1. Health Information Technology Nationwide Activities and Issues Roy H. Wyman, Jr. May 7, 2009

2. Agenda What I Couldn’t Do with Plenty of Money and a Clue We’re from the Government, and We’re Here to Help

3. Plenty of Money and a Clue How much Money? –$19 Billion through Medicare and Medicaid in grants, loans and incentive payments –$85 Million to Indian Health Services for HIT –$3.95B to the Workforce Investment Act of 1998 –$500M for health centers under the PHS Act –$2B to ONC $300M for regional or sub-national efforts toward HIE $20M to NIST

4. Plenty of Money and a Clue Give Me the Money! –Medicare/Medicaid: “Meaningful Use” ‘‘Meaningful Use Of Certified EHR Technology” –Certified EHR technology including the use of electronic prescribing –Connected in a manner that provides for the electronic exchange of health information –Apply for Loans: Be in the Right State Apply

5. Plenty of Money and a Clue Concerns in Adopting an EHR –Interoperability and Certification (CCHIT) –Work Flow –Interface –Training –Leadership Legal Limitations and Considerations –Stark and Anti-kickback Rules –Security and Privacy (yes, Encryption) –Policies and Procedures –Contract Liability

6. We’re from the Government, and We’re Here to Help

7. How Would You Design the System?

8. We’re from the Government, and We’re Here to Help The “W” Approach: –Bottom-Up –Private Entities or Private- Public Partnerships –Let the Market Decide The Result: –ONC & AHIC –NHIN –CCHIT –HITSP –HISPC

9. We’re from the Government, and We’re Here to Help The New Appr“O”ach: –Institutionalize the Process (i.e., add money) –Governmental Entities –Let the Best Minds Decide The Result: –ONC Agency –NHIN –HIT Policy Committee (AHIC?) –HIT Standards Committee (CCHIT? AHIC?)

10. The Nationwide Health Information Network

11. 11 The Nationwide Health Information Network Health Bank or PHR Support Organization Community #1 Integrated Delivery System Community Health Centers Community #2 State and Local Gov Labs Pharmacies CDC VA IHS DoD SSA The Internet Standards, Specifications and Agreements for Secure Connections Mobilizing Health Information Nationwide

12. The Health Information Security and Privacy Collaboration (“HISPC”) 44 States and Territories In Three Phases 1.Identify Barriers 2.Work Individually on Barriers 3.Work Together on Fixing them

13. The Health Information Security and Privacy Collaboration 7 Multi-State Collaboratives –Consent 1 – Data Elements –Consent 2 – Policy Options –Harmonizing Privacy Law –Consumer Education and Engagement –Provider Education –Adoption of Standard Policies –Interorganizational Agreements

14. Where Are We? HHS Regulations for Breach by Covered Entities –Destroy or Encrypt –Use NIST standards FTC Regulations on Breach by Personal Health Record Vendors –“Breach” means whatever HHS says Enforcement by AGs and Tiered HIPAA Penalties in Place

15. What’s Next? Standards, spec’s and cert. criteria: 12/31/09 Competitive Loan Money to States: 1/1/10 Regional Extension Centers Funded: 2010 (Reg’s by 5/18/09) Privacy/Security Provisions: 2/16/10 Incentive Payments begin: FY11 EHR Accounting Effective: 1/1/11 Breach Notification Rules: 8/16/09

16. What’s Next (cont.) First Annual Report of Breaches: 2/16/10 Minimum Necessary Rules: 8/16/10 Regulations re: Sale of PHI: 8/16/10 Rules re: CMPs to Victims of Disclosure: 2/16/12 Rules re: De-Identification: 2/16/10 Universal Use of EHR: 2014 Penalties for Non-use Begin: 2015

17. Roy H. Wyman, Jr. P.O. Box 12109 Research Triangle Park, NC 27709 919.981.4313 rwyman@williamsmullen.com www.williamsmullen.com rwyman@williamsmullen.com