1 NC Strategy for Building HIT and HEALTH Steve Cline, DDS, MPH HIT Coordinator, NC DHHS June 22, 2012 NC Primary Care Conference Asheville, NC

2 Outline Introduction – Why HIT? Quick overview of HITECH grants to NC NC HIT Landscape HIT and Health Care Reform Q & A

Questions to Ponder 1)Why do we tolerate “low” IT in health? 2)What would it take to change that? 3)Who has to change? or Who is going to resist? 4)Will the federal plan work in NC? 5)What should we do next? 3

HIT Goals Improved healthcare quality Better health outcomes –Individuals –Populations Control costs Better engage health care consumers 4

The Problem Paper is inefficient Duplicate tests Medical errors Lack of information Too much information Consumer engagement Quality-Quality-Quality 5

Waste in Healthcare Six areas account for 21% of the cost of healthcare Berwick and Hackbarth, JAMA,April Failures of Care Deliver ($ B) 2.Failures of Care Coordination ($25-45 B) 3.Overtreatment ($ B) 4.Admin complexity ($ B) 5.Pricing failures ($ B) 6.Fraud and Abuse ($ B) 6

Federal HIT Strategy Office of the National Coordinator of Health Information Technology (ONC) Federal Stimulus Act (ARRA) HITECH Component = HIT States charged with developing solutions (no single national system) 7

1. Admit we have a problem The nation cannot afford to keep doing business as usual in healthcare. HIT transformation is coming, like it or not. Simply automating what we currently do will not fix the problem. The right technology already exists, it’s the people that need to change. We CAN do better! 8

2. Must get clinical information into an electronic sharable format (EHRs) NC NC AHEC 9 Existing Regions Existing Relationships Existing Quality Initiative $13.6 million FEDS HITECH – Regional Extension Centers 9

3. Incentivize targeted providers to adopt EHRs and meaningful use (MU) NC NC Medicaid Eligible providers and hospitals MU “bar” $63,000 M’caid $44,000 M’care $500 million to hospitals FEDS HITECH – Incentive Payments Medicare Medicaid 10

4. Create a new standard for EHR functionality and interoperability NC Private entities Temporary Certification “Preferred Provider” list Cost to providers FEDS HITECH – EHR Certification Program 11

5. Build a mechanism for sharing health information electronically NC NC HWTF NC HIE Non-profit CEO level Board Public-Private Partnership $12.9 million FEDS HITECH – State Level Health Information Exchange (HIE) 12

State Strategy for Meaningful Use Priorities for HIE to enable MU Structured lab results reporting e-Prescribing Sharing of clinical record summaries Public Health reporting 13

+ Leveraging the power of North Carolina’s health information exchange to improve patient outcomes

+ What is NC HIE? NC HIE operates North Carolina’s statewide health information exchange, a secure, standardized electronic system where providers can share important patient health information. NC-based: The Board of Directors are active and prominent in the North Carolina medical community and represent a variety of organizations and interests. Independent: NC HIE is independent and is not owned by insurance companies, health care organizations, associations, employers or government. Nonprofit: NC HIE is a private nonprofit organization. It is funded by many sources including North Carolina health care organizations and grants. Multi-stakeholder: Involves Consumers, Providers, Payers, Business and Government. 15

+ How does it work? NC HIE’s network combines information from separate health care sites to create a single virtual patient health record. Patient health information is automatically uploaded or linked from a provider’s electronic medical record system. The information is standardized and aggregated across care sites. Clinicians can seamlessly access their patient’s information in NC HIE from within their EMR. 16

+ What is in the network? In the NC HIE Network:  Patient Identifier and Demographics  Encounter History  Laboratory and Microbiology Results  Radiology Reports and Images  Adverse Reactions/Allergies  Medication History  Diagnosis/Conditions/Problems (primary and secondary)  Immunizations  Dictated/Transcribed Documents 17

+ Consent Policy Consumers are automatically part of NC HIE if their health care provider is a participant. North Carolina law requires NC HIE follow an opt-out consent policy allowing patients the choice of not participating. This policy was written with input from stakeholders representing patients, providers, employers, payers, and government. Consumers may opt-out by mail using the opt-out form or by phone. In the future consumers will be able to opt-out online. State law requires participating providers give the patient a state-approved form the first time they visit that provider location. 18

Hospital Systems NC Medicaid Physicians and Providers Commercial Payers Financing Principles Core System Cost Allocation

6. Make sure healthcare providers know how to use the new systems NC NC Community College System-Pitt 13 State Region Curriculum Development-Duke Distance Learning $20.1 million FEDS HITECH – Workforce Development 20

21

7. Make sure the network has the capacity for all these new users NC MCNC NC Research and Education Network “Middle mile strategy” to connect health $28.2 million-Phase 1 $75.8 million Phase 2 FEDS HITECH – Broadband Technology Opportunities Program (BTOP) 22

8.Make good use of the data (Data Analytics) NC UNC, Duke, Wake, ECU, RTI, & others Evidenced-based medicine Best practices “Learning System” $200+ million FEDS HITECH – Comparative Effectiveness Research (CER) 23

9. Make good use of the technology to improve health NC NC Telehealth Network Rural health strategy Community Health Centers $6.1 million FEDS HITECH – Telehealth 24

10. Children as a priority NC (1 of 10) NC Medicaid-CCNC NC Pediatric Society, NC Academy of Family Physicians, and NC Quality Alliance EMR for children $9.3 million FEDS HITECH – Children’s Health Insurance Program Reauthorization Act (CHIPRA) Establish a national quality system for children’s health care 25

11. Learn from the leaders NC (1 of 17) Southern Piedmont Community Care Plan (CCNC) Existing community partnerships Cabarrus, Rowan, and Stanly Counties $15.9 million FEDS HITECH – Beacon Community Program 26

12. Sustainability Value added proposition (ROI) Integral to how we do business Lower the cost of doing business Patient-centered Dynamic and responsive Improve quality 27

HIT Landscape in NC Existing HIT systems: Hospitals, RHIOs, Public Health, Individual Provider Practices, Payers Medicaid MMIS Replacement System: New claims processing system, reporting and analytics Quality in NC: NC AHEC Quality Initiative, NC Healthcare Quality Alliance, Carolinas Center for Medical Excellence Community Care of NC: Informatics Center NC Laws: Legal framework for HIE, NC is Opt Out Economic Crisis: $3.5 billion “hole” Healthcare Reform 28

Information Technology Reform IS Health Care Reform ARRA/HITECH is to HIT as PPACA is to health care reform PPACA assumes new models of HIT are in place – can’t do it without it 29

30 Keys to Success EHR Adoption Consumer Engagement Change Leadership Strengthen the “Trust Fabric” of health information exchange GOOD USE OF THE DATA!

And the Winner Is... Whoever can figure out how to take the tsunami of new health data that is heading our way and turn it into actionable health information. Whoever can help us move from surveillance and reaction to event prediction and prevention. 31

32 Questions?