Arizona Health Care Cost Containment Health System Medicaid Transformation Grant Program

Health Information Exchange (HIE) & Electronic Health Record (EHR)

Utility Project

The HIeHR Project

Provider Focus GroupsFall 2007

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Agenda

• Slide Presentation• Overview of Key Concepts

• Written Survey• Focus Group Discussion

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OVERVIEW OFTHE HIeHR PROJECT

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Medicaid Transformation Grant Program

• Competitive grants program established by Deficit Reduction Act (DRA) of 2005

• Administered by CMS (Centers for Medicare and Medicaid Services)

• Designed to slow Medicaid spending growth while increasing access to healthcare

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AHCCCS Medicaid Transformation Grant

• February 2007 to November 2009• Awarded $11.7 Million• Strategy is to develop and deploy

statewide1. Health Information Exchange (HIE)

and Viewer2. Web-based portal and electronic

health record (EHR)3. Database and analytics for clinical

decision support and population health management

• Together, called the HIeHR Utility Project

HIeHR is…

A web-based electronic health record (EHR) and health

information exchange (HIE) to give all providers access to AHCCCS patients’ health information via Internet

connection at the point of service

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HIeHR UtilityProject Vision

• Improving healthcare delivery at point of care (quality and safety)

• Single view of patient information• Integrated clinical decision support tools

• Reducing costs and achieving efficiencies• Eliminate duplicate tests and imaging• Reduce administrative burdens on medical

practices• Eliminate duplicate communication channels (labs,

x-rays, etc.)• Analytical tools for effective care management

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• Enhancing self-management by AHCCCS members

• Enable access to health information and online wellness materials

• Increase public health and bio-surveillance

• Automated disease reporting• Automated syndrome reporting

HIeHR UtilityProject Vision (cont.)

HIeHR UtilityProject Vision (cont.)

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HIeHR will start with…• AHCCCS Providers

throughout the state• Primary Care Providers• Physician Specialists• Long-term Care• Behavioral Health• Emergency Departments• Dentists• Consulting Pharmacists

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Key HIeHR Partners• Clinician Providers• Hospitals (Emergency, Inpatient, Outpatient, and

Diagnostic Imaging)• Services providers (lab, imaging, pharmacy)• Managed care organizations and health plans• State Agencies (immunization, birth records, chronic

illness registries and laboratory data)• Academic medical centers • Community Health Centers (CHCs)• Professional societies• Quality and patient safety organizations • Health and chronic illness advocacy organizations• Other Arizona HIEs• Arizona Health-e Connection • State Medicaid Programs Collaboration (14 states)

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UNDERSTANDING THE

TERMINOLOGY

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Health Information Exchange (HIE)

• Mobilizes healthcare information electronically across organizations within a region or community

• Capable of electronically moving clinical information between disparate healthcare information systems while maintaining the meaning of the data exchanged

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Goal of HIE• Facilitate access to and

retrieval of clinical data to provide safer, more timely, efficient, effective, equitable, patient-centered care

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RHIOs

• Regional Health Information Organizations (RHIOs) are electronic networks intended to help multiple healthcare organizations such as hospitals, labs, radiology centers, etc. in a given area exchange health and patient data through an HIE.

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Electronic Health Record(EHR)

• Longitudinal record, including all patient medical information from multiple sources

• Accessible from any location by any authorized provider caring for a patient in the system

• Includes demographics, progress notes, problems, medications, medical history, immunizations, lab data, radiology reports

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Not to Be Confused with EMR

• The Electronic Medical Record (EMR) is the electronic replacement for paper charts in one particular physician’s practice.

• The EMR is the physician’s own electronic record of his or her patient’s medical care.

• An EHR for a patient could include records from multiple EMRs originating from each of the providers participating in the care of this patient.

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Or Confused with PHR• The Personal Health Record (PHR) is

medical information in the possession of an individual patient or the patient’s non-professional caregiver.

• Format may be paper documents, electronic media, or a combination of both.

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THE ARIZONA LANDSCAPE

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Health-e Connection• Governor’s executive order for Arizona Health-

e Connection Roadmap issued in 2005• Goals:• All medical records into electronic format• Create statewide health data exchange• Achieve by 2010

• Arizona Health-e Connection non-profit organization formed in 2007 to implement Health Information Exchange and the deployment of Health Information Technology in the state

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Southern Arizona Health Information Exchange (SAHIE)• Coalition of all southern AZ hospitals, major

practices, most commercial plans, AHCCCS plans, Community Health Centers

• Coordinating at technical and adoption levels with AHCCCS and Health-e Connection

• 25-member steering committee (Funding institutions plus organizations representing regional and state-level interests)– Governance structure planning completed– Implementation will start in Dec. 2007– Currently selecting vendor for HIE design and technology

Arizona Government Information Technology Agency (AZ GITA)

2007 Rural Health Information Technology Adoption Grants - $1.5 million• 7 Grants Awarded

2008 Rural Health Information Technology Adoption Grant Process - $1.4 million• Focus on Regional Health Information Organization (RHIO) Facilitation

