open source hit richard thoreson substance abuse mental health services administration u.s....
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Open Source HITOpen Source HIT
Richard Thoreson Substance Abuse Mental Health Services Administration
U.S. Department of Health & Human Services
Regional HIT Conference San Francisco, CA Thursday, July 21, 2011
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Getting to Meaningful Use, 2015
1. Better health, better health care, with spending limits
2. Service & Informationsystems integration
a. Specialty MH and SA together?
b. With primary care/health homes?
c. With other safety net services?
d. With criminal justice?
State Health & Human Services Information Network Needs, Utilization/Payments, & Outcomes
1. Health Home
2. Primary Care
3. FQHC/HRSA
4. Specialty Behavioral Health/SAMHSA
5. Other Specialty Health
6. Hospital 7. State Information Exchange/ONC
8. State Insurance Exchange/ONC
9. State Medicaid/CMS
10. Medicare/CMS
11. Children & Family Agency/ACF
12. Public Health /CDCP
13. Pharma-Medical Device Vender/FDA
14. School/DOE
15. Housing Agency/HUD16. Other Safety-Net Agencies/DoA-WIC
17. Income Maintenance/SSA
18. Criminal Justice/DoJ
19. Tax & Other Adm. Agencies/IRS
20. Oversight/ GAO & IGs
Un-Silo
Family & IndividualHistory Research
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Electronic Health Record systems (EHRs)
The technology foundation for incremental quality
improvement (doing more with less!)
Get better information to clinicians & patients
when they need it
Develop knowledge faster
We can’t improve what we don’t measure!
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Standard Terminology ASAP!!
• SNOMED-CT
• LOINC
• RxNorm
• Core Data Sets to measure needs, quality, & outcomes
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Services Oriented Architecture (SOA)
• Centrally-hosted Web-based services
• User communities drive system requirements• Venders compete around replaceable Web
services
• Low barriers to vender entry into markets
State Health & Human Services Information Network Public Sector IT Spending Plans & Expectations
Service Systems Integration
SAMHSA:• Primary Behavioral Health Care Care Integration $15M 2011• OBHITA/REM $3.2M/yr 2009-13• ONC Privacy Project $2.77M 2011• Quality Measures $100Ks/yr • Suicide Hotline w/DOD $0
Other Federal• Medicaid $10Bs/yr• HRSA $B’s/yr• ACF $Bs/yr• IHS $10Ms/yr
Reusable Open Source• VA/DOD $Bs/yr
Federal IT Investments
1. Health Home
5. Other Specialty Health
6. Hospital
9. State Medicaid/CMS
13. Pharma-Medical Device Vender/FDA
12. Public Health /CDCP
15. Housing Agency/HUD18. Criminal Justice/DoJ
17. Income Maintenance/SS
A
14. School/DOE
16. Other Safety-Net Agencies/DoA-WIC
4. Specialty Behavioral Health/SAMHSA
2. Primary Care
3. FQHC/HRSA
7. State Information Exchange/ONC
8. State Insurance Exchange/ONC
10. Medicare/CMS
11. Children & Family Agency/ACF
19. Tax & Other Adm. Agencies/IRS
20. Oversight/ GAO & IGs
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Performance Measurement
• Encounter & episode quality measureso Priority needs met first?o Patient self-reportso Automated EHRs extracts
• 3rd Party verification (needs & Outcomes): o Cross-check records from different
providers o Cross check safety net beneficiary records
across State agencies
State Health & Human Services Information NetworkPublic Spending for Performance Monitoring
SAMHSA*• GPRA Data Warehouse
$10M/yr, 5 yrs• Block Grant/DASIS-TEDS $ Ms/yr • Prescription Drug Monitoring $Ms before 2011, $0 after
Other Federal*
• CMS $? • CDCP $? • FDA $?• HRSA $?• ACF $?• IHS $?• VA/DOD $?
* Tank sizes not to scale relative to each other
Federal IT Investments10San Francisco Regional meeting
20. Oversight/ GAO & IGs
1. Health Home
5. Other Specialty Health
6. Hospital
9. State Medicaid/CMS
13. Pharma-Medical Device Vender/FDA
12. Public Health /CDCP
15. Housing Agency/HUD18. Criminal Justice/DoJ 17. Income
Maintenance - SSA
14. School/DOE
16. Other Safety-Net Agencies/DoA-WIC
4. Specialty Behavioral Health/SAMHSA
2. Primary Care
3. FQHC/HRSA
7. State Information Exchange/ONC
8. State Insurance Exchange/ONC
10. Medicare/CMS
11. Children & Family Agency/ACF
19. Tax & Other Adm. Agencies/IRS
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Open Source Advantages?
• Share all best practices & lessons learned, no black box technology
• Build once, re-use software at no cost, minimize vender lock-in
• User-driven software development based on common, public sector needs
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SAMHSA Open Behavioral Health Information Technology Architecture Project
Next Generation Open Source EHR can be used for meaningful use quality measure pilots• Fully Meaningful Use Compliant
• Integrated Primary & Behavioral Health Services
• Reference Electronic Health Record Model (REM)
– Standards derived model EHR application» HL7 Reference Information Model
» HL7 Clinical Document Architecture
» Common Terminology Server (CTS), U.S. standard
o SNOMED-CT, LOINC, ICD, etc.
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SAMHSA’s 3 Largest HIT Investment Projects in 2011
GPRA Data Warehouse (draft RFC)• Contract to automate reporting, storage, and analysis of performance data from
SAMHSA’s discretionary grantees.
Primary Behavioral Health Care Integration (PBHCI) HIT Enhancement Grants
• $500k for 4 years + one time $200K IT Supplement per grantee (64 grantees)• $500k Grants to 5 States to integrate specialty behavioral health into
State Health Information Exchange (HIE)
Open Behavioral Health Information Technology Architecture (OBHITA)• Contract to develop open source EHRs and HIE systems & related terminology &
quality measureso Health Home Reference Electronic Health Information Model (REM) o Safety Net Information Banking Service (SIBS) for Personal History Recordso Partnerships with VA and leading States