HIT-Enabled Care Transformation Claudia Williams Director, Health Information Exchange Program Office of the National Coordinator for Health IT

Medicare and Medicaid EHR Incentive Programs

ADOPTION

EXCHANGE

State Grants for Health Information Exchange

Medicaid Administrative Funding for HIE

Standards & Certification Framework

Privacy & Security Framework

Regional Extension Centers

Medicaid EHR Program 1st Year Incentive

Workforce Training

MEANINGFUL USE

1

CARE TRANSFORMATION

Better Health

Better Health Care Lower Costs

HIT-Enabled Care Transformation Meaningful Use is The Roadmap

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Adoption – Rapid Progress in Medicare and Medicaid EHR Incentive Programs

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– By end of December 2011, providers and hospitals had received >$2.5 billion in EHR incentive payments, >$14 million went to Maryland providers

– This will accelerate now that Maryland’s Medicaid incentive program is launched

– More than two-thirds of hospital CIOs and CEOs identified achieving Meaningful Use as their top IT priority

– The number of attestations nearly doubled between November and December

– With over 120K providers enrolled with a REC-- approximately 40 percent of primary care providers nationwide--we expect these numbers to increase rapidly in 2012

Progress is Rapid

3

8/25/11 Office of the National Coordinator for Health Information Technology

Meaningful Use and Exchange: Investments in the State’s Innovation Infrastructure

– Infrastructure is not just about roads and schools

– HIT investments lay the foundation for improving care and reducing cost

– And they also create jobs and attract new businesses, fostering new innovation potential and market opportunities for states

HIT = Investments in Innovation Infrastructure for States

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– As of today more than 1,500 EHRs have been certified

– 60% of the vendors are small businesses with 50 or fewer employees

– The growth in the EHR market fosters competition, innovation, and gives providers more choices than ever before

– How many of these businesses are in Maryland?

Take EHR Market as Example

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3

Exchange – HIE Will Take Off in 2012

Capture structured data

HIE and care coordination

Outcomes measurement & improvement

2009 2011 2013 2015

More Rigorous HIE Requirements In Stage 2 Meaningful Use

HITECH Policies

MU Criteria HIE and care coordination

• Governance • Exchange progress • P&S of data

sharing • Consumer eHealth

(tools and decision support)

MU Criteria Outcomes

measurement and improvement

• Next generation QMs • Clinical decision

support • Population

management

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We are Here Today…

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Receipt of Discharge Information by PCPs

*Respondents could select multiple responses. Base excludes those who do not receive report. Source: 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians.

27%

Less than 48 Hours

29%

2 to 4 Days

26%

5 to 14 Days

1%

More than 30 Days

6%

Rarely/Never Receive Adequate Support

4%

Not Sure/Decline to Answer

15 to 30 Days

6%

Time Frame (n=1,442)

62%

Fax

30%

Mail

8%

Email

Remote Access

15%

1%

Not Sure/ Decline to Answer

11%

Other

Delivery Method (n=1,290)*

19 percent of hospitals are exchanging clinical care records with ambulatory providers outside system (2010)

We are Looking for This Curve For care summary exchange? For lab exchange?

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Number of e-Prescribers in US by Method of Prescribing

Stand-alonee-Rx System

EHR

Total

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To Get There… Need to Reduce the Cost and Complexity of HIE

Cost of exchange high , time to develop is long

• Interfaces cost $5K to $20K due to lack of standardization, implementation variability, mapping costs – how reduce costs?

• Community deployment of query-based exchange has often taken years to develop – how speed up?

Poised to grow rapidly, spurred by new payment approaches

• New payment models are the business case for exchange

Opportunities to reduce cost and complexity

• Re-usable services

• Adoption of national standards that resolve core challenges

• Common baseline of policy requirements

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Indiana Progress: 13 Million Results Sent, 1.2 million Record Queries as of 12/31/11

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Need at Least Three Types of HIE

– Send and receive information to support care coordination and planned care (directed exchange, results delivery)

– Find patient information (query-based exchange)

– Aggregate and share patient information in PHR or patient “information home” (consumer-mediated)

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We have

– Easily adopted standards for transporting information

– Direct and modularized SOAP

– Ready-to-use content standards to support care transitions and lab results delivery

– C32/Consolidated CDA and LRI initiative

We Are Building the Toolkit for Scalable HIE – of Whatever Type

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Priorities for This Year

– Directories – standards and policies to make them consistent, reliable, findable and open to be queried

