1. 1 In the Thick of ARRA & HITECH: “It’s only just begun” NC Medical Society Quality of Care and Performance Improvement Committee August 7, 2009 Presented by: Sam Spicer, MD CMO, New Hanover Regional Medical Center President, NCHICA

2. 2 H.R. – 1 The American Recovery and Reinvestment Act of 2009 (ARRA) The Health Information Technology for Economic and Clinical Health Act (HITECH) H.R. – 1 The American Recovery and Reinvestment Act of 2009 (ARRA) The Health Information Technology for Economic and Clinical Health Act (HITECH)

3. 3 $19 billion allocated to Health IT $17 Billion – incentive bonuses for providers meeting “Meaningful Use” as determined by HHS secretary. $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.

4. 4 Estimate of Potential Stimulus Impact on NC Hospital Incentives for EHR - $300M – $400M Physician Incentives for EHR - $396M – $792M HIE / HIT Competitive Grants – ?($2B) –Regional Extension Center - ? –EHR Adoption Loan Funds - ? Broadband Infrastructure – Proposals ($7.2B) Workforce Training Grants - ?($ ? ) –Medical Health Informatics - ? ($ ? ) –EHR in Medical School Curricula - ? ($ ? ) –Worker Training- ? ($250M) Comparative Effectiveness Research - ? ($1.1B) Community Health Centers - $2.6M + ? ($2B) Prevention & Wellness (CDC) - ? ($1B) SSA - ? ($500M) ($17.2B) }

5. Excludes “hospital based” professionals | Physician billing/employment relationship is irrelevant Qualification based upon the setting in which the provider furnishes their services Medicare Incentive Payments - 75% add-on to fee schedule payments Maximum Medicare Incentive Payments Medicaid Incentive Payments - (requires Medicaid share of 30+ %) Maximum Medicaid Incentive Payments 20112012201320142015201620172018Total $25,000$10,000 $0 $65,000 -$25,000$10,000 $0 $65,000 --$25,000$10,000 $0$65,000 ---$25,000$10,000 $65,000 ----$25,000$10,000 $55,000 -----$25,000$10,000 $45,000 201120122013201420152016Total $18,000$12,000$8,000$4,000$2,000$0$44,000 -$18,000$12,000$8,000$4,000$2,000$44,000 --$15,000$12,000$8,000$4,000$39,000 ---$12,000$8,000$4,000$24,000 HITECH Overview Physicians Not to exceed $63,750 Penalty for failure to implement by FY15 –> reduction of reimbursements by 1% in 2015, 2% in 2016, etc.. Can receive Medicare OR Medicaid Incentives

6. 6 $ = EHR + HIE + Quality Reporting

7. 7 NC HIT Strategic Planning Task Force Established by Governor Bev Perdue Part of NC Recovery Office Task: Develop a Strategic Plan for ARRA Healthcare Stimulus Funding investment Weekly meetings in April and May Draft Outline of plan established Draft Plan out for public comment until June 17 th Final Plan delivered after incorporating comments NC HWTFC NC HIT Collaborative NC HIT Action PlanGovernor announces NC HWTFC as “Qualified State-Designated Entity” on July 16 th and will appoint NC HIT Collaborative to make recommendations on implementing the NC HIT Action Plan.

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10. 10 NC HIT Collaborative Members Chair 2 Vice Chairs NC Dept. of HHS NC Medical Society NC Nurses Assn. NC Hospital Assn. Community Care of NC NC Assn. of Health Plans NC Health Quality Alliance NC AHEC Centers NCHICA Ex-Officio Members: NC HWTFC Chair NC HWTFC Executive Director Rep. from Office of the Governor NCHICA Executive Director Advisory Group: Public Sector Representatives Private Sector Representatives

11. 11 $ = EHR* + HIE* + Quality Reporting * By “meaningful use” of “certified” systems

12. Meaningful Use Estimated Timeframes 20092010 JanAprJulyOctJanAprJulyOct Final rule issued (spring) NPRM issued by HHS/CMS (fall) Public comment (Fall/Dec) Interim final rule issued (Dec 31)

13. Meaningful User - Draft Sample Provider Requirements* Outcome2011 (Oct 1, 2010)20132015 Improve quality, safety, and efficiency CPOE for all order sets Drug-drug; allergy; formulary checks Problem list of diagnosis based on ICD-9 or SNOMED e-prescribing Active medication list Active medication allergy list Record demographics, advanced directives, vital signs, smoking status Patient reminders One clinical decision rule Progress note for each encounter Online eligibility verification Evidence-based order sets Clinical documentation Chronic condition management using patient lists and clinical decision support CDSS at point of care Specialists report to registries Closed loop medication management CDS for national high- priority conditions Medical device interoperability Multi-media support Engage patients and families Electronic copy of health information (PHR, patient portal, CD, USB drive) Clinical summaries for each encounter Real-time populated PHR Patient preferences Family medical history Home monitoring device uploads Self-management tools Electronic reporting on experience of care Improve care coordination Capability to exchange key clinical information among providers Medication reconciliation at relevant encounters and each transition of care Retrieve/act on e-Rx fill data Summary care record for every care transition Medication reconciliation at each transition from all settings Comprehensive patient data from all available sources Improve population & public health Data to immunization registries Reportable lab results to public health Electronic syndromic surveillance data to public health Receive immunization histories from registries Receive health alerts from public agencies Electronic syndrome surveillance data with capacity to link to personal identifier Use epidemiologic data Automated real-time surveillance Clinical dashboards Ensure privacy and security of PHI Compliance with HIPAA and NHIN data sharing practices Use summarized or de-identified data for population health reporting Full accounting of TPO disclosures *Complete draft requirements in the appendix

14. Meaningful User - Draft Sample Measures for Providers* Outcome2011 (Oct 1, 2010)20132015 Improve quality, safety, and efficiency % diabetics with A1c under control % hypertensive patients with BP under control % offered smoker cessation % patients with recorded BMI % CPOE orders Many other preventative screenings (mammogram, flu vaccine, etc.) Additional NQF-endorsed quality reports Inappropriate use of imaging report Critical outcomes measures (TBD) Efficiency measures (TBD) Safety measures (TBD) Engage patients and families % patients with access to electronic PHI % encounters with clinical summaries % of patients with real-time populated PHR % patients with recorded preferences % patients with secure patient messaging % of transitions with shared summary care record Ability to upload home monitoring device data NPP quality measures related to patient and family engagement Improve care coordination % encounters with med reconciliation Implemented HIE capability % of transitions in care where summary care record is shared Improved NQAF-endorsed measuresClinical summary aggregation from multiple sources NQF Care coordination measures (TBD) Improve population & public health Childhood immunizations report % of electronically submitted reportable lab results % patients with immunization assessment completed during visit % patients where public health alert needed to be triggered/audit evidence that trigger occurred HIT enabled population measures HIT enabled surveillance measures Ensure privacy and security of PHI Conduct/update security risk assessment Summarized de-identified data for health reporting Timely accounting of TPO Technology to segment sensitive data * Complete draft requirements in the Appendix

15. 15 Bi-directional Exchanges Within a Community (example)

16. 16 A Community may create a Community HIE “Utility” (example) HIE Note: Reduction of 50% of point-to-point Connections

17. 17 A Community may choose to qualify their HIE to connect to the NHIN as an NHIN-HIE or “NHIE” Community #1 NHIE NHIN

19. 19 Thank You www.nchica.org/ARRA/intro.htm