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PRIVACY AND SECURITY

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Arizona Health Privacy Project

Purpose:• Build privacy and security

infrastructure for health information exchange in Arizona• Technical standards• Policy standards• Legal requirements

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Now Developing…

Three Legal projects:• Propose statutory and regulatory amendments to

remove barriers to HIE• Design an enforcement framework for

inappropriate access to HIE • Draft model policies/procedures and a model

participation agreement for Arizona’s HIEs/RHIOs

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ELECTRONIC HEALTH RECORD

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Interoperability Overview

• Interfaces• Use of industry standard formats

• Coding standards• Translation mapping• Version control

• Registry Integration• Immunization, EPSDT, public health

surveillance measures

• Scanning• Secure Communications

• Email, Fax, Instant Messaging

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Security Overview

• Follows community and industry standards• Password compliance• Auditing• Appropriate controls for record access• Record locking• Patient Privacy• Secure Portal for Patient Access

• Methods for Data Recovery• Archiving

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We Need Your Input!Potential EHR Features

• e-Prescribing • Clinical Encounter Management• Lab Orders/Results• Radiology orders/Results• Case Management• Eligibility Inquiry/Verification• Authorization/Referral Management• Analytics/Reporting• Claims submission Support

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e-Prescribing

• Medication Orders• Medication search, favorites, and order sets

• Medication History• Eligibility/Formulary Checking• Drug Interaction Management

• Drug-drug, drug-food, drug-allergy, etc.

• Refill Management• Electronic Submission • Warnings/Alerts

• Contraindications, substitution not allowed, etc.

• Patient Education Materials

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• Clinical Documentation (SOAP)• Problem Lists

• Status• Link to Encounter, Meds, Labs, etc.• Code search• “Favorites” (frequently used codes & meds)

• Allergies• Assessment Templates• Treatment Plan

• Variances from standard and ability to create site-specific templates

• Comprehensive, Historical View

Clinical Encounter

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Lab Orders/Results• Lab Orders

• Test search, “favorites,” andorder sets

• Status Inquiry• Electronic Submission• Warnings/Alerts• Instructions to Patient/Facility• Result Management

• Normal/abnormal• Trending/graphing• Routing• Annotation

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• Imaging Order• Test search, “favorites,” and

order sets• Status Inquiry• Electronic Submission• Warnings/Alerts• Instructions to Patient/Facility• Result Management

• Normal/abnormal• Routing• Image linking

Radiology Orders/Results

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Case Management

• Collaboration with case managers through HIE• Case Creation• Case List

• Assignment rules• Care Planning• Notes

• By case manager• By provider

• Alerts• Workflow Support

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• Link to Payer Web Sites• Electronic Verification• Online Display of Detail

• Health and Prescription Benefits

• Support Manual/Electronic Capture

Eligibility Inquiry/Verification

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• Referral Generation/Communication• Internal/external• Clinical Guideline/Admin Support• Link Relevant Clinical Records w/ Referral• Referral Status/History• Consult Report Management

• Authorization Management• Business Rules re: Auth requirements• Auth Status/History

• Electronic Submission of Referrals & Authorizations

Auth/Referral Management

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• Reports by Individual and Groups of Patients• e.g., print out EPSDT reports

• Outcomes Reporting• Standard Reports Able to Be Modified• Define Report Formats for Display, Print, and

Export• Ad Hoc, on demand, and scheduled• Identified and de-identified data• Sort By, Group By, and Statistics• Save Report Parameters for Later Re-Generation

• Support for Internal/External Reporting Tools• Registry Integration

• Immunization, EPSDT, public health surveillance measures

Analytics and Reporting

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Claims Submission Support

• Claims Creation• Attachments• Coding support• History

• Clean Claim Edits• Claim Status• Eligibility Verification• Electronic

Submission/Routing/Receipt

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Thank you for helping us to achieve our Mission:

Shaping tomorrow’s managed care from today’s experience,

quality and innovation

www.ahcccs.state.az.us

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For more information

• Medicaid Transformation Grant Program http://www.cms.hhs.gov/MedicaidTransGrants/02_012507awards.asp

• Arizona Health Care Cost Containment System (AHCCCS), Arizona’s Single Medicaid Agency http://www.azahcccs.gov/site/

• AHCCCS Health Information Exchange & Electronic Health Record Utility Project (HIeHR) http://www.azahcccs.gov/eHealth/

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How to Become an AHCCCS Provider

• Provider will need to access the following link to download and fill out required forms to become an AHCCCS Provider.http://www.azahcccs.gov/PlansProviders/ProviderRegistration.asp

• The registration forms must be completed, signed and mailed to AHCCCS Provider Registration, P.O. Box 25520 Mail Drop 8100 Phoenix, AZ 85002.

• Existing providers may fax address updates to (602) 256-1474.• For further questions regarding registration, please call the AHCCCS

Provider Registration Unit at (602) 417-7670, option #5. The in-state toll free number is 1-800-794-6862. The out-of-state toll free number is 1-800-523-0231.

• Please note: Effective March 1, 2007, the National Provider Identifier will be required prior to registration. This applies to all applicable providers.