State HIE Update Barrows

© Deloitte Touche Tohmatsu 2006. All rights reserved.
Update On
State HIE Cooperative

Agreement Program
Columbia University
Center for Advanced Information Management,
Annual Informatics Update
Oct 5 2011
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Tohmatsu
Discussion Plan
•Overview of State HIE Cooperative Agreement
Program
•Role in HITECH and MU
•Essential domains for statewide HIE planning,
implementation, evaluation
•Current Status & Activities
•Approved Plans
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Touche Tohmatsu
State HIE CA Program: Overview
•Fund sustainable expansion of HIE within and
between states
•Awards to state agencies or SDEs
•Support provider “meaningful use” requirements
•Statutorily-mandated “State Plan” requirement
•Cooperative Agreement assistance instrument
– Anticipates ONC involvement in performance of work
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FROM: Linder, Ma, Bates, Middleton, et al; Electronic Health Record Use and the Quality of Ambulatory Care in the United
States.
ARCH INTERN MED/VOL 167 (NO. 13), JULY 9, 2007.
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HITECH Programs
RECs/HITRC
Workforce Training Adoption of EHR-S

CC Consortia
Univ-based Training
Curriculum Dev Ctrs
Competency Exam Prog Improved Individual and
Population Health Outcomes
Meaningful Use
EHR Incentive Program
EHR Stand & Cert Criteria Meaningful Use of Increased Transparency and
NIST HIT Test Procedures EHR-S Efficiency
Cert Program for HIT
Improved Care Delivery and

State Grants for HIE Study Ability
Standards/Cert Health Information

Framework Exchange
Privacy/Security
Framework Demonstrations to Enhance
HIT
Research to Enhance HIT Beacon Communities CA Program
SHARP Program:
Security in HIT
Cognitive Support in HIT
App-Arch/Svc in HC Nets
LSI/Agg
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MU Objectives Supported by HIE
– 170.304(b) Generate/transmit permissible prescriptions
– 170.302(b) Implement drug-formulary checks
– 170.302(j) Medication reconciliation at encounters/transition of care
– 170.302(h) Incorporate structured/coded clinical lab results into EHR-S
– 170.304(i) Exchange key clinical info among providers/authorized entities
– 170.304 (h) Provide summary of care record for transitions/referrals
– 170.304(h) Clinical summaries to patient after each visit
– 170.304(f) Provide patients with copy of health info/discharge instructions
– 170.304(g) Provide patients with timely access to health info
– 170.302(k) Submit data to immunization registries
– 170.306(g) Submit reportable lab results to public health
– 170.302(l) Submit syndromic surveillance data to public health
– 170.304(j) Report ambulatory quality measures
– 170.302(i) Generate lists of patients by condition
– 170.302(m) Patient-specific health education resources
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Cooperative Agreement Awards
• Based on CA/grant application
– Requirements in Federal Opportunity Announcement (FOA)
• 40/56 states/territories awarded February 2010
– 1 year Anniversary of HITECH
• Remainder awarded March 2010
– Total 56 states and territories: $547,703,438
• Cooperative Agreement includes
– Terms & Conditions
– Milestones
– Possible funds restriction pending remediation or milestone
achievement
• Milestone for release of implementation funding
– Approval of State Plan by HHS Secretary (ONC)
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State Plan
• HITECH Sec 3013 requires “State Plan”
– Activities to facilitate HIE according to national standards
– In public interest
– c/w ONC strategic plan
– Implementation activities (operational plan)
– Elements as specified by HHS (as per FOA)
• FOA defines “State Plan”
– Strategic Plan
– Address vision, goals, objectives, and strategies, to promote statewide HIE
– Operational Plan
– Execution and implementation details of strategic plan
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Program/Plan Domains & HIE Services
• Essential Domains for incremental progress
– Governance
– Finance (sustainability)
– Technical Infrastructure
– Operations (business & technical)
– Legal & Policy (challenges & solutions)
• HIE Services
– e-eligibility & e-claims transactions
– eRx and e-refill requests
– Medication fill Hx and Rx fill status
– Clinical lab e-orders and results e-delivery
– Clinical summary exchange (care coordination, patient engagement)
– Quality Reporting
– Public health e-reporting (immunizations, notifiable lab results)
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Governance
•Collaborative, multi-stakeholder model
– HITECH 3013(g) statutory “consultation” requirement
•Sustain trust and participation

•Resource allocation
•Oversight & accountability
•Provide transparency
•State HIT Coordinator and role
•“Public-Private Partnership” ?
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Public Governance Models for HIE
From: Report to the State Alliance for eHealth, prepared by U. Mass Med School CHPR, NORC, and NGA Center for Best Practices
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Finance
•Financial Sustainability beyond Program
– 4-year period of CA Program (HITECH/ARRA) funding
•Cost estimates
•Staffing plan
•Project plan
•Risk analysis & mitigation strategies
•Financial procedures and controls
•Compliance with GAAP and OMB circulars
•Required reporting
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Technology Infrastructure
•Alignment with HHS interoperability standards
•Architecture
– Reflects business/clinical requirements
– Statewide HIE for
– Providers
– Public Health
– Patient engagement
– Protects health data
– NHIN alignment
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Business & Technical Operations
•Leverage resources
– Bandwidth
– Workforce
– HIOs/HIEs
– EHR-S installations
– Registries
– Repositories
•Reach all providers/geographies
•Standard operating procedures
•Project/Program Management
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Legal & Policy
•HHS Privacy & Security Framework
– “Nationwide Privacy and Security Framework for Individually Identifiable Health
Information” [December 15, 2008]
•Legal analyses
•Statutory changes
•Policies and Procedures
•Trust Agreements
•Oversight and enforcement
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Program Information Notice
• Review
– One-time investment
– Concern with mandated provider participation
• Clarify
– State/SDE responsibilities
– Roles of HIT Coordinator
– Elements of S & O Plans (State Plan)
Focus
•
– Operationally feasible plan to enable
– eRx
– Receipt of structured lab results
– Sharing patient care summaries
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Status
•Approved state plans
– CA, DE, MD, ME, NM, UT (__, __)
– State HIE Toolkit website (MD, NM, UT)
– State/SDE website (CA, ME, others)
•Other plans: under review

•Examples
•Discussion
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© Deloitte Touche Tohmatsu 2006. All rights reserved.

State HIE Cooperative

Workforce Training Adoption of EHR-S

Improved Care Delivery and

Standards/Cert Health Information

•Sustain trust and participation

•Other plans: under review

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