and coordination (DNR) 3.Patient education and decision support 4.Patient identification and consent 5.Current PHR product readiness 6.Continuity of care record with the PHR 7.Secure patient-clinician clinician-clinician interaction 8.Additional patient data sources including Telemedicine 1.PHR and medication management crossover 2.Emergency services and coordination (DNR) 3.Patient education and decision support 4.Patient identification and consent 5.Current PHR product readiness 6.Continuity of care record with the PHR 7.Secure patient-clinician clinician-clinician interaction 8.Additional patient data sources including Telemedicine Connecting NYers and Clinicians Public Health 1.Integrating current public health data sources – coordinated input 2.High priority to deal with projects already out 3.Bi-directional data flow through the Universal Public Health Node 4.Access to public programs as an issue for public health 5.Coordination with other efforts – CDC and NHIN 1.Integrating current public health data sources – coordinated input 2.High priority to deal with projects already out 3.Bi-directional data flow through the Universal Public Health Node 4.Access to public programs as an issue for public health 5.Coordination with other efforts – CDC and NHIN Coordinate with other Workgroups (EHR Collaborative, Protocols/Services, Privacy & Security) Define clinical priorities that best demonstrate critical areas and opportunities for improvement in both the quality and efficiency of health care for New Yorkers Develop clinical requirements, identify workflow issues, and advance policy recommendations to help drive and test the development of policies, protocols and standards for NYS Health Information Infrastructure Workflow requirement documents and narratives to support clinical practice redesign Clinical requirements document to guide technical development and implementation: Hone value proposition for increased patient safety, improved quality, efficiency and decreased cost; Identify and prioritize clinical data types & elements, features and functions & CDS Provide detailed workflow analysis, including charts and narratives Reimbursement requirements document Identify and prioritize reimbursement requirements to support sustainability Demonstrate and communicate the value of interoperable health IT adoption and effective use to clinicians and other stakeholders

19 19 EHR Collaborative – Comprehensive System of Adoption Support Services Knowledge- sharing Convene and share best practices and lessons learned among participants and users Policies & Standards Products & Services Recommend common policies, standards, and technical approaches among HEAL projects Recommend statewide services to reduce the cost and/or increase the quality and consistency of EHR adoption and support Value-Oriented Project Management Vendor selection and contracting Practice transformation & workflow planning System deployment & implementation Post- implementation support Reporting, decision support, and performance measurement Inter-operating with internal and external systems Readiness assessment & planning

20 Federal Stimulus Legislation: Multiple Areas of Focus Appropriations for Health IT & HIE New Incentives for Adoption $2 billion for loans, grants & technical assistance: HIE Planning & Implementation Grants EHR State Loan Fund National Health IT Research Center & Regional Extension Centers Workforce Training New Technology R&D New Medicare and Medicaid payment incentives to providers for EHR adoption $20 billion in expected payments through Medicare $14 billion in expected payments through Medicaid ~$34 billion in gross expected outlays, $4.3 billion for broadband & $2.5 billion for distance learning/ telehealth grants Directs ONC to invest in telehealth infrastructure and tools Directs the new FACA Policy Committee to consider telehealth recommendations Broadband and Telehealth Comparative Effectiveness $1.1 billion to HHS for CER Establishes Federal Coordinating Council to assist offices and agencies of the federal government to coordinate the conduct or support of CER and related health services

21 Details about Available Funding/Programs

22 Medicare and Medicaid EHR Adoption Incentives MedicareMedicaid Funding mechanism(s) Federal Incentive Payments State matching payments (for admin costs) Payment AgentMedicare carriers and contractorsState Medicaid agencies Payment Recipients Hospitals and physiciansHospitals, physicians, NPs,dentists, mid- wives, third-party entities promoting EHR adoption State Medicaid agencies for program admin Amounts for Hospitals $2 million base amount Plus increases for annual discharges, number of inpatient days attributable to Medicare, and charges attributable to Medicare $2 million base amount Plus increases calculated using similar methodology as Medicare incentive (eligible entities include Acute Care and Children’s Hospitals) Amounts for physicians & other health professionals Up to $44,000 in Medicare reimbursements Over 5 year period Up to $64,000 Over a 5 year period covering up to 85% of eligible implementation costs Providers must demonstrate “Meaningful Use of Certified EHR Technology” to receive payments

23 23 HIE Infrastructure – SHIN-NY: Governance, Policy and Technical Components Planning and Implementation Grants for State HIE Plan – NYeC = state designated entity Regional Extension Centers – EHR Service Bureau, CHITAs Loan Fund – Dormitory Authority Key Concepts in Federal Stimulus and Alignment with NY’s Strategy

24 24 Definition of “Meaningful Use” of EHRs Crosswalk to NY Strategy Framework Three Components Uses EHR in a meaningful manner, which includes electronic prescribing as determined to be appropriate by the HHS Secretary Uses EHR that is “connected in a manner” that provides for the electronic exchange of health information to improve the quality of health care, such as promoting care coordination (in accordance with law and standards applicable to the exchange of information) Submits information on clinical quality measures and other measures as selected and in a form and manner specified by the Secretary Framework for NY’s Health Information Infrastructure Statewide Health Information Network Clinical Informatics Services Clinician/EHR


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