– Certificate management and discovery - common guidelines for establishing and managing digital certificates and making the public keys “findable”

– Governance - baseline set of standards and policies that will accelerate exchange by assuring trust and reducing the cost and burden of negotiations among exchange participants

We Are Building the Toolkit for Scalable HIE – of Whatever Type

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State HIE Program: Give Providers Viable Options to Meet MU Exchange Requirements

• Focus - Give providers viable options to meet MU exchange requirements – E-prescribing

– Care summary exchange

– Lab results exchange

– Public health reporting

– Patient engagement

• Approach – Make rapid progress

– Build on existing assets and private sector investments

– Every state different, cannot take a cookie cutter approach

– Leverage full portfolio of national standards

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Evolving conception of the role of state HIE program

Prior Assumption

• Always one state-run HIE network serving majority of exchange needs of the state

• Singularly focused on developing query-based exchange

Current

• There may be multiple exchange networks and models in a state

• Key role of the state HIE program is to catalyze exchange, fill gaps and assure common trust baseline, building on the market and focusing on stage one meaningful use

2/8/2012 Office of the National Coordinator for

Health Information Technology 17

HIE Models

Orchestrator Elevator Public Utility Capacity-builder

$ $

Rapid facilitation of directed exchange capabilities to support Stage 1 meaningful use

Bolstering of sub-state exchanges through financial and technical support, tied to performance goals

Thin-layer state-level network to connect existing sub-state exchanges

Statewide HIE activities providing a wide spectrum of HIE services directly to end-users and to sub-state exchanges where they exist

Preconditions:

Operational sub-state nodes

Nodes are not connected

No existing statewide exchange entity

Diverse local HIE approaches

Preconditions:

Operational state-level entity

Strong stakeholder buy-in

State government authority/financial support

Existing staff capacity

Preconditions:

Sub-state nodes exist, but capacity needs to be built to meet Stage 1 MU

Nodes are not connected

No existing statewide exchange entity

Preconditions:

Little to no exchange activity

Many providers and data trading partners that have limited HIT capabilities

If HIE activity exists, no cross entity exchange

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Strategies

Opportunity Strategies to Address Number

White Space Directed Exchange - Jumpstart low-cost directed exchange services to support meaningful use requirements

51

Duplication Shared Services - Offer open, shared services like provider directories and identity services that can be reused

54

Information Silos

Connect the nodes - Infrastructure, standards, policies and services to connect existing exchange networks

25

Disparities REC for HIE - Grants and technical support for CAHs, independent labs, rural pharmacies to participate in exchange

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Emerging Networks

Support local networks – Connectivity grants and trust/standards requirements for emerging exchange entities

5

Public Health Capacity

Serve reporting needs of state - Support public health and quality reporting to state agencies

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No Shared Trust/Interop Requirements

Accreditation and validation of exchange entities against consensus technical and policy requirements

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– Broad-based buy-in

– Flexible infrastructure

– Can serve the health care transformation needs of state

– Adapts to evolving exchange requirements

CRISP= Investment in Maryland’s Innovation Infrastructure

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Care Transformation – States are Driving HIT-Enabled Care Transformation

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Real Momentum in Payment Reform in Medicare, Medicaid and Private Plans

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Source: AHIP

Many Opportunities

• Analytic infrastructure for payment reforms – MD: reporting readmissions – Many states: All payer claims data bases

• Shared services that can be re-used across HIE, HIX, MMIS – MA: Directories, identity services

• Care coordination for health homes (and other transformation initiatives) – RI: Referrals and utilization events

• Aligning HIT investments and payment reform initiatives – OR: HIT requirements for CCOs 23

Health Information Exchange is Critical

• Need to reduce costs to protect Medicaid and the fragile safety net – Reduce duplicative tests

– Reduce errors

– Reduce readmissions

– Reduce poorly managed transitions

– Improve and pay for quality

– Manage the care of patients across the entire care team

• All depend on HIT and information exchange

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States have the tools to increase the uptake of HIT and health information exchange

For Instance:

– Medicaid uses reimbursement levers to encourage providers to electronically share visit summaries when patients are referred and discharged

– Medicaid includes labs sending electronic lab results in a structured format in preferred network

– State includes health information exchange requirements in its state employee insurance plan contracts

– Achieving meaningful use is requirement for providers participating in payment reforms 25