_experience the commitment TM John W. Loonsk, MD FACMI Health IT, Meaningful Use and Healthcare Reform

Hannah Hannah = Health IT? 2

3 National HIT - Lots of Moving Parts and Pieces Legislation HITECH (part of ARRA) Affordable Care Act (Health Insurance Reform) Rules Meaningful Use Standards, Specifications, and Certification Criteria Interim and Permanent Certification Modifications to HIPAA Privacy…Rule Programs and Grants Nationwide Health Information Network (NHIN) Exchange, Connect and Direct Health Information Exchange (HIE, HIO, RHIO) Designated entities and plans SHARP and Workforce Grants Regional Extension Centers (RECs) Recognized Certification Bodies (RCBs) Beacon Communities

Focus Today – Path Forward High level MU and Incentive Payment Programs Quality Reporting Health Information Exchange and Data Availability Health IT for Health Reform 4

5 Road Ahead for Health IT and Health Providers need to invest Disruptive to practice Easier, safer, and more strategic to hold data Payors benefit most Quantity of care dominates Patient empowerment - mostly Internet searching Purchasers of care struggle to manage quality and costs Population users stovepiped and secondary Limited Health IT use, interoperability and benefits HITECH Incentives ? HITECH Incentives ? ACO’s and Medical Homes ? ACO’s and Medical Homes ? Health Insurance Reform? Health Insurance Reform? PHRs?

6 Incentive Payment Programs and Meaningful Use Medicare Medicaid

Meaningful Use Incentive payments through Medicaid and/or Medicare to use (current generation) of EMRs Use a certified EMR in a “meaningful manner” Provide for the electronic exchange of health information Submit information on clinical quality, and other, measures MU measures dialed-back significantly from Notice of Proposed Rule Making, but point toward major systems efforts CPOE, eRx, CDS, problem and med list management, e-copies to patients Limited data and technical standards to support MU (in companion rule) Criteria to be updated bi-annually 7

Quality Reporting Interim final rule had almost 100 quality measures - push back lead to: 15 core (required) and 5 of 10 (menu) for hospitals 3 core (required) and three additional (menu) for eligible providers No specialty-oriented Eligible and Critical Access Hospitals Emergency Department Throughput Time from ED arrival to ED departure for admitted patients Admission decision time to ED departure time for admitted patients Ischemic Stroke (+/- Hemorrhagic) Discharge on anti-thrombotics, Anticoagulation for A-fib/flutter, Thrombolytic therapy for patients arriving within 2 hours of symptom onset, Antithrombotic therapy by day two, Discharge on statins, Stroke education, Rehabilitation assessment VTE Prophylaxis within 24 hours of arrival, Intensive Care Unit Prophylaxis, Anticoagulation overlap therapy, Platelet monitoring on unfractionated heparin, Discharge instructions, Incidence of potentially preventable 8

Quality Reporting Folks who really wanted to be doing healthcare quality and reform work, but got the HIT instead No traceability from use of these EMRs to differences in the quality measures Meaningful Use, right now, isn’t Quality measures to be electronically reported in 2012 Estimates that only 1/3 of data available in EHRs Providers burdened with adoption of EMRs and doing quality measures 9

Confidential 10

Beacon Community Awardees and Data 11 Beacon CommunityBeacon Community Goals for Population Health in Service Area Community Services Council of Tulsa, Tulsa, Okla. Leverage broad community partnerships with hospitals, providers, payers, and government agencies to expand a community-wide care coordination system, which will increase appropriate referrals for cancer screenings, decrease unnecessary specialist visits and (with telemedicine) increase access to care for patients with diabetes Delta Health Alliance, Inc., Stoneville, Miss. Focus on achieving improvements for diabetic patients by electronically linking isolated systems and practices for care management, medication therapy management and patient education Eastern Maine Healthcare Systems, Brewer Maine Expand community connectivity, including long-term care, primary care and specialist providers, to existing Health Information Exchange and promote the use of telemedicine and patient self- management in order to improve care for elderly patients and individuals needing long-term or home care Geisinger Clinic, Danville, PA Enhance care for patients with pulmonary disease and congestive heart failure by creating a community-wide medical home, promoting Health Information Exchange and extending Geisinger’s proven model for practice redesign to independent healthcare organizations throughout region HealthInsight, Salt Lake City, Utah Improve Diabetes management performance measures by increasing availability, accuracy and transparency of quality reporting, leverage Intermountain Healthcare’s strategies to reduce health systems costs throughout the region, and improve public health reporting Indiana Health Information Exchange, INC., Indianapolis, Ind. Expand the country’s largest Health Information Exchange to new community providers in order to improve cholesterol and blood sugar control for diabetic patients and reduce preventable re-admissions through telemonitoring of high risk chronic disease patients after hospital discharge Inland Northwest Health Services, Spokane, Wash. Focus on increasing preventive services for diabetic patients in rural areas by extending Health Information Exchange and establishing anchor institutions in close proximity to remote clinics that will promulgate successes in health IT supported care coordination Louisiana Public Health Institute, New Orleans, La. Reduce racial health disparities and improve control of diabetes and smoking cessation rates by linking technically isolated health systems, providers, and hospitals; and empower patients by increasing their access to Personal Health Records

