Health Information Exchange Across the Nation ~ Across Montana

2nd Annual MT HIMSS Conference May 3, 2013

HIE Topics

• Benefits

• Challenges

• Nationwide Strategy

• Cooperative Agreement

• Challenge Grants

• Privacy/Security

• Interoperability

• eHealth Exchange

• Sustainability

• Meaningful Use

• Medicare CoP

• Montana’s Designated HIE

• Collaboration

• Montana Legislative Activity

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

HIE Benefits • Increase provider profitability by reducing their operating expenses

• Reduce total healthcare cost

• Reduce unnecessary activity

• Improve quality

• Improve population health

• Modernize the infrastructure

• Provides a basic level of interoperability among EHRs maintained by individual physicians and organizations

• Provides the backbone of technical infrastructure for leverage by national and State-level initiatives

• Provide the “right information to the right person at the right time”

• Allow information to “flow with the patient”

• Increase value

• Increase efficiency

• Transform healthcare This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

HIE Challenges

• Often, HIE must be implemented in conjunction with other activities in order to realize benefits

• HIE is a “product in search of a market” • Providers and payers will rarely voluntarily reduce

their revenue (i.e. purchaser’s cost) • Purchasers desire lower cost but are generally

unprepared to address political or structural issues to achieve it

• Currently, HIE can be an interruption, rather than an enhancement to provider workflow

• Patient privacy/security – always on the front burner

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Office of the National Coordinator for Health Information IT (ONC)

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

ONC’s Nationwide HIE Strategy

ONC’s current HIE priorities include:

• Set clear goals for health information exchange and measures of success, including improved patient outcomes

• Develop policies and standards that can solve interoperability issues and reduce the cost of adoption

• Ensure patients remain at the center of health information exchange and have access to their electronic information

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

State Health Information Exchange Cooperative Agreement Program

• In March 2010, ONC completed the announcement of State Health Information (State HIE) Exchange Cooperative Agreement Program awardees. In total, 56 states, eligible territories, and qualified State Designated Entities (SDE) received awards totaling $548 million

• Awardees will use their funding to:

– Create and implement up-to-date privacy and security requirements for HIE

– Coordinate with Medicaid and state public health programs to establish an integrated approach

– Monitor and track meaningful use HIE capabilities in their state

– Set strategy to meet gaps in HIE capabilities

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Theme Challenge Grants

On January 27, 2011, an additional $16 M was made available to states through ONC’s new Challenge Grants program. The following State HIE’s that have received additional funding as a result of winning these Challenge Grants:

• Colorado

• Georgia

• Indiana

• Maryland

• Massachusetts

• Montana • North Carolina

• Oklahoma

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Consumer Innovation Challenge Grants

In early 2012, ONC issued the Consumer Innovation Challenge to State Health Information Exchange grantees to increase consumers’ access to their health information. The goal of the challenge is to get electronic information into consumers’ hands so they can share it with family members and multiple providers who care for them and use it to improve their health and health care. The following states are participating in this Challenge Grant:

• Indiana

• Nebraska

• Montana • Illinois

• Maryland

• Georgia This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Privacy and Security

The HIPAA Omnibus regulations will improve patient privacy and security protections by:

• Extending the Office for Civil Rights’ (OCR) enforcement to business associates and covered entities,

• Strengthening individuals' rights to request and receive their medical information in electronic form, and

• setting new limits on the use and sale of individuals’ information

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Sustainability

• Federal funds must be drawn down by September 2014

• Competitive markets/corporate HIEs are developing

• HIEs must continue to identify, define, and prove their value

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Current Interoperability

• CCD – The holy grail of interoperability wasn’t quite that…

• CDA – We’re hoping it will improve upon the CCD

• HL7 – Doable, but complicated, expensive and time consuming

• Direct Secure Messaging - Fills in some of the gaps

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Future Interoperability

April 4, 2013 - ONC Partners with the EHR|HIE Interoperability Workgroup and DirectTrust to:

• develop and adopt policies, interoperability requirements and business practices that align with national priorities

• overcome interoperability challenges

• reduce implementation costs and

• assure the privacy and security of health information exchange

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

EHR|HIE Interoperability Workgroup

• will address some of the stickiest implementation challenges facing the exchange of health information including patient matching, querying provider directories and applying good governance principles for both query-based and directed exchange

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

DirectTrust

• will continue and expand their work to establish security and trust rules of the road for Directed exchange and advance adoption of these rules through their trusted agent accreditation program. DirectTrust’s critical work will facilitate and enable vendor to vendor and provider to provider exchange for Meaningful Use Stage 2

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

eHealth Exchange (formerly the Nationwide Health Information Network)

Standardizes flow of information by:

• sending health information to other participating organizations

• finding and requesting copies of healthcare information from other participating organizations--where permitted by law and policy

• matching patients to their data without a national patient identifier

• subscribing to receive updates to health information

• currently 40 participants from all across the nation

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Meaningful Use – Stage 2 Advanced Clinical Processes

• More rigorous health information exchange (HIE)

• Increased requirements for e-prescribing and incorporating lab results

• Electronic transmission of patient care summaries across multiple settings

• More patient-controlled data

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Meaningful Use – Stage 3 Improved Outcomes

• Improving quality, safety, and efficiency, leading to improved health outcomes

• Decision support for national high-priority conditions

• Patient access to self-management tools

• Access to comprehensive patient data through patient-centered HIE

• Improving population health

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Could Electronic HIE Become a Medicare CoP?

• In early 2013, HHS issued a request for information on ways to accelerate electronic health information exchange within the health care industry

• HHS is considering making electronic HIE one of the Medicare Conditions of Participation (CoPs)

• Possible game changer for HIEs?

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

HIE Here in Montana

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

HealthShare Montana Montana’s Designated HIE

• December 2005 - HealthShare Montana is created

• January 2007 - Steering Committee is chosen

• July 2007 - 21-member board is created

• May 2009 - Governor Brian Schweitzer chooses HSM as Montana’s designated HIE

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Interstate and Statewide Collaboration

• HIEs in the northwestern region • Montana • Wyoming • Washington • Idaho • South Dakota • North Dakota

• Other HIEs across Montana • Billings Clinic • St. Vincent HealthCare (Sisters of Charity of Leavenworth Health System) • St. Patrick Hospital (Providence) • HIEM • Frontier Medicine Better Health Partnership • Many others…

• HealthShare Montana and the MT/WY REC (HTS)

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

2013 MT Legislative Activities

• All Claims/All Payers Database

• Montana Healthcare Workforce

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.

Questions?

Thank you! Brad Putnam, Executive Director

(406) 794-0170 bputnam@healthsharemontana.org

This project is funded in whole or in part under a contract with the Montana Department of Public Health. The statements herein do not necessarily reflect the opinion of the Department.