1. Electronic Health Records and Health Information Exchange: Implications for Rural Hospitals Rick Snyder Vice President, Finance & Information Services Oklahoma Hospital Association Brian Yeaman, MD Director, Physician Informatics Norman Regional Health System Greater Oklahoma City Hospital Council

2. American Recovery and Reinvestment Act of 2009 (ARRA) Incentive payments for meaningful use of certified Electronic Health Records Hospitals and Eligible Professionals Medicare incentives Medicaid incentives

3. Hospital Incentive Payments Qualify as early as Oct 1, 2010 –Range for OK PPS: ~$2 million - $8 million –Median: $3.7 million –State potential: $311 million Qualifying after FFY 2013 reduces amount CAH: Medicare share of capital + 20% FFY 2015: Incentives end; penalties begin

4. Hospital Incentive Payments Medicaid Requires: 10% Medicaid inpatient volume CAHs can qualify – not based on costs –$500,000 to $1,200,000 $108 million potential for OK hospitals State has some discretion in design

5. Eligible Professionals Medicare incentives capped at $44,000 (plus 10% in HPSAs) OR Medicaid incentives capped at $63,750 (if 30% of practice is Medicaid (Peds: 20%)) Paid over 5 years beginning Jan. 2011 Penalties for non-adoption begin Jan. 2015 Hospital-based professionals ineligible

6. EHR Adoption Rates 2008 RWJF study of 2,952 hospitals Comprehensive EHR:1.5% of US hospitals Basic EHR (physician, nursing notes): 7.6% Rural hospitals: –0.6% comprehensive EHR –4.0% basic EHR

7. OHA members tell us:

8. OHA members tell us: Potential obstacles to your hospital adopting EHR: 1.Insufficient IT staff 2.Incentive payments will likely not cover EHR costs 3.Medical Staff is not supportive 4.Cannot find a suitable EHR

9. OHA members tell us: OHA can help most by… 1.Providing education on incentives 2.Providing education on EHRs 3.Offering a group deal 4.Helping arrange financing 5.Helping select EHR

10. EHR Certification Certification Commission for Health Information Technology (CCHIT) –CCHIT Certified –Preliminary ARRA certification –Site certification HHS Health IT Policy Committee recommendation –Allow multiple Certification organizations –Accreditation process for certifying organizations HHS will propose rules

11. Meaningful Use HIT Policy Committee HIT Standards Committee Public input Policy Committees August 19 matrix Proposed rule due by December 31 –60 day comment period –Final rule: middle or end of spring 2010

12. NE Oklahoma origins Oklahoma City exchange Projects around the state Attractive pricing for hospitals and their physicians

13. Regional Extension Centers – ARRA Section 3012 National: HIT Research Center –Develop or recognize best practices to support and accelerate efforts to: Adopt, implement, and effectively utilize HIT for –Electronic exchange and –Use of information Regional Extension Centers –Provide technical Assistance –Disseminate best practices and other information –Support and accelerate efforts to adopt, implement, and utilize HIT

15. Regional Extension Centers ARRA law: –Hospitals (public, NFP, CAH) –Federally Qualified Health Centers –Entities serving uninsured, medically underserved –Individual and small group practices in primary care Funding opportunity: –Primary care providers in small group practices, public hospitals & CAHs, CHCs and RHCs, other settings for the uninsured/medically underserved

16. Regional Extension Centers OFMQ selected by stakeholders Three waves of funding $6.5 million potential for Oklahoma Substantial matching required in years 3 and 4

17. State Loan Program 5:1 federal match for loans to providers Administered through Medicaid agencies OHCA will apply; has requested state match in SFY 2011 budget Projected availability: October 2010

18. SHIECAP State Health Information Exchange Cooperative Agreement Program Planning and Implementation grants State funding required –20111/10 –20121/7 –20131/3

19. SHIECAP

20. SHIECAP: Oklahoma Health Information Exchange Network of networks Planning phase beginning Jan. 2010 TBD: Governance, financing, … ONC approval of State plan required before implementation is funded OHA participating in planning; volunteers?

21. OHA Trade Show – HIT vendors Spectron Corp – McKesson products & more – booth 320 CPSI – booth 800 Phoenix Health Systems – booth 111 –Meditech, CPSI, others, including MedSphere OpenVista

22. Resources http://healthit.ahrq.gov/RuralHITtoolbox http://www.cchit.org/ http://www.okoha.com/ARRA