Health Information TechnologyNationwide Activities and Issues

Roy H. Wyman, Jr.Roy H. Wyman, Jr.

May 7, 2009May 7, 2009

Agenda

• What I Couldn’t Do with Plenty of Money and a Clue

• We’re from the Government, and We’re Here to Help

Plenty of Money and a Clue

• How much Money?– $19 Billion through Medicare and Medicaid in grants,

loans and incentive payments– $85 Million to Indian Health Services for HIT– $3.95B to the Workforce Investment Act of 1998– $500M for health centers under the PHS Act– $2B to ONC

• $300M for regional or sub-national efforts toward HIE

• $20M to NIST

Plenty of Money and a Clue

• Give Me the Money!– Medicare/Medicaid: “Meaningful Use”

• ‘‘Meaningful Use Of Certified EHR Technology”

– Certified EHR technology including the use of electronic prescribing

– Connected in a manner that provides for the electronic exchange of health information

– Apply for Loans:

• Be in the Right State• Apply

Plenty of Money and a Clue

• Concerns in Adopting an EHR– Interoperability and Certification (CCHIT)– Work Flow– Interface– Training– Leadership

• Legal Limitations and Considerations– Stark and Anti-kickback Rules– Security and Privacy (yes, Encryption)– Policies and Procedures– Contract Liability

We’re from the Government, and We’re Here to Help

How Would You Design the System?

We’re from the Government, and We’re Here to Help

• The “W” Approach:– Bottom-Up– Private Entities or Private-

Public Partnerships– Let the Market Decide

• The Result:– ONC & AHIC– NHIN– CCHIT– HITSP– HISPC

We’re from the Government, and We’re Here to Help

• The New Appr“O”ach:– Institutionalize the Process (i.e., add money)– Governmental Entities– Let the Best Minds Decide

• The Result:– ONC Agency– NHIN– HIT Policy Committee (AHIC?)– HIT Standards Committee (CCHIT? AHIC?)

The Nationwide Health Information Network

11

The Nationwide Health Information Network

Health Bank orPHR Support Organization

Community #1

IntegratedDelivery System

Community Health Centers

Community #2

State and Local Gov

Labs

Pharmacies

CDC

VA

IHS

DoD

SSA

The InternetStandards, Specifications and Agreementsfor Secure Connections

Mobilizing Health Information Nationwide

The Health Information Security and Privacy Collaboration (“HISPC”)

• 44 States and Territories• In Three Phases

1. Identify Barriers

2. Work Individually on Barriers

3. Work Together on Fixing them

The Health Information Security and Privacy Collaboration

• 7 Multi-State Collaboratives– Consent 1 – Data Elements– Consent 2 – Policy Options– Harmonizing Privacy Law– Consumer Education and Engagement– Provider Education– Adoption of Standard Policies– Interorganizational Agreements

Where Are We?

• HHS Regulations for Breach by Covered Entities– Destroy or Encrypt– Use NIST standards

• FTC Regulations on Breach by Personal Health Record Vendors– “Breach” means whatever HHS says

• Enforcement by AGs and Tiered HIPAA Penalties in Place

What’s Next?

• Standards, spec’s and cert. criteria: 12/31/09

• Competitive Loan Money to States: 1/1/10• Regional Extension Centers Funded: 2010

(Reg’s by 5/18/09)• Privacy/Security Provisions: 2/16/10• Incentive Payments begin: FY11• EHR Accounting Effective: 1/1/11• Breach Notification Rules: 8/16/09

What’s Next (cont.)

• First Annual Report of Breaches: 2/16/10• Minimum Necessary Rules: 8/16/10• Regulations re: Sale of PHI: 8/16/10• Rules re: CMPs to Victims of Disclosure:

2/16/12• Rules re: De-Identification: 2/16/10• Universal Use of EHR: 2014• Penalties for Non-use Begin: 2015

Roy H. Wyman, Jr. P.O. Box 12109Research Triangle Park, NC 27709919.981.4313

rwyman@williamsmullen.comwww.williamsmullen.com