Public Health and Health Information Exchange Connecting health to improve outcomes for all

Agenda Health Information Exchange (HIE) CORHIO and ARRA HITECH Opportunities for Public Health Colorado Health Information Initiatives Q & A 2

3 HIE Improves Efficiency & Communication Hospitals Primary care physician Specialty physician Ambulatory center ( e.g. imaging centers) Payors Pharmacy Laboratory Public health Point to Point Interfaces Specialty physician Pharmacy Laboratory Hospitals Primary care physician Ambulatory center (e.g. imaging centers) Payors Public health Health Information Exchange Model HIE 3

Benefits of HIE Saves Time & Reduces Cost – Less time searching, calling and faxing = more efficient use of resources – Streamlined access to patient histories and discharge summaries – Decreased need for unnecessary and duplicate tests, medications and hospitalizations – Fewer mistakes Improves Care – More time with patients; less time searching through paper records and waiting for information – Increased transparency of identified patient populations thru analysis and reporting – Longitudinal record of patient care reduces errors – Fewer delays in treatment Enhances Patient Privacy – Less paper; controlled and audited access to patient health information 4

Why state-level HIE? Greater Impact – Community based focus goes beyond HIE as an IT Tool and focuses on clinical use and workflow – Shared HIE = No Wrong Door for patients – Close alignment with State systems Broader Reach – Statewide connectivity increases reach of all participating providers – Improves public system communication and interaction with providers Lower Cost: – Volume based vendor contracts allow for shared cost savings over enterprise implementation – Reduced duplication of data and processes – Reduced resource demands for collecting and analyzing data 5

About CORHIO Our Mission – To facilitate health information exchange to improve care for all Coloradans Our Vision – Shared health information for all individuals in every Colorado community promoting the right care at the right time and place Goals – Health information exchange deployed in every community – 85% of all primary care providers and safety-net providers are meaningful users of electronic health records (EHRs) – 85% of all providers statewide are meaningful users of EHRs *Meaningful Use described below 6

About CORHIO Current Initiatives, Projects and Progress State Designated Entity for HIE HIE Rollout Community–by–Community – Boulder, Colorado Springs, and San Luis Valley – Centura and Children’s Hospital – Integrating with QHN State and Federal Policy – Health Reform, CIVHC – Privacy & Security – Behavioral Health ARRA HITECH Act 7

American Recovery and Reinvestment Act (ARRA) signed February 2009 Included Health Information Technology for Economic and Clinical Health (HITECH) Act Regional Extension Centers (RECs) Updates to HIPAA Certification of EHR Technology Health Information Exchange (HIE) Health IT Workforce Medicare & Medicaid EHR Incentive Program 8

ARRA HITECH Medicare & Medicaid EHR Incentive Program Purpose – encourage the adoption and meaningful use of health information technology to improve efficiency and quality of care Approach – provide financial incentives to Medicare and Medicaid providers to adopt, implement, upgrade, and become “Meaningful Users” of Electronic Health Records (EHRs) and the electronic exchange of health information Timeline – ARRA HITECH February 2009, Notice of Proposed Rule Making January 2010, Final Rule July 2010, Incentive payments begin

Meaningful Use As a Driver to Health Care Transformation 10 Quality Reporting Clinical Decision Support Improving Care Coordination Engaging Patients Managing Population Health Meaningful Use Quality Improvement Technology Practice Redesign Exchange

Meaningful Use: Who is eligible for incentives? MedicareMedicaid Eligible Professionals (EPs) Doctor of Medicine or OsteopathyPhysicians Doctor of Dental Surgery or Dental MedicineNurse Practitioners (NPs) Doctor of Podiatric MedicineCertified Nurse-Midwives (CNMs) Doctor of OptometryDentists ChiropractorPhysician Assistants (PAs) who practice in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) led by a PA* Eligible Hospitals Acute Care HospitalsAcute Care Hospitals, CAHs Critical Access Hospitals (CAHs)Children’s Hospitals * FQHC or RHC considered “PA-led” if PA is clinical or medical director at clinical site of practice, is the primary provider at a clinic, or if PA owns the RHC. 11

Meaningful Use Incentives Eligible hospitals can participate in Medicare and Medicaid programs Eligible professionals (EPs) must choose between Medicare or Medicaid incentives – Allowed to switch between programs one time Medicaid EPs must serve at least 30% Medicaid patient volume to receive incentive payments – Pediatrician threshold at 20% Medicaid volume – For EPs working in FQHCs or RHCs, organization only needs to meet threshold of 30% “needy individuals” (Medicaid, CHP, uninsured, sliding scale) Medicare payment reductions begin 2015 for non-meaningful users Incentive payments based on cost for implementing – Medicaid maximum for EPs is $63,750 over 6 years – Medicare maximum for EPs is $44,000 over 5 years – Eligible hospitals receive $2M base + calculation based on discharges 12

