1. The American Recovery and Reinvestment Act (ARRA) IHS Office of Information Technology March 15, 2010

2. American Recovery and Reinvestment Act of 2009 (ARRA) As stated on www.recovery.gov website: As stated on www.recovery.gov website: ARRA is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century… preserve and improve affordable health care…” ARRA is an unprecedented effort to jumpstart our economy, create or save millions of jobs, and put a down payment on addressing long-neglected challenges so our country can thrive in the 21st century… preserve and improve affordable health care…”

3. ARRA FUNDING Signed into law February 17, 2009 Signed into law February 17, 2009 Jumpstart economy Jumpstart economy IHS received $500 million IHS received $500 million Health facilities construction, maintenance, and improvements; sanitation facilities construction; and health equipment to help improve healthcare in Indian Country. Health facilities construction, maintenance, and improvements; sanitation facilities construction; and health equipment to help improve healthcare in Indian Country.

4. ARRA FUNDING –cont’d. Modernization and extension of electronic health information technology used by IHS, Tribal, and Urban programs. Modernization and extension of electronic health information technology used by IHS, Tribal, and Urban programs. IHS received $85 million in ARRA funding for health information technology IHS received $85 million in ARRA funding for health information technology The IHS Office of Information Technology (OIT) has focused this funding to modernize and extend electronic health information technology throughout Indian Country and to achieve Meaningful Use of EHR The IHS Office of Information Technology (OIT) has focused this funding to modernize and extend electronic health information technology throughout Indian Country and to achieve Meaningful Use of EHR

5. “ These Recovery Act funds will provide critical assistance to American Indian and Alaska Native communities… These funds will help improve healthcare, create jobs and make our native communities stronger.” “ These Recovery Act funds will provide critical assistance to American Indian and Alaska Native communities… These funds will help improve healthcare, create jobs and make our native communities stronger.” Yvette Roubideaux Yvette Roubideaux Director IHS Director IHS

6. ARRA Objectives for IHS Office of Information Technology Hire and deploy IT staff Hire and deploy IT staff Deploy certified electronic health records that meet the requirements of “meaningful use” Deploy certified electronic health records that meet the requirements of “meaningful use” Implement a personal health record tool Implement a personal health record tool Upgrade the reliability, redundancy, and security of the IHS network Upgrade the reliability, redundancy, and security of the IHS network Ensure an adequate telemedicine infrastructure Ensure an adequate telemedicine infrastructure

7. MEANINGFUL USE Will be accomplished in three stages Will be accomplished in three stages Requirements for each subsequent stage build upon the requirements of previous stage. Requirements for each subsequent stage build upon the requirements of previous stage. Incentives will be given during each of the three stages that meet definition of meaningful use. Incentives will be given during each of the three stages that meet definition of meaningful use.

8. Meaningful Use cont’d Stage 1: focus is on capturing data. Will begin in 2011. Stage 1: focus is on capturing data. Will begin in 2011. Stage 2: focus on reporting health information and tracking key clinical conditions. Will begin in 2013. Stage 2: focus on reporting health information and tracking key clinical conditions. Will begin in 2013. Stage 3: focus on improving performance and health outcomes. Will begin 2015. Expected to add more requirements. Stage 3: focus on improving performance and health outcomes. Will begin 2015. Expected to add more requirements.

9. STAGE 1: Health IT Functionality Measures & Clinical Quality Measures Health IT Functionality: 25 provider measures and 23 hospital measures. Health IT Functionality: 25 provider measures and 23 hospital measures. Some measures show “interoperability” Some measures show “interoperability” Clinical Quality: Hospitals to report on a set of 35 Medicare inpatient measures Clinical Quality: Hospitals to report on a set of 35 Medicare inpatient measures

10. Functional & Interoperability Measures-Pharmacy specific Computerized Provider Order Entry Computerized Provider Order Entry Ambulatory – at least 80% of all orders must be entered directly into EHR by the provider Ambulatory – at least 80% of all orders must be entered directly into EHR by the provider Inpatient – at least 10% of all orders must be entered directly into EHR by the provider Inpatient – at least 10% of all orders must be entered directly into EHR by the provider Drug-drug, Drug-allergy, drug-formulary checks Drug-drug, Drug-allergy, drug-formulary checks All sites must implement these features of EHR All sites must implement these features of EHR

11. Functional & Interoperability Measures Pharmacy Specific cont’d Medication Reconciliation Medication Reconciliation Perform medication reconciliation for at least 80% of inpatient/outpatient encounters and transitions of care Perform medication reconciliation for at least 80% of inpatient/outpatient encounters and transitions of care Documentation of Allergies Documentation of Allergies At least 80% of inpatients and outpatients must have drug allergies documented in the EHR (or notation of no allergies) At least 80% of inpatients and outpatients must have drug allergies documented in the EHR (or notation of no allergies)

12. Functional & Interoperability Measures cont’d Problem Lists Problem Lists At least 80% of patients (inpatient and outpatient) must have a current Problem List At least 80% of patients (inpatient and outpatient) must have a current Problem List Electronic Prescribing Electronic Prescribing At least 80% of prescriptions must be entered and transmitted electronically At least 80% of prescriptions must be entered and transmitted electronically Medication Lists Medication Lists At least 80% of inpatient and outpatients must have a medication list documented in the EHR (or notation of no medications) At least 80% of inpatient and outpatients must have a medication list documented in the EHR (or notation of no medications)

13. BOTTOM LINE Achieving Meaningful Use does not simply mean installing a certified EHR. Rather, it is just the beginning. Achieving Meaningful Use does not simply mean installing a certified EHR. Rather, it is just the beginning. A lot of work is required by the IHS OIT, the 12 Area Offices, and the hospitals and providers that will apply for the incentives. A lot of work is required by the IHS OIT, the 12 Area Offices, and the hospitals and providers that will apply for the incentives. The requirements for achieving Meaningful Use are not final yet and are subject to change. However, we cannot wait until they are released. Work must start now. The requirements for achieving Meaningful Use are not final yet and are subject to change. However, we cannot wait until they are released. Work must start now.

14. RESOURCE/CONTACTS IHS Meaningful Use Website IHS Meaningful Use Website http://www.ihs.gov/recovery/index.cfm?module=dsp_arr a_meaningful_use http://www.ihs.gov/recovery/index.cfm?module=dsp_arr a_meaningful_use IHS Meaningful Use Contacts IHS Meaningful Use Contacts Theresa Cullen, MD, MS, CIO Theresa Cullen, MD, MS, CIO (301) 443-9848 (301) 443-9848 Theresa.Cullen@ihs.gov Theresa.Cullen@ihs.govTheresa.Cullen@ihs.gov Stephanie Klepacki, Meaningful Use Project Lead Stephanie Klepacki, Meaningful Use Project Lead (505) 821-4480 (505) 821-4480 Stephanie.Klepacki@ihs.gov Stephanie.Klepacki@ihs.govStephanie.Klepacki@ihs.gov

15. ARRA PHARMACY CONSULTANTS CAPT Mike Allen CAPT Mike Allen CDR Mary Ann Niesen CDR Mary Ann Niesen LCDR Lori Moore LCDR Lori Moore LCDR Carla Stearle LCDR Carla Stearle

16. QUESTIONS??