Health Information Technology: Health Information Technology: Moving North Carolina Forward Vandana Shah, Executive Director September 2, 2009

Sales / Orders © California HealthCare Foundation The Biggest Challenge? Silos of Information

The Tipping Point: Hurricanes Katrina and Rita “…the disaster demonstrates a broader need to computerize individual health records nationwide and make them available throughout the medical system.” Washington Post, 9/14/05 How did we get here?

A Call to Action in 2006 A Call to Action in 2006 Creation of the National Health Information Network To avoid dangerous mistakes, reduce cost, and improve care by leveraging technology to create a health care “e-highway” NHIN

H.R. – 1 The American Recovery and Reinvestment Act of 2009 (ARRA) The Health Information Technology for Economic and Clinical Health Act (HITECH)

$19 billion allocated to Health IT $17 Billion +  incentives for providers meeting “Meaningful Use” requirement [$’s to “prescribers”] $2 Billion to HHS / ONC  standards development, evaluation and validation  infrastructure for Health Information Exchange (HIE)  grants to states for the purpose of furthering EHR adoption  improvements in HIT manpower  the establishment of Regional Health IT Resource Centers, Extension Programs, Enterprise Integration Research Centers, etc.

ONC FOAs for Grants Released Aug. 20 th  3012 – HIT Regional Extension Centers Program  EHR Adoption Assistance  Preliminary application due Sept. 8 th  NC AHEC Program leading application development  NOT $s for EHR purchases  3013 – State HIE Cooperative Agreement Program  Application due October 16 th  One application per state  $4 up to $40 million grant over four years  NC Health and Wellness Trust Fund will apply for NC  NCHICA expected to assist in developing application  NOT $s for EHR purchases

3012 – HIT Regional Extension Centers Program  Summary of Funding  Type of Award: Cooperative Agreement  Total Amount of Funding Available in FY2010 $598,000,000  Average Award Amount $ 8,543,000  Award Floor $ 1,000,000  Award Ceiling $ 30,000,000  Approximate Number of Awards 70  Project Period Length  four-year project period  with two separate two-year budget periods  Estimated Start Date: January 15, 2010

3013 – State HIE Cooperative Agreement Program  Type of Award: Cooperative Agreement  Total Amount of Funding Available: $564,000,000  Award Floor: $4,000,000  Award Ceiling: $40,000,000  Approximate Number of Awards: 50  Program Period Length: 4 years  Anticipated Project Start Date: January 15, 2010

$ = EHR + HIE + Quality Reporting Incentive Payments to Providers Enabled by “Meaningful Use”

“Meaningful Use”  Governed by CMS, administered by Medicaid and Medicare  Definition expected to include:  Use of a “certified product” with ePrescribing capability  The EHR technology is connected for the electronic exchange of PHI  Submission of reports on clinical quality measures  CMS to issue Notice of Proposed Rule Making in late 2009  Regulation defining “Meaningful Use” issued in early 2010  Focus on health outcomes, not software & networks

NC HIT Strategic Planning Task Force  Established by Governor Bev Perdue as part of NC Recovery Office - March 2009  Task: Develop a Strategic Plan for ARRA Healthcare Stimulus Funding investment  Weekly meetings in April and May 2009  Draft Outline of plan submitted for public comment - June 2009 NC HIT Action Plan  Final NC HIT Action Plan delivered - July 2009

NC HWTFC Governor announces NC HWTFC as “Qualified State-Designated Entity” on July 16th and NC HIT Collaborative has appointed NC HIT Collaborative to make recommendations on NC HIT Action Plan implementing the NC HIT Action Plan.

Governor’s Executive Order North Carolina Health Information Technology Collaborative Members: Chair NC Medical Society (Vice Chair) NC AHEC Program (Vice Chair) NC Dept. of HHS NC Nurses Assn. NC Hospital Assn. Community Care of NC NC Assn. of Health Plans NC Health Quality Alliance NCHICA Ex-Officio Members: NC HWTFC Chair NC HWTFC Executive Director Rep. from Office of the Governor NCHICA Executive Director

NC Health and Wellness Trust Fund  Created in 2000 by the NC General Assembly and funded through 25% of NC’s share of the Tobacco Master Settlement Agreement (MSA)  Commission appointed in May 2001  The NC Health and Wellness Trust Fund Commission (HWTF) invests in programs and partnerships to address access, prevention, education and research that help all North Carolinians achieve better health HWTF has provided:  Over $ 287 million in funding for over 400 grants and programs  $109 million for access to care programs  $178 million for preventive health initiatives

 Deliver critical health information services reliably, securely, and affordably to clinicians; patients; state, county, federal health agencies; local exchange efforts throughout NC.  Create a secure, electronically connected North Carolina population of providers, patients, and consumers.  Offer an information infrastructure that supports optimum care delivery methodologies, transparency, patient empowerment, and integrated healthcare records.  Facilitate regional health information exchanges and interconnections among them. Statewide HIE Program: Critical Objectives

State Designated Entity (SDE)  Facilitate HIE initiatives across NC  Establish a common approach to governance, processes, technology  Support Regional initiatives  Ensure inclusion of safety providers and underserved populations  Ensure consistency with national HIE objectives  Identify and support legislation and regulation Statewide HIE Program: Critical Objectives

Tentative Timeline for NC Efforts  NC HIT Strategic Planning Task Force  March – July 2009  NC HWTF HIE Proposal Development & Submission  July 2009 – October 2009  NC HWTF HIE Stimulus Fund Management for Startup  January  Ongoing Governance & Management [Structure TBD]  January ongoing

Clients/Patients The Overarching Goal: Integrated Data Flow Pharmacy Laboratory Diagnostic Hospital Emergency Homecare Community Care Center Clinic Emergency Services Specialist Clinic