Meaningful Use: Stage 1 Overview To meet certain objectives/measures, 80% of all providers’ patients must have records in the certified EHR technology EPs have to report on 20 of 25 MU objectives – 15 “core” objectives, select 5 more from “menu set” Eligible hospitals have to report on 19 of 24 MU objectives – 14 “core” objectives, select 5 more from “menu set” Medicare / Medicaid same requirements, except states have option of moving 4 public health objectives from “menu set” to “core” for Medicaid incentives – generate lists of patients by specific conditions – provide electronic syndromic surveillance data to public health agencies – submit electronic data to immunization registries/systems – provide electronic submission of reportable lab results to public health agencies 13

Meaningful Use: Clinical Quality Measures (CQM) Eligible Professionals must report on 6 total CQM: – 3 required core measures (substituting alternate core measures where denominator would be zero on 3 required) and 3 additional measures from a set of 38 CQM Eligible hospitals must report on 15 CQM Alignment with other quality programs / initiatives – coordinating with PQRI, RHQDAPU, CHIPRA, and PPACA development NQF Measure & PQRI Implementation Number Clinical Quality Measure Title Core Set for EPs NQF 0013Hypertension: Blood Pressure Measurement NQF 0028Preventive Care and Screening Measure Pair: a) Tobacco Use Assessment, b) Tobacco Cessation Intervention NQF 0421 PQRI 128 Adult Weight Screening and Follow-up Alternate Core Set for EPs NQF 0024Weight Assessment and Counseling for Children and Adolescents NQF 0041 PQRI 110 Preventive Care and Screening: Influenza Immunization for Patients 50 Years Old or Older NQF 0038Childhood Immunization Status 14

Meaningful Use: Stages 2 & 3 Overview Centers for Medicare and Medicaid Services (CMS) intends to propose Stages 2 & 3 through future rulemaking Stage 2 will build upon Stage 1 – Current “menu set” will be transitioned into “core” – Possibly higher thresholds for objective measures – Greater emphasis on HIE across entities – Possibly greater state flexibility – Possibly include administration simplification (i.e. electronic eligibility and claims transactions) Stage 3 will emphasize use of EHR technology and HIE to improve quality, safety, and efficiency 15

Why Meaningful Use Matters Medicaid and Medicare incentive payments – Time-limited opportunity to encourage EHR adoption and begin progress toward HIE Administrative efficiencies and savings EHRs and electronic info exchange have potential to: – Improve quality, safety, efficiency, and reduce health disparities – Engage patients and families in their health care – Improve care coordination – Improve population and public health – Ensure adequate privacy and security protections for personal health information Realizing the benefits of EHRs and HIE only possible with broad participation As Meaningful Use advances to Stages 2 & 3, those who are not participating will get left behind 16

What is CORHIO Doing to Support Meaningful Use? Colorado Regional Extension Center – Technical assistance, guidance, and information on best practices to support and accelerate Colorado health care providers' efforts to become meaningful users of EHRs – Help qualified primary health care providers implement and meaningfully use: EHRs, HIE, clinical workflow, process redesign, local workforce development and quality improvement Health Information Exchange – CORHIO building statewide HIE and partnering with Quality Health Network (QHN) on Western Slope – HIE can facilitate Meaningful Use requirements including eRx, drug formulary checks, structured lab results, medication reconciliation, structured care summaries, public health State Medicaid HIT Plan – CORHIO working with HCPF and stakeholders to create comprehensive strategic vision for state support of Meaningful Use and HIE, including developing Medicaid EHR Incentive program administration 17

Opportunities for Public Health presented by HIE and EHRs Easier access to better quality, more up-to-date, more flexible, longitudinal data Reduced resource needs to collect and store data–surveys, databases, etc. One interface for results delivery / immunization tracking – One interface for providers – One interface for the State / counties Possible direct provider communication (i.e. public health alerts) through single portal 18

Opportunities for Public Health presented by HIE and EHRs Clinical Decision Support tools customized for public health – (i.e. prompts about flu shots for at-risk populations, chronic disease management guidelines, etc.) Personalized care plans, information, and reports with development and adoption of Personal Health Records Possibility for secure, limited, auditable exchange of sensitive health information to provide for better health outcomes and simultaneously protect vulnerable populations – (i.e. substance abuse, HIV, etc.) 19

Other Colorado State Health Information Initiatives CDPHE – Public health data improvements - immunization registry, etc.* HCPF – Accountable Care Collaborative (RCCOs, SDAC)* – CBMS modernization – State Medicaid HIT Plan – MMIS strategic planning* – EHR (Meaningful Use) Incentive Program Administration* DHS – Focus on integrating behavioral and physical health* CIVHC – All Payer Health Claims Database* – Delivery System / Payment Reform* Government Data Advisory Board – Interdepartmental state data standards* National Health Reform – Insurance exchanges, grant opportunities, etc.* State Health IT Strategic Planning* Colorado Telehealth Network Colorado Beacon Consortium* 20 *indicates CORHIO involvement

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