Beacon Community Awardees and Data 12 Beacon CommunityBeacon Community Goals for Population Health in Service Area Mayo Clinic Rochester, Minn. Enhance patient management and, reduce costs associated with hospitalization and emergency services for patients with diabetes and childhood asthma and address reduce health disparities for underserved populations and rural communities Rhode Island Quality Institute, Providence, R.I. Improve the management of patients with diabetes through several health IT initiatives to support Rhode Island’s transition to the Patient Centered Medical Home model and adapt infrastructure proven to improve childhood immunizations in order to achieve improvements in adult immunization rates Rocky Mountain Health Maintenance Organization, Grand Junction, Colo. Enable robust collection of clinical data from health systems, providers, and hospitals in order to inform practice redesign to improve blood pressure control in patients with diabetes and hypertension, increase smoking cessation counseling, and reduce unnecessary emergency department utilization and hospital re-admissions Southern Piedmont Community Care Plan, Inc., Concord, N.C. Improve care coordination for patients with diabetes, heart disease, hypertension, and asthma by engaging patients and providers in bidirectional data sharing through a Health Record Bank, empowering patients and family members to participate in self-management through patient portals, and expanding access to care managers to facilitate post-discharge planning The Regents of the University of California, San Diego, San Diego, Calif. Expand pre-hospital emergency field care and electronic information transmission to improve outcomes for cardiovascular and cerebrovascular disease, empower patients to engage in their own health management through web portal and cellular telephone technology, and improve continuity of care for veterans and military personnel through the Veterans Affairs/Department of Defense Virtual Lifetime Electronic Record initiative University of Hawaii at Hilo, Hilo, Hawaii Implement a region-wide Health Information Exchange and Patient Health Record solution and utilize secure, internet-based care coordination and tele-monitoring tools to increase access to specialty care for patients with chronic diseases such as diabetes, hypertension, and obesity in this rural, health-professional shortage area Western New York Clinical Information Exchange, Inc., Buffalo, N.Y. Utilize clinical decision support tools such as registries and point-of-care alerts and reminders and innovative telemedicine solutions to improve primary and specialty care for diabetic patients, decrease preventable emergency room visits, hospitalizations and re-admissions for patients with diabetes and congestive heart failure or pneumonia, and improve immunization rates among diabetic patients The Greater Cincinnati HealthBridge, Inc HealthBridge and its partners will use its advanced health information exchange program to develop new quality improvement and care coordination initiatives focusing on patients with pediatric asthma, adult diabetes, and encouraging smoking cessation. The Southeastern Michigan Health Association (SEMHAT) This community collaboration will leverage existing and new technologies across health care settings to improve the availability of patient information at the point of care, regardless of where the patient is in the health system.

Health Information Exchange (HIE) Confusion over what HIE should be Existing morass of organizational variants Lack of comfort with HIE (NHIN, HIOs, RHIOs, heavy state) Defaults to “private HIEs” Data standards and specifications Not adequate for demonstrable interoperability Do add requirements for standard recording of some data Integration costs will remain high Exchange needs in conflict with privacy and security agenda “Blue Button” for always being able to download Focus information exchange on pushing data from provider to provider (consent recommendations, NHIN Direct, HIPAA modifications) 13

HIT for Health Insurance Reform ACO and Medical Home Needs (and requirements) Seamless transitions in care Longitudinal, cross-organizational records Look-up, data queries Managed problem, medication, allergy lists + Quality and efficiency management data and services Including claims and process data, workflow integration Population analytic tools and registries Cross-organizational team communications and care Including patient communications Clinical Decision Support 14

Questions and Comments John W. Loonsk, MD FACMI 15