1. Health Information Technology and Puerto Rico Juan Eugenio Rodríguez de Hostos Chief Information Officer, Government of Puerto Rico Dr. José Piovanetti Chief Medical Information Officer / CIO, Health Umbrella

2. Facts Quality of Health Care in America Committee of the Institute of Medicine (IOM) - September 1999 - Boeing 767 ± 200 Passengers 44,000 to 98,000 people die in hospitals each year due to preventable medical errors… – Equivalent to 120 to 260 persons / day One jet airliner crash, daily, for one year…

3. Health IT and the Government The Government of Puerto Rico has awakened to the fact that our healthcare system is broken and that IT can play a pivotal role in enhancing the health of our citizens. The CIOs strategic plan is based on connectivity, service, integration, interoperability and data security across the entire Government and Island. Healthcare is a main focus. Why? The benefits to citizens are IMMENSE

4. Action Plan Reevaluate how PR-DoH does business Look for ways to serve our customers better: – Integrate ASES and PAM from technological point of view MMIS – Improve Reformas offerings through operational and technological integration with other welfare agencies TGP and data-exchanges – Digitize and integrate medicine in Puerto Rico HIE and EMR – Provide better connectivity for the Health Ecosystem PREPA.net and Broadband

5. How can Broadband facilitate better health? Connected patients – Telemedicine requires bandwidth to transmit images in real time – Personal Health Records (PHR): Patients control information and participate in their health Connected health care providers, laboratories, pharmacies – Supports a system that provides the right information to define the right care at the right time for any patient. – Allows access to information from anywhere on the island. Connect PR to the National Health Information Network

6. Funding Sources ARRA Broadband – Mapping and Planning*: $1.4 million approved – Infrastructure, Public Computer Centers, Adoption $12.6 million to INTECO for Infrastructure Second round will be closing in a couple of weeks ARRA HITECH – HIE Planning and Implementation*: $7.8 million approved – Regional Extension Centers – EMR and Health Informatics educational curricula – EMR incentives Other Health IT non-ARRA – MMIS* – planning grant approved – HIT* – working on grant approval * States Only

7. Health Information Exchange Patient Care Resolution MPI and Record Locator Transformation & Translation Business / Sector Rules State and Federal Healthcare-related Agencies Hospitals / IDNs CDC FDA SSA DoH Medicare / Medicaid Labs. Pharmacies Hosted or On-Site EHRs PHRs Payers / Health Plans State, Nationwide and International HIE Networks

8. Clinical Encounter Index of Where Patients Have Records Temporary Aggregation of Patient History Patient Authorized Inquiry Hospital Record Laboratory Results Specialist Record Patient Data Delivered to Physician PR-HIO Records Returned Records Returned Requests for Records Community

9. Index of Where Patients Have Records Temporary Aggregation of Patient History Authorized Inquiry from HIO Hospital Record Laboratory Results Specialist Record Patient Data Delivered to Other HIO PR-HIO Records Returned Records Returned Requests for Records Nationwide Another HIO

11. Approach Health Umbrella CIO, José Piovanetti, MD Health Information Exchange – Environmental assessment, strategic and operational plans to be completed by September 2010 – Steering body to be created with local stakeholders – Clinical/Public Health, Technical, Operational, Legislation, Financial, and Governance working groups – HIE Implementation, 2-3 years Accelerate Governments HIT/EMR project(s) Government ensures money used correctly, Meaningful Use criteria are met and plan followed

12. Our involvement with you! We will be… – Providing periodic updates and info about ARRA programs and deadlines – Asking stakeholders to participate in various concurrent initiatives, committees and workgroups – Holding Town Hall meetings to communicate progress with HIE planning and hear ideas and concerns – Educating citizens on Electronic Medical Records and their benefits and address concerns regarding privacy – Interested in meeting consultants, product and service providers as we finalize HIE planning – Recruiting your help communicating with Association members and enlisting their responses – Asking you to call Washington so PR gets its fair share of funds

13. HIT/HIE Timeline 20092010201120122013201420152016 ICD-10 CM/PCS Adoption Oct 1, 2013 NHII / NHIN NPRM Dec 30, 2009 NPRM Dec 30, 2009 Meaningful Use MU Stage 1 MU Stage 2 MU Stage 3 Medicare Incentives Medicaid Incentives MMIS / MITA HIPAA v5010 Transactions Penalties State Health Information Exchange Cooperative Agreement Program